American Journal of Tropical Medicine and Hygiene最新文献

Opsoclonus myoclonus ataxia syndrome (OMAS) is a rare neuroinflammatory disorder that is typically associated with paraneoplastic and postinfectious processes. Opsoclonus myoclonus ataxia syndrome has not been previously reported in association with tuberculous meningitis (TBM). This report presents a unique case in which TBM manifested as OMAS, highlighting the complex interplay between tuberculosis and autoimmune neurological conditions. A 1.5-year-old previously healthy girl, presented with acute-onset jerky movements, opsoclonus, irritability, and reduced sleep over 4 weeks. A neurological examination revealed opsoclonus, irritability, generalized tremulousness, and fragmentary myoclonus. Neuroimaging was suggestive of TBM. A cerebrospinal fluid (CSF) analysis indicated lymphocytic pleocytosis with positive CSF cartridge-based nucleic acid amplification test results for tuberculosis. The patient was treated with methylprednisolone pulse therapy, intravenous immunoglobulins, and anti-tuberculous therapy (ATT). Significant symptom improvement was observed within 2 weeks. This case underscores a rare association between OMAS and TBM, demonstrating that tuberculosis can trigger OMAS through autoimmune mechanisms. A timely diagnosis and treatment with ATT and immunotherapy can lead to substantial recovery.

Antitubercular treatment (ATT) is associated with multiple cutaneous adverse drug reactions. Second-line ATT is also associated with numerous adverse reactions; however, cutaneous reactions are under-reported. Oral drug provocation (ODP) in multidrug-resistant tuberculosis is challenging because of the paucity of time and the risk of developing secondary drug resistance in the case of interrupted medication. In this paper, we report a case of drug reaction with eosinophilia and systemic symptoms caused by cycloserine in an 18-year-old girl, which was confirmed with ODP and a patch test.

Acute Q fever diagnosis via paired serology is problematic because it requires follow-up for convalescent sample collection; as such, it cannot provide a diagnosis to inform a treatment decision at the time of acute presentation. Real-time polymerase chain reaction (PCR) may be a useful approach for the diagnosis of acute Q fever in endemic settings. Among febrile patients enrolled in a sentinel surveillance study for Q fever at two referral hospitals in Moshi, Tanzania, from 2012 to 2014, we analyzed those with paired sera for IgG to Coxiella burnetii (C. burnetii) phase II antigens using immunofluorescent antibody (IFA) testing, and acute serum was tested for C. burnetii with PCR. Acute Q fever was defined as a fourfold or greater rise from the acute to convalescent sample in IFA reciprocal titer or PCR detection that was confirmed through repeat testing. Test characteristics were tabulated. Among 496 participants tested using both paired IFA and PCR testing, 463 (93.3%) tested negative on both IFA and PCR, five (1.0%) tested positive for Q fever on both IFA and PCR, and 28 (5.6%) tested positive for Q fever on IFA alone. The sensitivity of PCR testing using paired IFA testing as an index was 0.15 (5/33), and the specificity was 1 (463/463). C. burnetii PCR testing provides a clinically specific method that may aid in timely diagnosis in settings in which acute Q fever is a common cause of febrile illness. However, we found a low clinical sensitivity of PCR testing on serum when compared with paired IFA serology.

The identification of factors that influence the distribution of visceral leishmaniasis (VL) is key for future surveillance and control. This study sought to understand how environmental and climate variables can interfere with VL expansion in the Doce River basin located in Brazil. This ecological study explored the influence of anthropogenic, environmental, and climatic factors on VL expansion. Ecological niche modeling was used to assess the current situation and predict the future spread of the disease. The study used 855 human cases of VL recorded in the Doce River basin from 2001-2018 and analyzed them within the context of climatic and environmental variables. To model the current and future distributions, MaxEnt with the kuenm R package was used. To model the future projections, the global climate model of the National Centre for Meteorological Research (CNRM-CM6-1) was used as well as two Shared Socioeconomic Pathways (SSP370 and SSP585) for 2021-2040 and 2061-2080. Variables that contributed to the VL distribution were the human footprint index (62.6%), isothermality (28.1%), precipitation during the wettest month (6.4%), and temperature during the hottest month (3.8%). Future climate change scenarios showed areas suitable for the disease increasing over time (by about 7% between 2021 and 2041 and about 12% between 2061 and 2080) and the maintenance of the disease in places already considered endemic. Our results demonstrate the importance of anthropic and climatic factors in VL expansion. We hope that these results will contribute to boosting surveillance and vector control programs along the Doce River basin.

Rapidly identifying Anopheles-carrying malaria parasites is crucial for imported malaria prevention. However, suitable methods still lack quick detection in limited-resource situations. In this study, disc microfluidic isothermal amplification integrating loop-mediated isothermal amplification (LAMP) and microfluidic chip technology were applied to develop rapid and precise detection with low resource requirements. Primer set EMP1G2, which is specific to Plasmodium falciparum (P. falciparum) erythrocyte membrane protein 1, and primer set 18sG2, which is specific to ribosomal 18s subunit RNA, were screened for optimal LAMP-specific primer sets. The minimum detection limits were 125 copies/µL for the EMP1G2 and 6,562 copies/µL for the 18sG2. Subsequently, optimal primer sets were evaluated for specificity with nucleic acid from other mosquito-borne pathogens and arthropod vectors. No nonspecific amplification was observed in optimal amplification-specific primer sets with the DNA of Anopheles mosquitoes and morphologically similar arthropods or with the copy DNA of Zika virus, yellow fever virus, or dengue virus 1. The detection method was evaluated in a simulated scenario and demonstrated a robust capacity for rapid on-site detection. Additionally, polymerase chain reaction (PCR) and quantitative real-time PCR methods were compared using this method. In this study, a rapid detection method based on disc microfluidic isothermal amplification was developed that could be used to detect P. falciparum carried by mosquitoes in a field setting under limited resource conditions.

People living with HIV (PLWH) are known to exhibit more severe or prolonged symptoms of mpox (formerly monkeypox). However, the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on PLWH with mpox has not been adequately described. We report a case of mpox in an AIDS patient who had recurrent symptoms due to SARS-CoV-2 infection. The patient presented with a low CD4+ lymphocyte count (CD4 count) without antiretroviral therapy (ART) and suffered from severe mpox. The ART was initiated 17 days after the diagnosis of mpox, and the patient's skin lesions began crusting after 1 week of ART. However, after a SARS-CoV-2 infection, the mpox flared up again. The patient presented with more severe symptoms than those during the initial bout and with rectal involvement. We speculate that SARS-CoV-2 infection might cause a recrudescence of mpox in AIDS patients, which requires further investigation.