American Journal of Tropical Medicine and Hygiene最新文献

Mayaro virus (MAYV), an alphavirus found in Latin America related to the chikungunya virus, is transmitted primarily by sylvatic Hemagogus mosquitoes. Sporadic cases have been reported in French Guiana, with notable outbreaks occurring in 2020. In this study, a cluster of MAYV infections observed among European researchers in French Guiana in early 2024 is described. The study included individuals who stayed at the Nouragues Nature Reserve between January 1 and February 28, 2024. The case definitions were based on clinical symptoms and virological tests (polymerase chain reaction or IgM serology). Complementary investigations in asymptomatic exposed individuals were also conducted. Six European individuals developed acute fever, polyarthralgia, headache, or rash. Polymerase chain reaction testing was used to confirm two cases, and serology was used to identify two probable cases. Symptoms resolved within weeks for most, but two cases had chronic arthralgia that lasted more than 3 weeks. In addition to the six symptomatic individuals, 13 people stayed for more than one night at the scientific station, and all were asymptomatic. Five of them underwent anti-MAYV IgM serological testing between 4 and 8 weeks after their stay, and all results were negative. Entomological investigations had revealed Hemagogus janthinomys, a MAYV vector, in the area just a few months before. The cluster highlights the potential for sylvatic MAYV outbreaks among visitors to the Amazon rainforest. These findings highlight the need for greater awareness of MAYV symptoms and the potential for underdiagnosis.

The diagnosis of central nervous system histoplasmosis is challenging because histoplasmosis can mimic tuberculosis and the performance of mycological diagnostic methods in the cerebrospinal fluid is questionable. A 50-year-old woman with HIV infection, living in Amapa (northern Brazil), on suboptimal antiretroviral therapy for 8 years, presented to our unit with a 3-year history of recurrent undocumented meningoencephalitis, with several unsuccessful empirical antituberculosis and partially successful anticryptococcal regimens, and presented progressive motor weakness in the lower limbs, difficulty walking, and urinary and fecal incontinence for 6 months. Repeated lumbar punctures for mycological culture and Histoplasma polymerase chain reaction test were necessary to confirm the diagnosis. After 6 weeks of liposomal amphotericin B followed by itraconazole and intensification of her antiretroviral therapy, she improved clinically and biologically.

Although more than 30 case reports of eosinophilic meningitis have been attributed to Angiostrongylus cantonensis (A. cantonensis) in India, only three have been microbiologically confirmed (via polymerase chain reaction [PCR] or immunoblot testing). In seven ocular infections and two brain abscesses reported, A. cantonensis was identified on the basis of the morphology of recovered worms. Here, five cases of Angiostrongylus eosinophilic meningitis (AEM) in children and adults are reported, diagnosed via the detection of A. cantonensis DNA in cerebrospinal fluid using the AcanR3990 quantitative PCR (National Institutes of Health, Bethesda, MD). All patients responded to management with steroids and albendazole. When AEM cases reported from India were reviewed and mapped, the majority were reported from southern Indian states. Managing and preventing this emerging zoonosis in these areas requires 1) access to accurate and timely diagnostics, 2) increasing awareness among clinicians, and 3) risk assessment with public health officials on acquiring infections from water and food contaminated by gastropods and other paratenic hosts.

Twenty percent of French Guiana's population lives in remote villages surrounded by tropical forests, accessible only by plane or boat. Some specialists, including pediatricians, regularly visit these villages for consultation purposes. The main objective for the present study was to provide an epidemiological description of childhood diseases that require follow-up or consultation with pediatricians in remote health centers. A descriptive, retrospective, multicenter study of pediatricians' consultations in these health centers was conducted from January 1, 2011 to December 31, 2019. A total of 1,458 patients were included in the current study. In 2011, at the beginning of the pediatric missions, 91 patients had at least one consultation with a pediatrician, whereas in 2019, 319 patients were seen by a pediatrician in remote health centers. Sixty-two percent of pediatric consultations were single. Twenty-three deaths were recorded between 2011 and 2019, representing 1.4% of all children seen by the pediatricians. Forty-five percent of the children were under 2 years old at the time of their first consultation. The most common diseases were cardiac, infections, developmental delays, prematurity, and genetic diseases, including sickle cell disease. The current study revealed that the rate of children being followed up by pediatricians in the field is high. Children with chronic conditions can be followed up regularly, and additional investigations or support can be provided as needed. However, this comprehensive study highlights the difficulties pediatricians face in providing care, often due to external factors, such as a lack of healthcare infrastructure, cultural and linguistic differences, and educational and social difficulties, and emphasizes the need to reduce these barriers.

Transfusion-transmitted malaria risk in the United States is estimated at less than 1 per 10 million blood donations or about one case every 2 years. Since 2000, the 13 transfusion-transmitted malaria case donations were from former residents of a malaria-endemic area who were mostly outside the deferral windows. Recent autochthonous malaria outbreaks occurred in 2002, 2003, and 2023. From May to early July 2023 in Sarasota County, Florida, symptomatic Plasmodium vivax malaria was detected in seven individuals without recent malaria travel history. The local state department of health instituted mosquito control measures and increases in patient malaria syndromic surveillance on May 24th. The local blood center similarly responded to this autochthonous 2023 P. vivax outbreak by implementing a nontesting donor risk mitigation strategy of escalating blood donor screening measures and pathogen reduction to minimize the risk of transfusion-transmitted malaria in presymptomatic donors. In the absence of an approved blood donor screening test for malaria at the time, additional nucleic acid testing on 258 donor samples from four Sarasota zip codes and 178 donor samples from eight Miami zip codes collected from July to October was studied retrospectively using a transcription-mediated amplification with a limit of detection ranging from two to seven infected erythrocytes per milliliter. All donor samples were nucleic acid test nonreactive. No local transfusion transmission malaria cases were reported. Both the Florida Department of Health and the blood center took mitigation steps to decrease mosquito and blood donor transmission risks combined with increased surveillance.

Echinococcus granulosus is a zoonotic parasitic disease that affects populations with endemic exposure in sheep-raising communities worldwide and is rarely observed in travelers. Humans become accidental intermediate hosts after inadvertently ingesting parasite eggs, which form progressively enlarging cysts, most commonly in the liver or lungs. Pulmonary cystic echinococcosis poses significant management challenges, as cyst rupture may result in anaphylaxis, broncho-pleural fistulas, and seeding of the thoracic cavity. Peripheral eosinophilia is a potential marker for cyst leakage and is associated with an increased risk of complications. A case of an expatriate traveler with hepatic and bilateral pulmonary echinococcosis, complicated by robust eosinophilic pneumonitis requiring emergent surgical intervention and prolonged corticosteroids, is presented in the current study.

Infection with the soil-transmitted helminth Strongyloides stercoralis is typically asymptomatic but can result in life-threatening hyperinfection syndrome in immunocompromised individuals. To improve serological tests for strongyloidiasis, we evaluated the Ss-IR antigen using a multiplex bead assay and compared this assay to the commonly used Ss-NIE antigen. We assessed assay sensitivity and specificity using the following serum panels: sera from United States-bound refugees (57 positive stool polymerase chain reaction [PCR], 88 negative PCR) departing from Thailand-Burma border camps (panel 1); sera from individuals from Argentina with stool PCR confirmed S. stercoralis (panel 2, n = 50); and presumed negatives from the United States with no travel history (panel 3, n = 185). The Ss-IR antigen demonstrated sensitivities of 90.0% and 89.5% and specificities of 98.9% and 89.8% in panels 1, and panels 2 and 3, respectively. When compared with Ss-NIE, the Ss-IR antigen demonstrated superior sensitivity, area under the curve, and reproducibility than Ss-NIE, supporting more extensive validation for surveillance use.

French Guiana has developed a health organization to respond to its geographical situation. Remote health centers provide primary and emergency care in isolated areas. The limited technical facilities at the remote health centers result in a significant number of patient transfers to the Cayenne emergency department (ED). The objective of this study was to describe the epidemiology and management of patients transferred to Cayenne ED. A retrospective observational study was conducted from January 1 to December 31, 2019, and it included all patients transferred from remote health centers to Cayenne ED. All sociodemographic, prehospital, hospital, and referral data were collected; 842 patients were transferred by remote health centers to the Cayenne ED. The male/female ratio was 1.27, with an age of 36 (±23) years old. The two main modes of transportation used were helicopter (36%) and plane (22%). The most frequent reasons for transfer were trauma (28%), digestive (9%), respiratory (9%), and infectious (8%) conditions. Patients were hospitalized in 71% of cases. Among patients who were not hospitalized, 7% did not require further examination or specialist advice in the ED. Our work underlines the important use of airborne resources, particularly medical ones; they were initially intended for the management of vital emergencies, but they are also used for nonurgent situations. The geography and road access in French Guiana make alternative means of transport difficult. Our work identifies a number of areas for optimizing care to decrease the number of transfers: improving biomedical equipment, improving imaging equipment, and use of telemedicine.