American Journal of Tropical Medicine and Hygiene最新文献

Anemia in pregnancy, defined by a hemoglobin level (Hb) of less than 110 g/L, contributes to infant mortality and morbidity in sub-Saharan Africa. Maternal Hb changes physiologically and pathologically during pregnancy. However, the impact of these changes on long-term child neurocognitive function is unknown. This study therefore investigates the association between Hb at specific antenatal care visits and prenatal Hb trajectories during pregnancy and long-term child neurocognitive function. We analyzed data from a prospective cohort study that included 6-year-old singleton children born to women enrolled before 29 weeks of gestation into an antimalarial drug clinical trial. Hemoglobin level was analyzed from venous blood collected at least twice during pregnancy and at delivery. We used group-based trajectory modeling to identify distinct prenatal Hb trajectories. In total, 478 children (75.1% of eligible children) had assessment of cognitive and motor functions at 6 years of age. Three distinct Hb trajectories were identified: persistently anemic (Hb <110 g/L throughout the second and third trimesters), anemic to nonanemic (Hb <110 g/L at second trimester with increasing Hb toward the third trimester to Hb ≥110 g/L), and persistently nonanemic (Hb ≥110 g/L throughout the second and third trimesters). Children of women in the persistently anemic and anemic-to-nonanemic groups had significantly lower neurocognitive scores than children of women in the persistently nonanemic group (β = -6.8, 95% CI: -11.7 to -1.8; and β = -6.3, 95% CI: -10.4 to -2.2, respectively). The study shows that maintaining an elevation of Hb at or above 110 g/L from the second to third trimester of pregnancy may be associated with optimal long-term child neurocognitive function.

Malaria remains a significant public health concern in Madagascar. The WHO recommends using parasitological methods to confirm Plasmodium infection before treatment. This study evaluated the performance of two rapid diagnostic tests (RDTs), Bioline™ Malaria Ag Pf/Pan (Abbott Point of Care, Princeton, NJ) and Bioline™ Malaria Ag Pf/Pv (Abbott Point of Care, Princeton, NJ), compared with microscopy and polymerase chain reaction (PCR) as reference methods. A prospective, diagnostic performance study was conducted in two malaria-endemic districts with different epidemiological contexts: Ifanadiana (Plasmodium falciparum [P. falciparum] transmission) and Mandoto (Plasmodium vivax transmission). Symptomatic patients and asymptomatic individuals aged 3-81 years were enrolled between April and July 2023. Finger prick blood samples were used for RDTs, Giemsa-stained blood films, and molecular analysis. Among 675 participants (401 symptomatic, 274 asymptomatic), the performance for detecting P. falciparum and non-falciparum/vivax malaria in symptomatic patients for Bioline™ Malaria Ag Pf/Pan was 96.5% (95% CI: 93.4-98.4%) and 91.5% (95% CI: 82.5-96.8%) sensitivity and 76.0% (95% CI: 64.7-85.1%) specificity, and the performance for Bioline™ Malaria Ag Pf/Pv was 95.0% and 91.5% sensitivity and 76.0% specificity. In asymptomatic individuals, the performance was 90.3% (95% CI: 83.4-95.0%) and 33.3% (95% CI: 4.3-77.7%) sensitivity and 85.4% (95% CI: 78.9-90.6%) specificity for Bioline™ Malaria Ag Pf/Pan and 80.6% (95% CI: 80.1-93.1%) and 0% (95% CI: 0-84.2%) sensitivity and 86.0% (95% CI: 79.7-91.0%) and 86.1% (95% CI: 79.7-91.0%) specificity for Bioline™ Malaria Ag Pf/Pv. Rapid diagnostic test performance varies with local epidemiology in symptomatic patients. The results emphasize the need for careful consideration of RDT use based on local epidemiology and clinical context. Both RDTs could be used when microscopy and PCR are unavailable.

The viral hemorrhagic fevers Lassa fever (LF) and Ebola virus disease (EVD) have been documented to cause long-term health problems in survivors. Limited studies have noted the presence of adverse reproductive health outcomes, including menstrual irregularities and pregnancy loss, after recovery from infection. The objective of this systematic review and meta-analysis is to summarize existing knowledge surrounding reproductive health in female survivors of LF and EVD. Literature was gathered from PubMed, Embase, Ovid Medline, Cumulative Index of Nursing and Allied Health (CINAHL) Complete, Web of Science, and Global Health databases and subsequently reviewed in Covidence. Included studies described at least one reproductive health outcome in women after recovery from EVD or LF. Thirteen studies were identified in the systematic review, all of which only discussed reproductive health in EVD survivors. No studies of reproductive health among survivors of LF were identified. The included studies were conducted in Guinea, Sierra Leone, and Liberia, and they reported irregular menstruation, pregnancy loss, decreased libido, pelvic inflammatory disease, sexual dysfunction, female reproductive odor, and genital problems/infections among survivors. In a meta-analysis of nine studies, 14.0% of female EVD survivors experienced any adverse reproductive health outcome. However, there was significant heterogeneity among the included studies. This study highlights the health problems faced by female EVD survivors and underscores the need for more research surrounding the effects of viral hemorrhagic fevers on women's health.

Mycetoma is a granulomatous disease of subcutaneous tissue that is caused by different species of aerobic filamentous bacteria (actinomycetoma) or fungi (eumycetoma). Mycetoma treatment depends on the causative pathogen, and it mainly consists of antimicrobial interventions or surgery. Aspergillus terreus is an etiologic agent of invasive aspergillosis and a rare cause of eumycetoma that is common in central and southern China. The present case report describes a 45-year-old female patient with subcutaneous swelling and multiple active and healed sinuses over the dorsal aspect of the left foot who was diagnosed with eumycetoma caused by A. terreus. This is the first such case reported in China. We applied a combination treatment consisting of itraconazole with topical luliconazole cream and radiofrequency microneedling, and this was followed by significant regression of the lesion. In addition, we reviewed the current literature to summarize the epidemiological characteristics of mycetoma in mainland China and cases of eumycetoma caused by A. terreus worldwide.

Qualitative research methods are central to understanding many public health problems. However, capacity building for qualitative research is globally skewed toward high-income countries, with a significant skills deficit in low- and middle-income countries (LMICs). To address this imbalance and provide a model program, we developed the Qualitative Research Leaders (QRL) program, a pipeline program to increase qualitative research capacity in LMIC institutions and foster leadership in qualitative research. The QRL program is a collaboration between Emory University and Vanderbilt University in the United States and two LMIC institutions Kilimanjaro Christian Medical College in Tanzania and the Public Health Foundation of India. The program had five phases conducted over 12 months: 1) mentored study design sessions, 2) an in-country skill-building workshop, 3) mentored proposal development sessions, 4) a residential grant writing program in the United States, and 5) mentor matching for field implementation. Program evaluation results showed that the QRL program was effectively designed, and scholars valued the program components, learning formats, and session content. The program increased scholars' knowledge, skills, and confidence as mentors in qualitative research. Furthermore, scholars demonstrated leadership in initiating postprogram research, mentoring, and teaching in qualitative research. Overall, scholars felt that the program could be extended to enable more time to internalize new knowledge and develop skills, and the role of in-country mentors could be expanded to further support scholars during fieldwork. In this article, we describe the components of the QRL program and its implementation, results of our program evaluation, and lessons learned for developing similar pipeline training programs.

As many as one in three people worldwide have anemia, with young children at increased risk of both disease and complications. In settings without clinical laboratories, portable hemoglobinometers serve important roles in diagnosing anemia and estimating prevalence. Here, we assess the validity of two such point-of-care devices-the HemoCue Hb201 and the HemoCue Hb301-relative to the international reference standard, the cyanmethemoglobin method. In total, 428 children ages 6-60 months were recruited at health posts in Lima, Peru, and venous and capillary blood samples were collected from each participant. Venous blood was assessed with the cyanmethemoglobin method, whereas capillary blood was assessed using the Hb201 and the Hb301; 16.1% of participants were found to have anemia using the cyanmethemoglobin method. Both the Hb201 (43.7%) and the Hb301 (20.6%) overestimated this prevalence, with the former reaching statistical significance (P <0.0001 and P = 0.11, respectively). Both devices also tended to underestimate hemoglobin concentration, with the Hb201 (mean difference = -0.99 g/dL; percentage error = -8.1%) being appreciably less accurate than the Hb301 (mean difference = -0.35 g/dL; percentage error = -2.7%). Areas under the curve for the Hb201 (0.92) and the Hb301 (0.93) were statistically similar (P = 0.28); however, the Hb201 incorrectly classified 29.4% of participants compared with 11.0% for the Hb301. Both devices had more false positives than false negatives. In conclusion, the Hb301 was found to be significantly more accurate than the Hb201 at measuring hemoglobin, diagnosing anemia, and estimating anemia prevalence.

Methylobacterium populi is a fastidious, pink-pigmented, Gram-negative bacterium that has been isolated from poplar trees that are found throughout the Northern Hemisphere in both temperate and subtropical regions. Herein, we report a novel case of M. populi peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD). A 45-year-old Japanese man with a history of hypertension and chronic kidney disease was diagnosed with CAPD-associated peritonitis. After starting broad-spectrum antibiotics, white blood cell (WBC) count in the CAPD effluent remained elevated. On day 7, the CAPD effluent grew Gram-negative vacuolated rods identified as M. populi using 16S ribosomal RNA gene sequences. After the treatment regimen was changed to intraperitoneal gentamicin, the WBC count in the CAPD effluent decreased, and the clinical features improved. Although infection with M. populi is rare, clinicians should advise patients on CAPD to avoid contact with poplar trees and provide training on adherence to CAPD exchange protocols, including hand hygiene.

Stingray injury is common in temperate and tropical waters worldwide. The majority of injuries are minor and can be managed with simple first aid at the shoreline; however, serious complications can occur. We report a case of Vibrio alginolyticus wound infection, retained foreign body, and posterior tibial artery pseudoaneurysm after stingray envenomation in a returning traveler. The patient presented with severe pain and dysesthesia associated with a puncture wound in the left lower leg 1 week after injury in Seychelles. Clinician awareness of infection and trauma-related complications of stingray and other penetrating marine injuries is important.

The rise in COVID-19 cases in late 2021 posed a grave threat to the public health system and the economy of Jamaica. A key pillar of controlling COVID-19 includes rapid diagnosis of SARS-CoV-2 infected individuals and their contacts. Hence, we evaluated the feasibility and acceptability of weekly deployment of antigen rapid diagnostic tests (Ag-RDTs) by conducting three 6-week studies within high-risk populations in Jamaica. We enrolled 1) 287 study participants (≥18 years) from low-income communities (Study A), 2) 262 healthcare workers (Study B), and 3) 88 students (14-17 years) (Study C). Conducting these independent studies was challenging. Willingness to participate was generally low with fear of phlebotomy (42%), discomfort associated with nasal swab (39%), and lack of parental consent (35%) being the most common reasons students gave (Study C) for lack of participation. Furthermore, only 57%, 66%, and 88% of participants concluded their final study visit in studies A to C, respectively. Participants' commitment and external factors, such as severe weather and outbreaks of violence affected follow-up. Overall, a total of six participants (<1%) tested COVID-19 Ag-RDT positive during all three studies, thus the number of infections detected were too low to draw any conclusions relating to the efficacy of the testing approach. Antibodies against SARS-CoV-2 were detected in most study participants (78-94%), but vaccination rates differed significantly between communities. Understanding these differences in vaccination rates is important because, given the low participation and follow-up rate, mass vaccination may present a more suitable public health intervention than regular testing.

Ralstonia species are recently emerging as pathogens of human importance. This study was performed to assess the distribution of Ralstonia species among bacteremia patients and the clinical and demographical factors of these patients. This retrospective observational study was performed in the Microbiology Department of a tertiary care center in North India from April 2022 to April 2024. All in-patients with blood cultures positive for Ralstonia species for the first time during the study period were included in the study. Positive blood cultures were inoculated on blood and MacConkey agar. Identification was done by matrix-assisted laser desorption ionization-time of flight mass spectrometry, and antibiotic sensitivity testing was determined by disc diffusion assay. During the study period, 26 isolates of Ralstonia species were identified. R. mannitolilytica was the predominant isolate, followed by R. pickettii. Most patients with Ralstonia bacteremia belonged to the age group of <60 years (n = 20; 78%). The median age of the study population was 62 years. The male-to-female ratio was 1.6:1. Most of the patients presented with complaints of fever (77%), followed by epigastric pain (38.4%). Among the underlying comorbidities, most of the patients with Ralstonia bacteremia had sepsis (73%), followed by multiorgan dysfunction syndrome (30.7%). None of the R. mannitolilytica isolates showed sensitivity to imipenem, meropenem, aztreonam, and ceftazidime. On comparing both the isolates, R. pickettii showed better sensitivity to amikacin, imipenem, meropenem, aztreonam, and ceftazidime than R. mannitolilytica. Overall mortality of the patients in the study was 22% (n = 6).