American Journal of Tropical Medicine and Hygiene最新文献

Mass drug administration (MDA) of ivermectin is currently being evaluated for malaria control. Uptake and adherence to MDA are shaped by various individual, social, and operational factors; however, the authors of most studies have focused on individual drivers of uptake. In the present paper, a longitudinal qualitative study undertaken alongside the Broad One Health Endectocide-Based Malaria Intervention in Africa (BOHEMIA) ivermectin MDA clinical trial is reported to examine community experiences and perceptions of the trial and the ivermectin MDA. Using purposive maximum variation sampling, researchers selected five villages involved in the BOHEMIA trial (two in the intervention arm and three in the control arm). Before the trial, researchers lived in each village for 1 month, making observations and conducting in-depth interviews (IDIs) and focus group discussions (FGDs). They returned before the first MDA round and remained throughout all three rounds, gathering insights on trial implementation, community perceptions, and perceived effects of the MDA. During this period, a total of 22 IDIs were conducted, along with structured observation reports. Two months after the MDA, 15 FGDs were held in eight additional villages. The findings indicate that during the trial, addressing needs and confidence in the implementing institution fostered participation, whereas previous negative experiences with MDA interventions and perceived exclusion from community engagement activities reduced involvement. The MDA was widely perceived as effective in reducing mosquitoes and malaria in both arms of the trial. It was also seen as highly effective against bedbugs in the intervention arm. These insights highlight the importance of trust, engagement, and previous experiences in shaping community participation in MDA programs.

Tuberculosis (TB) in pregnancies conceived via in vitro fertilization (IVF) presents unique diagnostic and management challenges, especially in TB-endemic regions. This systematic review synthesizes evidence on maternal and neonatal TB outcomes after IVF. We conducted a systematic review of case reports, case series, and cohort studies, following PRISMA 2020 guidelines. Databases searched included PubMed, Scopus, Embase, and Google Scholar. Quality assessment was performed using Murad's framework and the Newcastle-Ottawa Scale. Seventy-three IVF pregnancies complicated by maternal TB were analyzed. Median maternal age was 32 years; 63.0% had no prior TB history. TB was diagnosed during pregnancy (56.2%) or postpartum (38.4%). Miliary TB (38.4%) and genital TB (27.4%) were most common; central nervous system (CNS) TB occurred in 13.7%. Microbiological confirmation was achieved in 38.4%. Anti-TB therapy was administered to 79.5%; 8.2% had drug-resistant TB. Neonatal TB manifestations included congenital TB (39.7%), miliary TB (34.2%), and CNS TB (15.1%). Of 55 live births, 28 infants survived, 12 died neonatally, and outcomes were missing for 15; there were 18 pregnancy losses. Most mothers recovered, some had residual deficits, and three deaths occurred. Seven cohort studies from China reported earlier TB onset in IVF pregnancies (11-19 weeks' gestation), higher incidence of miliary and CNS TB, and poor fetal outcomes, including >80% pregnancy terminations or losses, in comparison with natural conceptions. TB after IVF is often undiagnosed before conception and carries high fetal risks. Routine TB screening before IVF is essential in endemic areas. Early diagnosis and maternal-neonatal management can improve outcomes.

Cervical cancer is a malignancy with a well-established viral origin linked to high-risk human papillomavirus (HPV) types. Globally, there are 348,709 estimated deaths among 662,301 cervical cancer cases. India faces a disproportionately high burden, contributing to 79,906 of these deaths and accounting for over 22% of global deaths. The nation's high mortality rate is attributable to the low rate of cervical cancer screening and HPV vaccination uptake. There is a greater impact of cervical cancer on those of lower socioeconomic status and a cultural stigma surrounding sexually transmitted infections. We recommend a comprehensive cervical cancer prevention strategy, including screening programs, culturally sensitive education for patients and providers, government-endorsed HPV vaccination, and continuing studies on diagnostics and vaccination in the Indian context.

This study investigated the epidemiologic and clinical characteristics of patients with dengue fever complicated by alopecia. Of the 1,302 patients diagnosed with dengue fever at a tertiary hospital in Guangdong Province between September 2024 and December 2024, 15 were identified with concurrent alopecia. Clinical data from these patients were systematically analyzed along with relevant literature. The incidence of dengue fever with alopecia was approximately 1.15% and occurred predominantly in females (93.33%). Hair loss most frequently developed during the convalescent phase of dengue fever, with telogen effluvium identified as the most common type. Platelet count and hematocrit values were significantly lower in patients with dengue fever and alopecia than those without alopecia. These findings suggest that dengue fever-associated alopecia primarily presents as telogen effluvium, predominantly affects females, and may be associated with reduced platelet count and hematocrit as potential risk factors.

The American Society of Tropical Medicine and Hygiene (ASTMH) established its Green Task Force (GTF) in 2019 and adopted its Green Statement in 2021 in consultation with the GTF to encourage collective efforts for mitigating climate change as a professional society. The GTF highlighted how climate action aligns with the society's mission to improve global health in a perspective piece published in 2022. The GTF conducted a survey in 2022 to assess the concerns of the ASTMH community surrounding climate change and the potential role of the society in addressing them. The majority of survey participants reported moderate to extreme concern about climate change as well as a negative impact of climate change on their global health work. Survey results demonstrated strong agreement for ASTMH to lead through interdisciplinary research, capacity building through training and education, development of decarbonization guidelines (particularly for laboratories), and advocacy for wider climate action.

Soil-transmitted helminths (STHs) remain a major public health concern, especially in low- and middle-income countries. Although Ascaris lumbricoides, Trichuris trichiura, and hookworms (Ancylostoma duodenale and Necator americanus) are commonly identified in humans, emerging evidence using molecular diagnostics capable of differentiating morphologically similar ova suggests zoonotic drivers of transmission, particularly in areas with close human-animal interaction. This pilot study investigated human and animal STH infections across nine villages of Meghalaya in the northeastern region of India, using quantitative polymerase chain reaction with species-specific primers. The estimated STH prevalence was 23.3% (95% CI: 17.9-29.9%). Zoonotic potential was evident, with Ancylostoma ceylanicum detected in humans (2.8%), and Ascaris spp. and Necator americanus detected in pigs (64.5% and 3.2%, respectively) and goats (15.2% and 3.0%, respectively). To meet World Health Organization's target of eliminating STH morbidity by 2030, endemic regions may need to adopt an integrated One Health approach.

Dihydroartemisinin-piperaquine (DP), the first-line treatment for uncomplicated malaria in Timika, Papua, Indonesia, has also been used for intermittent preventive treatment in pregnancy (IPTp-DP) since February 2022. Concerns about the potential emergence of drug resistance associated with this dual policy prompted the present study, which was conducted to assess DP efficacy in treating uncomplicated Plasmodium falciparum (P. falciparum) and Plasmodium vivax (P. vivax) malaria in the general population 15 months after IPTp-DP was introduced. Between May and December 2023, the current study recruited 75 P. falciparum and 75 P. vivax malaria patients, who received supervised DP treatment for 3 days. Clinical and laboratory data were collected daily (on days 1, 2, 3, and 7) and then weekly for 6 weeks. Molecular analysis was performed to detect genetic markers of P. falciparum resistance to DP and distinguish between recrudescence and reinfection. A total of 68 P. falciparum and 58 P. vivax patients completed their day 42 follow-up. The cumulative risk of same-species recurrence by day 42 was 1.5% (95% CI: 0-7.9%) in P. falciparum patients (polymerase chain reaction-adjusted) and 5.2% (95% CI: 1.1-14.1%) for P. vivax patients (unadjusted). No patients exhibited parasitemia on day 3. No P. falciparum isolates carried kelch 13 gene mutations or exhibited increased plasmepsin 2-3 copy numbers on either day 0 (0/75) or at recurrence (0/2). At the current level of IPTp-DP coverage (824 doses administered), there was no evidence of high treatment failure rates or the selection of resistant parasites in patients with uncomplicated malaria treated with DP. Continuous monitoring of DP efficacy remains crucial for both treatment and chemoprevention.

The ambiguous clinical presentation of leptospirosis poses challenges for accurately assessing the global burden of this emerging disease. As a result, leptospirosis has not been recognized for inclusion in the WHO's neglected tropical diseases list. This underscores the urgent need for a diagnostic biomarker for early detection of illness and well-defined estimation of disease burden in urban and low-income settings. The recently discovered PF07598 gene family encoding virulence-modifying proteins (VMPs), including full-length LA3490, its truncated N-terminal ricin-binding lectin (RBL) domain, and a natural variant encoding only the C-terminal domain (LA0591), was evaluated for its potential to detect anti-VMP-specific IgG antibodies in early infection. The study was conducted on a well-characterized sample of febrile patients from Sri Lanka, with leptospirosis confirmation by microscopic agglutination test (MAT) and Quantitative PCR. The sample included 113 confirmed cases, 45 probable cases, 75 febrile patients, and 41 healthy subjects. Among confirmed cases, mean ELISA optical density (OD) values for LA0591, LA3490, and RBLs were 1.045 (standard error [SE]: 0.063), 0.835 (SE: 0.032), and 0.536 (SE: 0.019), respectively, compared with 0.261 (SE: 0.043), 0.697 (SE: 0.026), and 0.303 (SE: 0.019) in healthy subjects. Anti-VMP antibodies were detectable as early as day 2. In seroconversion cases, ELISA OD for LA0591 in acute MAT-negative samples was 1.347, comparable with high MAT titers. ROC analysis showed AUCs of 0.947 for LA0591 and 0.930 for LA3490, confirming their reliability as diagnostic markers. LA0591 demonstrated superior sensitivity, specificity, and early diagnostic capability, establishing it as a valuable tool for leptospirosis detection.

Acute undifferentiated febrile illness (AUFI) is associated with several etiological agents, including vector-borne pathogens. In tropical areas endemic for multiple pathogens, it is difficult to efficiently determine the etiology of AUFI. The goal for this study was to diagnose several arboviruses and other pathogens in patients with AUFI in Yucatan, Mexico, during the final phase of the coronavirus disease 2019 pandemic. A total of 215 patients with AUFI were included, with 170 from the urban area of Merida City and 45 from the rural area of the Molas community. Between December 2022 and December 2023, subjects were enrolled at health facilities, one in the rural area and two in the urban area. Overall, 36.7% (79/215) of AUFI patients were confirmed to have dengue virus (DENV). A significant difference (P <0.05) was found in the prevalence of dengue in the urban area (84.8%) compared with that in the rural area (15.2%). When diagnosed patients were grouped by age, most cases occurred in young adults (17-29 years old). Acute infections caused by Leptospira interrogans (L. interrogans) serovars Bratislava and Australis, Rickettsia spp., and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were also identified in patients with AUFI. In Merida City, five cases of multiple infections were found with dengue, SARS-CoV-2, and L. interrogans serovars Bratislava and Australis. In conclusion, DENV was confirmed as the main causative agent of AUFI in the present study; however, the simultaneous circulation of other relevant endemic causal agents that cause febrile infections in the area is a key point to consider when making differential diagnoses.

Tuberculosis (TB) remains a leading cause of morbidity and mortality in sub-Saharan Africa. Community pharmacies, which are often the first point of contact for people with TB, are underutilized in expanding TB care. Engaging community pharmacies in TB care could facilitate personalized adherence counseling, the timely detection and reporting of medication side effects, and the integration of TB and HIV services for individuals with both TB and HIV. Pharmacies can reduce stigma and address social and psychological barriers by offering person-centered care in convenient, accessible settings, including for working people and hard-to-reach communities. Integrating community pharmacies into national TB programs could strengthen adherence, reduce loss to follow-up, improve case detection, and help achieve End TB Strategy goals. The authors of the present study advocate for deliberate policy, training, and data linkages to realize this scalable opportunity, including implementation research.