American Journal of Tropical Medicine and Hygiene最新文献

Dengue is a viral disease with a broad spectrum of clinical manifestations. Its severity is associated with risk factors such as periods of endemicity, although the extent of this contribution is unclear. In the present study, the characteristics of the clinical course and differences in the occurrence of severe and lethal outcomes were assessed by the degree of endemicity in patients with dengue treated in health institutions in Cali, Colombia, between 2019 and 2022. A longitudinal, observational-historical, single-cohort study was conducted. Analysis involved evaluating clinical complications during epidemic and endemic periods. Mortality, cumulative incidence of hospital or intensive care unit (ICU) admission, and survival time were estimated using the competing risks method. A total of 1,038 dengue cases were included. Patients with severe dengue and those with warning signs (WS) were consulted up to 6 or 5 days after symptom onset, respectively. A hospital stay of 2.0 days (Quartile [Q]1-Q3: 2-4 days) and an ICU stay of 4.5 days (SD ± 3.9 days) were estimated. A mortality rate of 5.5% was obtained for severe dengue, and a mortality rate of 0.4% was identified for patients with WS. In 2020 and 2021, the probability of hospitalization was 20% from initial contact. The likelihood of dying within 10 days after initial contact was 0% in 2019 and 11.2% (95% CI: 4.0-22.5%) in 2020. The incidence of hospitalization, number of hospital days, and ICU stays due to dengue varied by epidemiological year in a high-endemicity area. The probability of severe and lethal clinical outcomes was higher during 2020 and 2021.

Severe febrile illness (SFI), a major cause of child mortality in Sub-Saharan Africa (SSA), is frequently caused by bloodstream infections (BSI), increasingly caused by antimicrobial-resistant organisms. However, antimicrobial resistance (AMR) prevalence and patterns in this population are largely unknown. We conducted a prospective cohort study of children aged 28 days to 14 years with SFI at a referral hospital in Tanzania (July 2022-September 2023) to determine the prevalence, pathogen profile, and AMR patterns of BSIs. Blood cultures were performed on all participants. Isolates underwent AMR testing and whole genome sequencing (WGS) to identify AMR genes and assess genetic relatedness. The association between BSI and mortality was assessed using logistic regression. Among the 392 enrolled children (median age 17.8 months), 5.2% (n = 20) had culture-confirmed BSI, with a case fatality rate of 45%. Gram-negative bacteria predominated (Escherichia coli, Klebsiella pneumoniae), with 79% of isolates exhibiting phenotypic resistance to ceftriaxone, a first-line antimicrobial. WGS revealed extended-spectrum β-lactamase genes (CTX-M-15, CTX-M-27) in most Enterobacterales isolates and identical isolates among 2/4 patients with Streptococcus pneumoniae and 2/3 Candida albicans infections. Children with BSI had significantly higher mortality than those without BSI (adjusted odds ratio 3.9; 95% CI: 1.5-10.1, P <0.01). These findings emphasize the urgent need for expanded AMR surveillance systems, empiric antibiotic regimens tailored to local AMR patterns, and culture-independent diagnostics in SSA. These data are critical for understanding the cause of severe infection and have the potential to guide policy aimed at reducing child mortality from BSI.

Mother-to-child transmission of Trypanosoma cruzi, the parasitic cause of Chagas disease, occurs in 5-10% of affected pregnancies. Congenital infection is usually asymptomatic, so if maternal infection is not suspected, the affected newborn may go undetected. As detection and antiparasitic treatment in early life result in much higher cure rates than treatment later in life, it is important to explore opportunities for catch-up testing of children born to women found to have T. cruzi infection. We piloted a multidisciplinary adult-pediatric disease referral pathway and developed a clinic to screen children of women diagnosed with Chagas disease. We evaluated the impact, acceptability, and patient experience of the pathway, including exploration of barriers to accessing prior testing. Of the 28 referred children, 23 (82%) attended the clinic, 22 (79%) were tested, and 1 child was diagnosed with congenital infection. The service was deemed effective and beneficial by both healthcare professionals and parents.

Rheumatic manifestations are the third most common clinical features of Hansen's disease (HD), after cutaneous and neurological involvement. However, few studies have systematically characterized these manifestations, and most lack appropriate controls and standardized assessments. To address this gap, the present cross-sectional study was conducted to evaluate the rheumatic manifestations associated with HD. The study included 23 patients with HD and 23 age- and sex-matched non-HD controls from Puerto Rico. All participants underwent a standardized evaluation and examination for rheumatic features. Demographic data, clinical manifestations, comorbidities, and pharmacologic treatments were documented. Statistical analyses were performed using bivariate methods. The mean (SD) age of HD patients was 51.3 (15.7) years, and 60.8% were female. Regarding treatment status, 8.7% had received <1 year of multidrug therapy (MDT), 8.7% had received at least 1 year of MDT, and 82.6% had completed therapy. Overall, 87% of HD patients presented with rheumatic manifestations, most commonly arthralgia (73.9%) and arthritis (69.6%). Compared with controls, HD patients exhibited a significantly higher proportion of arthritis, particularly involving the small joints of the hands, as well as tendinopathy, dactylitis, and swollen hand and foot syndrome. These manifestations were significantly associated with leprosy reactions and multibacillary disease. In conclusion, rheumatic manifestations were present in 87% of HD patients, with several being significantly more frequent than in controls. Moreover, a substantial proportion of patients continued to experience persistent rheumatic manifestations despite receiving or completing MDT. Given their potential to substantially impair functional status, these manifestations should be recognized early to ensure timely and appropriate management.

Human infection with non-aeruginosa Pseudomonas (NAP) is not commonly observed but can be severe and associated with significant morbidity and mortality. The aim for the present study was to investigate the prevalence, patient characteristics, risk factors, and clinical presentation of patients with NAP bacteremia. Additionally, the antibiotic sensitivity patterns of NAP isolates were assessed. The current retrospective study was conducted in the microbiology laboratory of a tertiary care center from January 2022 to October 2024. Two sets of blood cultures were received in BACTEC bottles (Becton, Dickinson and Company, Franklin Lakes, NJ) and were incubated. The blood samples were cultured on blood and MacConkey agar, and microscopy was performed using Gram staining. Species identification was performed via matrix-assisted laser desorption ionization time-of-flight mass spectrometry. Antibiotic sensitivity testing was performed using meropenem, colistin, levofloxacin, amikacin, piperacillin-tazobactam, imipenem, aztreonam, ceftazidime, and cefoperazone-sulbactam. During the 2-year study period, 42 blood cultures grew Pseudomonas species other than Pseudomonas aeruginosa. The majority of patients were <60 years of age (76.1%). The age range of the population was 4-75 years. The male-to-female ratio of the population was 1.1:1. In this study, most isolates belonged to Pseudomonas mosselii (n = 13; 31%), followed by Pseudomonas stutzeri (n = 11; 26.1%), Pseudomonas putida (n = 9; 21.4%), Pseudomonas fluorescens (n = 5; 11.9%), and Pseudomonasalcaligenes (n = 3; 7.1%). The most common risk factors were the presence of a central venous catheter (n = 34; 81%) and mechanical ventilation (n = 25; 59.5%). Among the Pseudomonas mosellii isolates, the highest resistance was observed to meropenem (70%), imipenem (70%), and ceftazidime (70%). Timely diagnosis and treatment can help in reducing mortality and morbidity among NAP bacteremia patients.

Pediatric patients with tuberculosis who are not infected with HIV may still be at risk of developing tuberculosis-immune reconstitution inflammatory syndrome (TB-IRIS) during treatment. A case of TB-IRIS in an immunocompetent child with pulmonary tuberculosis is reported. On the 25th day of standard antituberculosis therapy, the patient experienced continuous fever and clinical deterioration, and new lesions were detected on follow-up radiographic imaging. Upon initiation of corticosteroid therapy, the patient showed marked clinical improvement and resolution of fever. This case highlights the importance of recognizing TB-IRIS in immunocompetent pediatric patients. After alternative causes are excluded, TB-IRIS should be suspected in children with tuberculosis who develop new or worsening symptoms accompanied by newly emerging radiological findings.

In Ghana, neonatal deaths account for >60% of infant deaths. Few studies have focused on umbilical cord care in Ghana's urban slums. This paper examines newborn cord care practices among mothers in two large urban slums in Accra, and the data come from a concurrent mixed-methods cross-sectional study. A quantitative survey was conducted among 279 randomly sampled mothers ages 15-49 years with live neonates. The qualitative component was conducted among women ages 15-49 years with live neonates, traditional birth attendants, community leaders, and public health managers who were purposively sampled. Descriptive analyses were used to describe cord care practices. Bivariate and multiple logistic regression analyses assessed factors associated with cord care practices at the 95% confidence level (CI). Qualitative data were analyzed thematically. Overall, the prevalence of appropriate cord care practices was low (28.3%). Despite a policy shift from the use of methylated spirit to chlorhexidine, >81% of mothers reported using methylated spirit for cord management. The adjusted odds of newborns receiving appropriate cord care (AOR: 2.82; 95% CI: 1.13-7.07; P = 0.027) were significantly greater among mothers who had skilled deliveries than among deliveries involving unskilled attendants. Mothers residing within a radius of 3-5 km of the nearest facility were more likely than those living within a 1-2 km radius (AOR: 2.34; 95% CI: 1.14-4.77; P = 0.020) to practice appropriate cord care. Improving cord care in slums requires strengthening antenatal care services and skilled delivery.

Timely access to reliable public health data is a critical determinant of effective response to health emergencies, including disease outbreaks, climate-related health shocks, and humanitarian crises. Although artificial intelligence (AI) has been promoted for its potential to enhance outbreak prediction, situational awareness, and resource allocation, its effectiveness depends on the speed, quality, and accessibility of underlying data systems. Inequities in digital infrastructure, particularly in low- and middle-income settings, undermine prompt public health data management and in turn weaken emergency response capacity. With examples from epidemics, climate-related health emergencies, and conflict-affected settings in and beyond the Middle East, we examine how delays arise across public health data transmissions that include reliance on paper-based data collection, fragmented and incompatible databases, linguistic barriers in non-English data processing, dependence on externally hosted cloud infrastructure, and vulnerability to telecommunications shutdowns. Geographical concentration of data centers in high-income regions compounds these challenges by introducing latency into time-critical data processing and limiting local control over surveillance and analytics. Case studies from Yemen, Iraq, Sudan, and regional refugee responses illustrate how such delays erode surveillance data operational value, rendering early warning systems reactive rather than anticipatory. In contrast, settings with locally hosted, interoperable, and resilient digital infrastructure demonstrate the capacity for nearly immediate analysis and faster public health action. AI should be understood not as a standalone solution but as a downstream tool within a broader public health data ecosystem. Strengthening local digital infrastructure and governance is thus essential for timely, equitable, and effective public health emergency management.

Urinary tract infections (UTIs) are a global health concern exacerbated by rising antimicrobial resistance (AMR), especially in developing countries where empirical therapy is common. Untreated UTIs can progress to sepsis with a poor prognosis. Understanding local AMR profiles of uropathogens is crucial for effective UTI treatment. This study aimed to identify the predominant uropathogens and determine their AMR profiles against a range of commonly used antimicrobials. This study was a 5-year retrospective cross-sectional surveillance study conducted on urine cultures processed from January 1, 2020 to December 31, 2024 at the University Teaching Hospital of Kigali. In total, 2,921 positive urine cultures and their antimicrobial susceptibility testing results were recorded and analyzed by pathogen and across care settings. Descriptive statistics were used to summarize the data. Associations were evaluated at a 5% significance level. This study found that among 2,921 isolates, Escherichia coli (64%) and Klebsiella pneumoniae (22.9%) were the predominant uropathogens. High resistance rates were observed against commonly used antibiotics, such as amoxicillin-clavulanic acid (>88%), third-generation cephalosporins (51-75%), and fluoroquinolones (∼55%) in both species, with K. pneumoniae showing a more extensive resistance profile. Conversely, the isolates were less resistant to carbapenems (imipenem and meropenem) and amikacin (<20%) across care settings. The findings reveal a significant burden of multidrug-resistant gram-negative pathogens at the University Teaching Hospital of Kigali, underscoring the urgent need for enhanced antimicrobial stewardship and sustained surveillance. Such measures are essential to preserve the efficacy of critical antibiotics, particularly carbapenems and aminoglycosides, and to guide effective clinical management.