American Journal of Tropical Medicine and Hygiene最新文献

Gram-negative pathogens are notable causes of diverse human infections. This study determined the antibiotic sensitivity profile of clinical isolates of gram-negative bacteria to provide insights into high-priority pathogens that are potential threats to public health in Ghana. Gram-negative isolates from urine, stool, wound, and blood samples of consenting participants were tested against 10 antibiotics using the Kirby-Bauer disc diffusion method. Escherichia coli and Klebsiella pneumoniae were the predominant bacteria isolated from the study participants. Resistance to colistin (4%) and meropenem (20%) was less prevalent, whereas isolates resistant to ampicillin (94%), tigecycline (85.5%), and chloramphenicol (76%) were widespread in the study participants. Acinetobacter baumannii exhibited the highest resistance phenotype among the clinical isolates of Gram-negative bacteria. Our data highlight the ineffectiveness of tigecycline, ampicillin, and chloramphenicol against several gram-negative pathogens isolated from the study participants. The utilization of meropenem and colistin should be strongly monitored to avoid misuse because they represent effective antibiotics for treatment of gram-negative infections.

Post-discharge mortality (PDM), defined as deaths that occur in the weeks and months after hospital discharge, remains a critical, yet under-recognized, contributor to high childhood mortality rates in sub-Saharan Africa. However, a comprehensive understanding of effective interventions to prevent PDM is lacking. The aim for the present study was to evaluate the efficacy of published interventions to prevent PDM among neonates and children aged 0-18 years in sub-Saharan Africa. A systematic review was conducted to assess the efficacy of interventions for preventing PDM. The CABI Global Health, Cochrane Reviews, Cochrane Trials, ProQuest Dissertations and Theses, Embase, PubMed, and Web of Science databases were searched without language restriction. Publications that involved interventions for preventing PDM, included children, and were conducted in sub-Saharan Africa were included in the present study. Of 4,893 publications screened, 17 were included, with 12,938 participants in total (10.6% experienced PDM). The most common interventions included supplemental feeding programs, kangaroo mother care, antibiotic use, and micronutrient supplementation. Effectiveness varied within and between intervention types. Only two interventions resulted in statistically significant reductions in PDM: vitamin A supplementation for children with pneumonia (hazard ratio: 0.51; 95% CI: 0.29-0.90; low quality of evidence) and linkage to services for children with sickle cell disease (adjusted hazard ratio: 0.26; 95% CI: 0.08-0.83; low quality of evidence). No single intervention type provided consistent benefits across studies. Most interventions targeted children with specific diagnoses; however, some strategies addressed social determinants of health. Future research must prioritize cost-effective, scalable strategies across diverse sub-Saharan African settings to accelerate the prevention of PDM among children.

Scrub typhus, caused by Orientia tsutsugamushi, is a mite-borne infection endemic to Asia, the Pacific Islands, and northern Australia. This study reports the first detection of O. tsutsugamushi DNA in postmortem specimens from stillbirths and neonatal deaths collected through the CHAMPS surveillance project from 2017 to 2024 in Bangladesh. O. tsutsugamushi DNA was detected in 11 cases including 1.7% of stillbirths (n = 461) and 0.7% of neonates (n = 443). Ninety percent of these deaths occurred between August and January; among stillbirths, detection was highest in cerebrospinal fluid samples (87.5%). Most stillbirths were preterm (75%) with low birth weight (87.5%), and maternal history of fever was recalled in 83.3% of stillbirth cases. These findings suggest scrub typhus may contribute to perinatal mortality in Bangladesh's endemic regions. Scrub typhus is treatable with inexpensive antibiotics such as doxycycline; early recognition and treatment could potentially reduce stillbirths and neonatal deaths in endemic areas.

We evaluated health care-seeking behavior among dengue patients in Puerto Rico (PR) before (January 1, 2014-March 31, 2020) and after (April 1, 2020-February 28, 2023) the COVID-19 outbreak declaration in PR ("after COVID-19") and calculated age-adjusted odds ratios of illness duration at presentation and hospitalization rates. A total of 70 and 185 patients with dengue were identified before and after COVID-19 began respectively. Dengue virus 1 (DENV-1) was the most common dengue serotype (89%) identified in both periods. The median age of patients with dengue was higher after COVID-19 (18, interquartile range [IQR]: 12-32 years) than before (14, IQR: 7-22 years). A higher proportion of patients presented >3 days post illness onset after COVID-19 (66%, n = 123) in comparison with before (49%, n = 34) (OR = 1.16; 95% CI: 1.02-1.33). These findings indicate that the COVID-19 outbreak may have affected health care-seeking behavior among patients with dengue in PR, delaying care and potentially negatively affecting patient outcomes.

Human brucellosis remains a neglected zoonosis with global distribution and diverse clinical manifestations. This report describes a case of brucellar spondylodiscitis in a 35-year-old female patient from Syria, residing in Brazil for seven years, with a history of brucellosis diagnosed and treated two decades earlier. The patient presented with chronic back pain, headache, and left upper limb discomfort, with no fever or weight loss. Magnetic resonance imaging revealed a pathological fracture of the T8 vertebral body. Histopathological examination showed a chronic granulomatous inflammatory process with fibrosis and focal necrosis, first treated as bone tuberculosis. After laboratory confirmation of brucellosis, the patient was treated with amikacin, rifampicin, and doxycycline for nine months, showing clinical, radiological, and laboratory improvement. This case highlights the importance of considering brucellosis as a differential diagnosis for spondylodiscitis, even many years after initial infection, especially in patients with relevant epidemiological history.

In low- and middle-income countries, informal healthcare providers are often the first point of contact for pediatric care. The present qualitative study, conducted in Bangladesh, was designed to explore why parents seek pediatric care from informal providers. Through in-depth interviews with 12 parents of children under 5 years of age, key drivers for visiting informal providers were identified, including geographic and financial accessibility, as well as trust and familiarity. Parents expected informal providers to offer them informed and effective treatment but did not have a clear understanding of evidence-based treatment of pediatric diarrhea. Although informal providers may meet families' immediate needs, they can also undermine formal healthcare visits and follow-ups that are essential to supporting children's long-term health. The study findings highlight the need for targeted health education to improve parents' knowledge, awareness, and informed decision-making. Strengthening trust in formal providers and addressing accessibility barriers is essential to improving pediatric health outcomes in low-resource settings.

This study aimed to investigate the impact of common polymorphisms in key cytochrome P450 (CYP) genes (CYP2C8, CYP2C9, CYP2C19, CYP2D6, and CYP3A5) on drug levels and treatment responses in Plasmodium vivax-infected patients treated with chloroquine (CQ) and primaquine (PQ). CYP2C8 and CYP3A5 are the key enzymes that metabolize CQ, whereas CYP2D6, CYP2C9, and CYP2C19 are those that metabolize PQ. A total of 99 DNA samples from Burmese patients with microscopically confirmed P. vivax monoinfection, who received standard doses of CQ (25 mg/kg) and PQ (15 mg/kg/day for 14 days), were included for genotyping of CYP polymorphisms using polymerase chain reaction-restriction fragment length polymorphism assays. The relationship between CYP polymorphisms and patients' clinical outcomes and drug level data was assessed. All patients achieved complete parasite clearance and resolution of fever without recurrence. The most frequent alleles were CYP3A5*3 (71.7%) and CYP2D6*10 (30.6%). The CYP3A5*3 variant was significantly associated with altered desethylchloroquine levels, whereas CYP2C19*3 was associated with faster parasite clearance. No significant associations were found between CYP2D6 or CYP2C8 variants and PQ levels or clinical efficacy. Notably, a patient homozygous for CYP2D6*4 (a poor metabolizer) responded successfully to treatment, suggesting the presence of alternative or compensatory metabolic pathways. Despite a high prevalence of reduced-function CYP variants, CQ-PQ therapy was effective in all patients, indicating that genetic polymorphisms may influence drug metabolism without compromising clinical outcomes. Nevertheless, CYP3A5*3 and CYP2C19*3 variants appear to modulate drug pharmacokinetics and parasite clearance kinetics. These findings underscore the importance of pharmacogenetic surveillance to optimize antimalarial therapy, particularly in elimination settings.

The WHO has listed snakebite envenomation as a neglected tropical disease. In Southeast Asia, the highest recorded incidence is 162 deaths per 100,000 population per year in the eastern Terai of Nepal. Education is an effective method to raise awareness among community people about snakebite prevention. The main objective of this study is to assess the knowledge regarding snakebite prevention among the community members of Kawaswoti Municipality Ward-08. A cross-sectional study was carried out from September 2022 to October 2022. Of 2,000 households, 323 samples were taken using convenience sampling technique. The median age was 42 years with interquartile range of 17, and the minimum/maximum age was 20/72 years. The majority of people identified locally occurring snakes. The overall knowledge regarding snake bite was unsatisfactory in nearly half of the population, but knowledge about prevention measures was high. More than two-thirds of the study participants recognized tourniquet application as appropriate first-aid treatment of snakebite, which is not the recommended practice at present; only 33.7% reported knowing the correct way to actually use tourniquets. There was a significant association between level of snakebite treatment or prevention knowledge and education levels. Hence, to develop culturally appropriate social and behavioral change strategies tailored to different population subgroups, considering variations in literacy levels and vulnerabilities, there is a need to understand current and local knowledge of members of the community.

Babesiosis is a tick-borne protozoan infection often caused by Babesia microti. Symptomatic babesiosis typically presents as a malaria-like syndrome; however, it may result in more serious presentations, including sepsis. Immunosuppression is a known risk factor for severe babesiosis; however, limited data exist on additional predictors of sepsis. The aim for the present study is to identify predictors, complications, and outcomes of babesiosis sepsis. Using the TriNetX research database, adults who had polymerase chain reaction-confirmed babesiosis between June 2010 and May 2024 were identified. Demographic, clinical, and outcome data were analyzed. Sepsis was defined using International Classification of Diseases, 10th Revision, codes. Among 1,566 patients identified, 159 (10.2%) developed sepsis. Sepsis was associated with female sex, older age, and predominantly cardiac or renal comorbidities. Complications of babesiosis sepsis included acute kidney injury, shock, and hemolytic anemia. Patients with sepsis had higher 30-day, 90-day, and 1-year mortality rates. Specific demographics and the presence of cardiac or renal comorbidities may be associated with increased disease severity.

Rare cases of aphthous ulceration and eosinophilic enteritis in humans caused by Ancylostoma caninum (A. caninum), a common intestinal nematode of dogs worldwide, have been reported over the past century in several regions of the world. The present report involves a case of aphthous ulceration of the colon caused by A. caninum in Western Australia. The identity of the worm recovered during routine colonoscopy of a 35-year-old immunocompetent male was confirmed via morphological analysis and sequencing of the mitochondrial cytochrome c oxidase subunit I gene and nuclear ribosomal internal transcriber spacer II region. A summary of this case and previous reports of human A. caninum intestinal infection is provided. Intestinal infection with A. caninum is likely an underdiagnosed zoonosis in tropical and temperate regions worldwide. Further epidemiological studies and increased clinical awareness of zoonotic hookworms in humans are warranted to clarify the prevalence and significance of A. caninum infection in human hosts.