American Journal of Tropical Medicine and Hygiene最新文献

Hospital readmissions among neonates are common and may reflect ongoing illness. We conducted a prospective observational cohort study of neonates discharged from two hospitals, one in Dar es Salaam, Tanzania, and one in Monrovia, Liberia, to develop and internally validate a risk assessment tool to identify neonates at risk for unplanned readmission within 60 days of discharge. One hundred and fifteen candidate variables were collected. The outcome of unplanned readmission was identified through phone calls to caregivers. We constructed a multivariable logistic regression model with best subset selection to identify the optimal combination of variables to identify neonates at risk for readmission. We used bootstrap validation with 500 repetitions to internally validate the tool. Of the 2,344 neonates discharged, 98.5% were enrolled and had 60-day outcomes. Of these, 3.6% were readmitted within 60 days of discharge, with 41.7% of readmissions occurring within 14 days of discharge. The risk assessment tool included eight variables that were predictive of readmissions. Neonates who had documented abnormal posturing during hospital admission (adjusted odds ratio [aOR] 7.29, 95% CI 1.51-35.12), hydrocephalus (aOR 7.52, 95% CI 1.21-46.95), and low birth weight (aOR 3.16, 95% CI 1.69-5.92) had the greatest risk of readmission. The overall discriminatory value of the risk assessment tool was 0.77 (95% CI 0.76-0.79). The risk assessment tool demonstrated excellent calibration for predicting readmissions at low scores. However, this tool requires external validation before it can be used in sub-Saharan Africa to direct resources for follow-up of high-risk neonates.

Laboratory-established sand fly colonies provide important material for leishmaniasis research; however, the establishment and maintenance of such colonies can be complicated. In this study, a colony of Phlebotomus argentipes (P. argentipes) was established using wild-caught sand flies in Bangladesh by following standard procedures described in the published literature. The colony was initiated in a controlled laboratory environment. A total of 430 female P. argentipes sand flies were collected to develop the colony. Over multiple generations (F0 to F6), 1,034 P. argentipes sand flies laid eggs. The number of eggs that successfully emerged differed significantly between the wild-caught generation and other generations, except for the F1 and F6 generations. A significant difference was observed in the incubation period between wild-caught (F0) and laboratory-reared sand flies (F1 to F6). The mean mortality rate was highest in the first instar (13.9) and lowest in the pupae stage (1.9%). The development from pupae to adult sand flies was 98% successful. It was observed that the copulation was much more frequent after the females had taken a blood meal. This is the first successful attempt to colonize sand flies from Bangladesh in laboratory settings. The study's findings will contribute to a better understanding of the role of P. argentipes as a vector of Leishmania parasites in Bangladesh, as well as in the region. The colony can also be used for xenodiagnoses, insecticide resistance monitoring, and other experimental infections to generate the necessary evidence.

Antimicrobial resistance (AMR) poses a major threat to public health worldwide. In Africa, the overall burden of AMR is not well understood or documented because of inadequate data and lack of surveillance, and empirical treatment takes a major part in the clinical management of infections. We assessed AMR in infected surgical wounds at the University Teaching Hospital of Kigali from January 1st to December 31st, 2022. The study analyzed a total of 136 swab cultures from the surgery department; 89 (65.4%) were culture positive and included in the analysis. The mean age of patients with positive culture was 37 ± 17 years old, and the sex distribution consisted of 65 males (73%) and 24 females (27%). Data were analyzed using SPSS v. 21. The study identified a diverse array of different bacterial isolates. Escherichia coli was the most prevalent (19.1%) followed by Staphylococcus aureus (17%) and Klebsiella pneumoniae (16%). Other notable isolates included Citrobacter freundii (11%), Pseudomonas aeruginosa (9%), and Acinetobacter baumannii (9%). Acinetobacter and Klebsiella had higher resistance rates of 80% and 76.5%, respectively. The average resistance rate across all isolates was 63%. Moreover, among the 89 patients who had positive swab culture results, 86 (96.6%) recovered completely, and 3 (3.4%) died. The study highlights a high level of antibiotic resistance, particularly among common Gram-negative pathogens, emphasizing the need for ongoing monitoring and the development of targeted treatment strategies to address this public health challenge.

A 30-year-old male presented with acute painful monocular diminution of vision, without any history of trauma or illness. Although the fundus image may resemble other retinal diseases, ophthalmic ultrasonography (US) was critical in detecting the problem. In the US, several scolexes were seen, indicating cysticerci, which are the larval stage of Tenia worm, infecting the optic nerve sheath at its scleral insertion. Only oral steroids were used because the inflammatory and toxic effects of albendazole-induced scolex-lysis on optic nerve function were uncertain. The authors reported no deterioration or recurrence on tapering doses of steroids.

India's National Malaria Elimination Program, which achieved notable success in reducing cases, is now facing challenges because of the rise in malaria cases in 2023 and 2024. This increase is linked to multiple factors, including disruptions in healthcare priorities during the coronavirus disease 2019 pandemic, drug and insecticide resistance, and the under-detection of asymptomatic carriers and pfhrp2-deleted parasites. The ultimate goal is to achieve sustainable reductions in malaria incidence and transmission, paving the way for a malaria-free India by 2030.

The optimal management of large tuberculous mass lesions (LTML) involving the central nervous system remains unclear. We conducted a single-center, retrospective, observational study that assessed the outcomes of patients with LTML from January 2010 to February 2023. An LTML was defined as a tuberculoma or tubercular abscess exceeding or equal to 3 cm. The primary outcome was independence in activities of daily living, as assessed by the modified Rankin Scale (mRS) at a follow-up of 6 months. Forty-six patients were identified during the study period. Their mean age was 27.6 ± 12 years, the median duration of antituberculous therapy (ATT) was 18 months, and the median duration of follow-up was 20 months (interquartile range 15.7-40). The favorable outcomes were 76.9% (10/13) for ATT alone, 62.5% (10/16) for ATT with steroids, 87.5% (7/8) for ATT with surgery, and 66.9% (6/9) for ATT, steroids, and surgery. The median mRS at baseline in the study was 2 (1-3), and at the 6 month follow-up, it was 1 (0-2). Adding steroids or surgical intervention to ATT did not significantly improve primary outcomes (P = 0.637). Further large-scale studies are necessary to confirm these preliminary observations.

Urinary tract infections (UTIs) are treated based on local antimicrobial susceptibility patterns; however, growing antimicrobial resistance necessitates continuous monitoring. This retrospective study examined the prevalence of pediatric UTIs, identified causative pathogens, and evaluated their antibiograms and resistance patterns. We examined the demographic data, microbiological profiles, and antimicrobial susceptibility results (September 2019-August 2021) of pediatric patients (neonates to 14 years) with positive urine culture results at Kanti Children's Hospital, Kathmandu, Nepal, using SPSS version 17.0 (IBM Corp., Armonk, NY). Among 8,072 urine specimens, 575 (7.1%) (95% CI: 6.6-7.7) tested positive for significant infections, primarily from outpatients (88.2%) and males (54.1%), with a median age of 2 years. Most UTIs (93.0%; 535/575) were caused by bacteria, primarily Escherichia coli (78.5%; 420/535). Cumulative resistance rates were 92.4% for penicillin, 69.3% for cephalosporins, 39.7% for quinolones, 30.2% for carbapenems, and 14.3% for aminoglycosides. One hundred sixty-eight (40.0%) E. coli strains and four (33.3%) Pseudomonas aeruginosa strains were multidrug-resistant. Seven (9.0%) Klebsiella pneumoniae strains were extensively drug-resistant (XDR), and 15 (21.1%) were extended-spectrum β-lactamase (ESBL) producers. Multidrug-resistant strains (36.5%; 210/575), XDR strains (22.6%; 15/575), and ESBL producers (14.4%; 83/575) showed >70.0% resistance to ampicillin, cefotaxime-clavulanate, and cefixime. Over the years, resistance to β-lactams has risen, whereas resistance to aminoglycosides, carbapenems, and cotrimoxazole has decreased. Resistance to quinolones has remained consistent. Pediatric UTIs were least common in this hospital, with the majority caused by E. coli. Multidrug-resistant bacteria were more prevalent than XDR and ESBL-producing bacteria. Although resistance to β-lactam antibiotics increased over the years, resistance to aminoglycosides, carbapenems, and cotrimoxazole declined.

In 2016-2019, Brazil faced the most important yellow fever (YF) outbreak in recent decades. In 2019, cases were concentrated in Ribeira Valley, in the southeast region of Brazil, and largely affected rural Quilombola communities, which can trace their origins to escaped, freed, or abandoned slaves in the mid-1800s, and which traditionally practice subsistence agriculture. We aimed to explore aspects of the YF outbreak and vaccination from the perspective of the Quilombola communities. This was a cross-sectional descriptive study conducted in two Quilombola communities in Ribeira Valley (Sapatu and Nhunguara), using an interviewer-administered questionnaire that included both closed and open-ended questions. Thematic reflective analysis principles were applied for qualitative analysis. We adopted a theoretical domains framework to identify and categorize reported facilitators and barriers to YF vaccination. A total of 226 participants were enrolled: 46% male, median age 44 years. Eighty participants reported acute illness during the outbreak; fever, headache, myalgia, and nausea were the most common symptoms. Only eight participants reported laboratory-confirmed YF. Almost all participants (96.5%) reported YF vaccination. Less than two-thirds of the participants were vaccinated before the first case in the Ribeira Valley; over a third were vaccinated after the death of a community leader. The themes were: concerns about the vaccine, difficulty in accessing healthcare, perception of disease risk, knowledge about disease severity, cultural beliefs, and influence of leaders. The outbreak in the Ribeira Valley may have been averted with an understanding of the vaccination decision-making process, influenced by individual, sociocultural, and contextual factors.