American Journal of Tropical Medicine and Hygiene最新文献

Typhoid fever is a human-specific disease caused by subspecies of Salmonella enterica (Salmonella Typhi). It spreads through ingestion of contaminated food or water and is diagnosed through blood culture or bone marrow culture. It typically presents as an intestinal infection, with a few patients developing severe disseminated infections. Here, we report a rare case of purulent pericarditis secondary to S. Typhi infection. A 67-year-old elderly male suffered from recurrent fever, diarrhea, and abdominal pain for 7 days. Initial blood and stool cultures were positive for Salmonella, and a follow-up blood culture confirmed S. Typhi. Magnetic resonance imaging showed pericardial abscess and hepatic abscess. After pericardiocentesis, the pericardial fluid culture grew S. Typhi, confirming the diagnosis of pericardial abscess secondary to S. Typhi infection. After percutaneous drainage of the pericardial abscess and administration of effective antibiotics, the patient's symptoms improved significantly. He subsequently recovered and was discharged from the hospital. During follow-up, there were no further recurrences. Disseminated infection secondary to Salmonella Typhi is extremely rare but can lead to serious life-threatening conditions. Our patient was found to have pericardial abscess caused by S. Typhi. Effective and adequate antibiotics, along with pericardial abscess drainage, can improve symptoms, assist in diagnosis, and enhance quality of life.

Most triatomine bugs inhabit nests and shelters of vertebrates, some of which are closely associated with palm trees. A few species occupy domestic and peridomestic habitats, posing a threat to human health as natural transmitters of Chagas disease. A peridomestic specimen that yielded positive results for Trypanosoma cruzi in both microscope and polymerase chain reaction tests was collected during a vector control survey in northeastern Paraguay. The specimen was identified as Rhodnius stali, marking a new record for the country. To the best of our knowledge, this is the southernmost report of this species documented to date. This record emphasizes the importance of considering this additional triatomine species in future vector and control surveillance efforts in Paraguay.

Measles or rubeola is caused by an enveloped single-stranded RNA virus belonging to the genus Morbillivirus in the Paramyxoviridae family. Here, we present five adult measles patients. The laboratory confirmation of measles by serology/polymerase chain reaction (PCR) was carried out in the National Measles Laboratory as per WHO standard operating procedure at the Department of Virology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. All of the patients presented with prodromal fever with rash. Diffuse erythematous maculopapular rash in a centrifugal manner was present. Measles was diagnosed based on clinical examination findings and positive serology or PCR reports from throat swab specimens. Two patients had a history of exposure; other patients denied any exposure. All of the patients were admitted and managed conservatively in the isolation ward during the period of infectivity.

Unexplained fever poses significant diagnostic challenges in resource-limited settings like Bamako, Mali, where overlapping endemic diseases include malaria, HIV/AIDS, yellow fever, typhoid, and others. This study aimed to elucidate the infectious etiologies of acute febrile illnesses in this context. Acute febrile patients of any age were enrolled after informed consent or assent. Baseline clinical and demographic data were collected, and samples were analyzed by using rapid diagnostic tests, reverse transcriptase polymerase chain reaction, ELISA, and virus-targeted metagenomic sequencing (virome capture sequencing platform for vertebrate viruses [VirCapSeq-VERT]). Among 108 enrolled subjects, most were male (51.9%) and under 15 years old (56.5%). Measles virus was identified in 39.8% of cases, primarily among children. Other findings included Plasmodium spp. (12%), Salmonella spp. (13%), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; 8.7%). The virome capture sequencing platform for vertebrate viruses was used for 101 subjects, corroborating many routine test results and identifying additional cases of measles virus (1), SARS-CoV-2 (5), and numerous other agents. Notably, nearly all subjects showed evidence of herpesviruses (90%) and anelloviruses (98%). Hemorrhagic fever viruses were not observed. With the inclusion of VirCapSeq-VERT, identifiable pathogens were found in 79.6% of cases, leaving 20.4% without a clear etiology. The identification of more than one concurrent pathogen was common (41.5%). Integrating metagenomic sequencing with routine laboratory diagnostic testing enhances the detection of pathogens in acute febrile illnesses, highlighting its potential value in identifying infectious etiologies in resource-limited settings.

Kaposi sarcoma is a low-grade vascular neoplasm linked to the human herpesvirus 8, with the AIDS-associated epidemic variant being the most common and aggressive. Although Kaposi sarcoma more commonly affects the cutaneous tissues, lymph nodes, and visceral organs, it can also be present in ocular and ocular adnexal tissues. We report a case of a 58-year-old Indo-Caribbean woman living with AIDS who presented with a large upper eyelid mass that was clinically diagnosed as Kaposi sarcoma. After the recommencement of the patient's highly active antiretroviral therapy (HAART), the lesion showed marked regression, highlighting the critical role of HAART in the management of Kaposi sarcoma. This is the first documented case of AIDS-associated ocular Kaposi sarcoma in the Eastern Caribbean region and underscores the need to consider Kaposi sarcoma as a differential diagnosis in patients living with HIV/AIDS who present with ocular or ocular adnexal masses.

Brucellosis remains an endemic disease in livestock populations in Rwanda, but the prevalence of the disease varies by geographic region. The common use of informal milk marketing channels represents a health hazard to humans when milk from Brucella-infected cows from one or more households is mixed with milk from other households for human consumption. In Rwanda, knowledge about the burden of brucellosis in livestock and factors associated with farmers' choice of milk marketing channels is very limited. The objectives of this study were 1) to estimate the seroprevalence of brucellosis in livestock in Rwamagana District in Rwanda and 2) to estimate the frequency of and identify determinants associated with farmers' choice of milk marketing channels. The seroprevalence of brucellosis in livestock at the household level was 1/160 (0.6%; 95% CI = 0.1-3.4%). Among 100 households that sold milk, 72 used informal milk trade channels. By the use of logistic regression, milk price and distance to closest milk collection center were positively associated with the use of informal milk marketing channels. Although the seroprevalence of brucellosis in livestock in Rwamagana District was low, the risk of disease transmission to humans through consumption of unpasteurized milk or milk products is not negligible. In this report, we present several policy options available to animal health authorities that can mitigate the risk of brucellosis disease transmission in populations.

Dengue infection poses a significant public health challenge in tropical countries. In Thailand, children ages 5-14 years are among the groups with the highest incidence of dengue. This study aimed to determine the prevalence of gastrointestinal (GI) manifestations in children with dengue infection and assess prognostic factors for severe dengue. We reviewed the medical records of children ages 0-14 years who were hospitalized with a diagnosis of dengue infection between 2019 and 2022 at Charoenkrung Pracharak Hospital in Bangkok, Thailand. Dengue severity was classified according to the 2009 WHO dengue guidelines. Clinical manifestations and laboratory data were analyzed for their association with severe dengue using a logistic regression model. The study included 556 dengue cases, with 48 cases (8.6%) classified as severe dengue. The mean age (SD) of patients was 9.9 (3.7) years. The most common GI symptoms were anorexia (91.7%) and vomiting (57.6%) followed by abdominal pain (38.3%), and diarrhea (33.3%). GI bleeding was found in 3.2% of patients. Hepatomegaly and ascites were found in 20.9% and 2.9% of patients, respectively. Acute liver failure and acalculous cholecystitis were found in 0.4% and 0.2% of patients, respectively. Children younger than 5 years of age exhibited a lower prevalence of vomiting and abdominal pain compared with older children, making the diagnosis of dengue more challenging. Vomiting, ascites, aspartate aminotransferase >450 U/L, and serum albumin <3.5 g/dL were significantly associated with severe dengue infection. Children with dengue infection presenting any of these factors should be closely monitored for severe dengue.

Although China has achieved malaria elimination certification, the risk of malaria transmission reintroduction due to imported malaria remains. We analyzed data on imported malaria cases collected from January 1, 2014 to December 31, 2021, using multivariable logistic regression analysis to identify the factors associated with severe and relapsing malaria. The odds of severe malaria were around 4-fold greater for patients who were initially diagnosed with a nonmalarial illness than for patients initially diagnosed with malaria. The risk of relapse from Plasmodium vivax or Plasmodium ovale varied depending on the regions of Africa where patients resided. Patients residing in western and southern Africa (compared with Central Africa) had a lower relative risk of relapse. In addition, treatment with primaquine provided protection against malaria relapse. Improving the timeliness of treatment of malaria patients could help reduce the severity of illness, and use of primaquine can mitigate the risk of relapse after treatment.

Infectious keratitis is a significant ocular disease that, if left untreated, can lead to blindness. Fungi are among the causative agents that can result in severe symptoms. Keratitis infections are prevalent globally, with a higher incidence reported in tropical and subtropical regions. The current research focused on the molecular diagnosis of fungal keratitis and its prevalence over a 3-year period in northeastern Iran. The study involved the collection of 38 corneal scraping specimens from the Eye Specialized Hospital of Khatam in Mashhad, northeastern Iran. These specimens were cultured on Sabouraud dextrose agar, and the isolates were identified using DNA-based techniques. Among the patients studied (n = 38), 22 (58%) cases were caused by Aspergillus species (A. flavus, n = 17, A. fumigatus, n = 3; A. terreus, n = 1; A. tubingensis, n = 1), seven (18%) by Neocosmospora species (N. falciformis, n = 4; N. solani, n = 3), three (7%) by Candida albicans, two (5%) by Fusarium annulatum, and one case each (2%) by Penicillium chrysogenum, Cladosporium cladosporioides, and Cytospora sp. In addition, one case had a combined infection of A. flavus and P. glabrum. The results indicate a higher incidence of fungal keratitis in males, particularly in the age range of 40-60 years. Aspergillus sp., and specifically A. flavus, had the highest prevalence. Cladosporium cladosporioides is reported for the first time in this area as causal agent of keratitis. Additionally, this is the first report of keratitis likely caused by Cytospora species.