American Journal of Tropical Medicine and Hygiene最新文献

Melioidosis is a neglected tropical infection caused by the Gram-negative bacterium Burkholderia pseudomallei, which is found in soil and water across tropical countries. The infection spectrum ranges from mild localized lesions to severe sepsis. The clinical presentation, severity, and outcome are influenced by the route of infection, bacterial load, strain virulence, and specific virulence genes of B. pseudomallei. This case series discusses nine melioidosis cases, highlighting the clinical and diagnostic challenges. It underscores the necessity for a high level of clinical suspicion to ensure a timely diagnosis and the prompt initiation of treatment.

Neurocysticercosis, a central nervous system infection caused by the zoonotic parasite Taenia solium, is a leading cause of acquired epilepsy worldwide. It is common in areas with extensive pig farming and pork consumption. This report presents an unusual case of neurocysticercosis in a 28-year-old male from Timor-Leste, a region of nonendemicity for human cases of Taenia solium. The patient, who had experienced seizures precipitated by headaches, was admitted to the hospital on June 15, 2020. Comprehensive examinations, including neuroimaging, identified multiple cystic lesions suggestive of neurocysticercosis. Initial treatment with praziquantel and prednisolone, as well as levetiracetam, alleviated symptoms. However, symptom recurrence after 5 months prompted additional treatment cycles. This case underscores the importance of increased clinical vigilance in patients from areas of nonendemicity and the challenges in managing neurocysticercosis because of its evolving nature. The global health initiatives aimed at enhancing disease surveillance for human taeniasis are crucial for refining our knowledge on neurocysticercosis.

India's National COVID Vaccination Program recommended vaccination of children ages 6-12 years in April 2022. This study assessed vaccine acceptance among mothers to better understand potential barriers and facilitators of national acceptance of pediatric coronavirus disease 2019 (COVID-19) vaccination. Qualitative data were collected through three focus group discussions (FGDs) with mothers who had children younger than 12 years of age; FGD-1 was composed of mothers who worked at a tertiary medical center in India, whereas FGD-2 and FGD-3 were composed of mothers who sought care at urban and rural community health centers. Investigators recorded, transcribed, translated, and analyzed FGDs by inductive thematic analysis. Emerging themes related to pediatric COVID-19 vaccination were categorized as knowledge and awareness, attitudes and perception, vaccine intent and facilitators, and future recommendations to promote vaccine uptake. FGD-2 and FGD-3 participants displayed limited knowledge and false beliefs regarding the pediatric COVID-19 vaccine, but mothers in FGD-1 demonstrated adequate knowledge, likely because they are health care providers. Mothers in all three FGDs expressed COVID-19 vaccine hesitancy because of concerns of side effects and low disease prevalence in children. They reported much more fear about giving the vaccine to their children than they felt about receiving it themselves. Overall, education was negatively correlated with vaccine knowledge, but mothers in all groups shared similar hesitancy about their intention to accept the vaccine for their children. Educating parents in India about the COVID-19 vaccine, especially its safety and efficacy in children, is crucial to the success of a national vaccine program.

Allied prisoners of war (POWs) working on the Imperial Japanese Army's railroad from Thailand to Burma during 1943-1945 devised a blood transfusion service to rescue severely ill fellow prisoners who were otherwise unlikely to survive the war. Extant transfusion records (1,251 recipients, 1,189 donors) in ledger books held by the United Kingdom National Archives at Kew were accessed and analyzed. Survival to the end of the war in 1945 was determined from Commonwealth War Graves Commission records. The records examined indicate that freshly donated whole blood was manually defibrinated and transfused after crossmatches based on POW medic sera. Overall survival to the end of the war was 74% in recipients and 88% in donors. Postwar survival rates were significantly higher for transfusion recipients with malaria (89.3%) than for other diagnoses: 52.6% for malnutrition, 59.3% for dysentery, 67.2% for skin ulcers, and 75.4% for other causes (odds ratio: 3.97; 95% CI: 2.79-5.28; P <0.0001). By 1945, the vast majority of blood transfusions were given for severe anemia caused by chronic relapsing vivax malaria. Although the POW situation was admittedly extreme, our data provide evidence that blood transfusions to treat severe anemia were associated with higher survival among patients with Plasmodium vivax infection than among those with other morbidities.

Plague is a rare, potentially fatal flea-borne zoonosis endemic in the western United States. A previous model described interannual variation in human cases based on temperature and lagged precipitation. We recreated this model in northeastern Arizona (1960-1997) to evaluate its capacity to predict recent cases (1998-2022). In recreating the original model, we found that future instead of concurrent temperature had inadvertently been used for the presented fit. Prediction from our revised models with lagged precipitation and temporally plausible temperature relationships aligned with low observed cases in 1998-2022. Elevated precipitation associated with high cases in historical data (>6 inches combined precipitation over two previous springs) was only observed once in the last quarter century, so we could not assess if these conditions were reliably associated with elevated (four or more) human plague cases. Observed weather conditions were similar to those previously associated with low (fewer than or equal to two) case counts, suggesting "baseline" conditions in the last quarter century.

Between April and November 2023, 27 unexplained human deaths that presented with swelling of the arms, skin sores with black centers, difficulty in breathing, obstructed swallowing, headaches, and other body aches were reported in Kyotera District, Uganda by the Public Health Emergency Operations Center. Subsequently, the death of cattle on farms and the consumption of carcass meat by some residents were also reported. Field response teams collected clinical/epidemiological data and autopsy samples to determine the cause of deaths. Metagenomic next-generation sequencing (mNGS) and target enrichment sequencing conducted on postmortem samples confirmed Bacillus anthracis, the etiological agent of anthrax disease, as the cause of the deaths. Applying mNGS to autopsy specimens is useful as a retrospective tool for identifying high-consequence pathogens during suspected outbreaks of unknown etiology.

We report two cases of recurrent malaria in U.S. travelers returning from Africa (Ghana and Central African Republic) despite a full course of artemether-lumefantrine (AL). Both patients presented to New York City hospitals, received AL treatment, and clinically improved. Within 2 weeks, they presented with recurrent Plasmodium falciparum malaria. Parasite isolates were sequenced, and P. falciparum kelch 13 propeller domain mutations that are validated or candidate markers of artemisinin partial resistance were not identified. Parasites had mutations within the P. falciparum multidrug resistance protein 1 gene. It is crucial to remain vigilant for recurrent malaria in travelers, even from African regions where partial resistance to artemisinin-based combination therapy has only rarely been reported.

Norovirus is the leading cause of acute gastroenteritis (AGE) globally. Few longitudinal studies have assessed norovirus-associated AGE incidence across age groups in community settings in Latin America. During April 2015-April 2019, active surveillance for AGE among community members of all ages was conducted through household visits two to three times per week in San Jeronimo, Cusco, Peru. An asymptomatic control household was selected for every fifth AGE case. Stool specimens were collected from AGE cases, asymptomatic household members, and control household members, and they were tested for norovirus using real-time reverse transcriptase polymerase chain reaction. Data on illness characteristics were collected from AGE cases during a 15-day follow-up period. Annual means of 247 households and 1,555 participants were enrolled during each April-March surveillance year, accounting for 4,176 person-years (PY) of observation. Of 1,099 AGE events reported, 1,014 stool specimens were tested, and 186 (18%) were norovirus positive. Norovirus AGE incidence was 4.4/100 PY (95% CI: 3.9-5.1); incidence was highest among those younger than 2 years old (60.9/100 PY; 95% CI: 46.8-79.4). Among 672 stool specimens from asymptomatic controls, 56 (8%) tested positive for norovirus. Odds of norovirus detection were significantly higher among cases compared with controls (odds ratio: 2.2; 95% CI: 1.6-3.1). Age-stratified norovirus incidence in this periurban community aligns with previously published estimates and was highest among those younger than 2 years old. Establishing baseline norovirus incidence in specific communities is crucial to identify target populations and assess effectiveness of future interventions, such as vaccines.

Trichoderma is a widely distributed thermophilic fungus that grows on moist soil, fallen leaves, and rotten wood. It plays an important role in agricultural production, food processing, and soil. However, some forms of Trichoderma can infect humans. Aggressive infections are more common in immunocompromised patients, with manifestations ranging from focal to disseminated infections. Here, we report a case of an invasive eye infection in China. The patient, a healthy 64-year-old man, was inadvertently struck by a puncture vine, injuring his eye and resulting in reduced visual acuity, lacrimation, and redness in the right eye. Upon admission, he was diagnosed with right eye perforation injury, right eye iris damage, right eye vitreous opacity, and right eye infection. After completion of the relevant auxiliary examinations, the diagnosis was confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and metagenomic next-generation sequencing, and the patient responded to antifungal therapy.

This report presents a rare case of acute transverse myelitis (ATM) after mumps infection in a 33-year-old male. Symptoms included fever, parotid and scrotal swelling, and subsequent sensory-motor paraparesis. Magnetic resonance imaging revealed long-segment spinal cord hyperintensity, and cerebrospinal fluid analysis showed pleocytosis and elevated protein, with positive mumps virus antibodies. Treatment with high-dose pulse steroids resulted in significant improvement. This underscores the association between mumps and ATM in adults, suggesting an autoimmune-inflammatory mechanism. The favorable response to steroid therapy emphasizes its efficacy in managing mumps-associated ATM. Recognizing such neurological complications is crucial for prompt diagnosis and appropriate intervention.