American Journal of Tropical Medicine and Hygiene最新文献

Minimally invasive tissue sampling (MITS) has been used as an alternative to complete autopsy to track causes of death (CoDs) in South Asia and sub-Saharan Africa as part of the Child Health and Mortality Prevention Surveillance program. However, community acceptance, rapid identification of deaths, and adequate functional laboratory infrastructures (e.g., pathology, conventional microbiology, and molecular microbiology) are critical for successful implementation. We describe the experience of implementing MITS in an urban district with socioeconomic and cultural diversity in Zambézia Province, central Mozambique. For successful implementation of mortality surveillance using MITS, high-level advocacy involving the Provincial Government and all stakeholders as well as engagement and sensitization of all segments of the communities, including traditional healers, community leaders, and mass media, were critical for the acceptability of the procedure. Additionally, social and behavior studies were conducted to assess perceptions, sociocultural factors, acceptability, and feasibility of the MITS procedure. These studies helped adapt the MITS protocol to the local context to minimize the risk of misunderstanding the mortality surveillance using MITS procedures. There was significant investment in capacity building, including financial support for laboratory equipment acquisition and maintenance, reagents, and consumables required for microbiological screening protocols of MITS and to support the needs for diagnostics of patients with severe disease seeking care. Experiences from Quelimane and other sites and data generated in the Countrywide Mortality Surveillance for Action to support evidence-based decision-making processes on health policy were critical for the community to understand the benefit of determining young children CoD to guide future interventions.

The long-term cognitive consequences of calcified neurocysticercosis (NCC) remain poorly understood. This population-based study investigates cognitive trajectories in individuals with calcified NCC in coastal Ecuador. Utilizing repeated Montreal Cognitive Assessment (MoCA) screenings, the study evaluates whether calcified NCC independently contributes to cognitive decline and the role of hippocampal atrophy (HA) in this context. Among 720 community dwellers ages 40 years old and older, 85 (12%) had calcified NCC. The mean interval between baseline and first follow-up MoCA was 3.27 ± 1.07 years and between baseline and second follow-up MoCA was 10.87 ± 1.22 years. Of 720 participants, 617 (86%) completed the first follow-up MoCA, and 464 (75%) of them also had the subsequent follow-up MoCA. Proportions of NCC patients included in follow-ups were consistent with their representation at baseline. Baseline MoCA scores (β: 0.40; 95% CI: -0.48 to 1.29) or rates of MoCA decline at follow-up visits (β: 0.17; 95% CI: -0.67 to 1.0) did not differ significantly between NCC and non-NCC participants after adjusting for relevant covariates. The magnetic resonance imaging substudy showed that 31 of 83 NCC cases and 40 of 283 controls had HA (adjusted odds ratio: 2.63; 95% CI: 1.15 to 4.11). Additionally, HA was significantly associated with lower MoCA scores at baseline (β: -1.86; 95% CI: -2.98 to -0.74) and follow-up (β: -2.76; 95% CI: -3.83 to -1.69). These results suggest that calcified NCC alone was not associated with cognitive decline over time. However, NCC-associated HA emerged as a major determinant of poor cognitive performance.

The footprint of melioidosis is expanding globally, but its historical roots are in Southeast Asia and northern Australia. Melioidosis has long been described in military personnel deployed to melioidosis-endemic regions; however, the magnitude of the risk has not been quantified, and the nature of infecting events remains speculative. As with infections in the endemic population, the greatest concern is for inhalational melioidosis. Soil and air at four military locations in the highly melioidosis-prevalent environment of Darwin, Northern Territory, Australia, were sampled. Burkholderia pseudomallei (B. pseudomallei) was recovered from soil in all four sites but not from air samples. Genotyping revealed four B. pseudomallei sequence types (STs), with each ST recognized in human melioidosis cases from the region. Further systematic air sampling for B. pseudomallei is required both during the monsoonal wet season and under other circumstances, including aircraft with vertical takeoff and landing capabilities, to better understand the risk of inhalational melioidosis.

Strongyloidiasis remains endemic in Okinawa, Japan; however, epidemiological data over the past 30 years are limited. This study aimed to assess the current seroprevalence of strongyloidiasis in Okinawa. We conducted a cross-sectional study at Okinawa Chubu Hospital in 2022. Serum samples from 1,485 participants were screened using an ELISA-based antibody test with the recombinant Strongyloides stercoralis antigen NIE. Seropositive participants underwent three stool examinations: the formalin-ether concentration method, agar plate culture, and real-time polymerase chain reaction. The crude seroprevalence was 3.2% (n = 47/1,485, 95% CI: 2.3-4.2%), and the age-adjusted seroprevalence was 2.4% (95% CI: 1.3-4.2%). Age 80 years old or older was a significant risk factor (odds ratio: 7.84, 95% CI: 3.59-17.2; P <0.001). This age group had 8.5% seropositivity (95% CI: 5.5-12.4%) and comprised 51.1% of all positive participants. However, five seropositive participants were ages younger than 40 years old. Of the seropositive individuals who underwent stool testing, 30.8% (n = 8/26) had positive results, and all were 70 years old or older. Despite the absence of a strongyloidiasis control program over the past 30 years, the seroprevalence has markedly declined. The shift toward older age among seropositive participants suggests that environmental transmission is now rare in Okinawa, with most infections likely acquired decades ago. Nonetheless, the persistent high endemicity among the elderly calls for continued clinical awareness of strongyloidiasis.

Ethiopia accounts for 59% of the global trachoma burden. To eliminate trachoma as a public health problem by 2030, modified mass drug administration (MDA) strategies have been proposed, including more frequent than annual MDA. In the present study, the cost of the "child MDA" (CMDA) strategy, defined as an initial community-wide MDA treatment followed by another treatment targeting children aged 6 months to 9 years, was estimated in the Lasta and Wadilla districts, Amhara, Ethiopia. A micro-costing analysis was conducted from a payer perspective, documenting the total financial and economic cost, cost per person treated, and cost per treatment. The cost per person treated was calculated by dividing the total cost by the total number of people treated during the community-wide MDA distribution. The cost per treatment was calculated by dividing the total cost by the total number of treatments distributed overall. The total financial cost of implementing the CMDA strategy in Lasta and Wadilla was $106,427, corresponding to a financial cost per person treated of $0.41 and a financial cost per treatment of $0.32. In Lasta, 168,175 treatments were distributed at a financial cost of $61,978, corresponding to a cost per person of $0.48 and a cost per treatment of $0.37. In Wadilla, 169,248 treatments were distributed at a financial cost of $44,449, corresponding to a cost per person of $0.34 and a cost per treatment of $0.26. This information is useful to stakeholders considering the CMDA strategy in similar contexts and may contribute to future cost-effectiveness analyses of the strategy.

Snakebite envenomation is an endemic problem in tropical countries like Nepal. Deaths from envenomation are preventable through robust management systems and widespread public awareness. This case report describes a case of a 16-year-old boy from the Terai region of Nepal who presented with acute bilateral ptosis, head lag, and inability to elicit protrusion of his tongue after a krait bite. The patient was managed with antivenom, mechanical ventilation, and supportive care. Early neurological recovery after krait-bite envenomation is generally expected in victims who receive timely antivenom along with intensive supportive care. As usual, recovery of ptosis, tongue protrusion, and head lag occurred within a week; however, residual weakness in all limbs persisted for months. Gradual onset and offset of neurological symptoms are often characteristic of krait bites. Delayed neurological recovery after krait-bite envenomation is uncommon as illustrated in this case.

Residual brain calcifications that occur after antiparasitic treatment in neurocysticercosis (NCC) can serve as foci of enduring neuroinflammation and associated seizures. Etidronate, a first-generation bisphosphonate, has exhibited efficacy in reducing the formation of ectopic brain calcification. In the present proof-of-concept study, its effects on post-treatment calcifications were evaluated in 12 pigs naturally infected with NCC, confirmed via magnetic resonance imaging. All animals received albendazole plus praziquantel for 5 days, either alone (n = 6) or with etidronate (20 mg/kg/day for 2 weeks, then 10 mg/kg/day for 8 weeks; n = 6). Eight months post-treatment, the animals were euthanized for ex vivo brain computed tomography, histology, and scanning electron microscopy of calcified lesions. Etidronate reduced the risk of calcification by 21% (risk ratio = 0.79; 95% CI: 0.65-0.90; P = 0.020); however, there was considerable individual variability in the magnitude of this risk reduction, as well as significantly decreased calcium and phosphorus content in granulomas. Etidronate was well tolerated and may serve as an adjunctive therapy to reduce residual calcification after antiparasitic treatment in NCC.

Children are vulnerable to Taenia solium, a parasitic tapeworm causing cysticercosis (a common cause of epilepsy) and taeniasis. We sought to better understand T. solium prevalence and associated risk factors in Nigeria using data from a 2018 nationally representative household survey estimating HIV incidence. We used a multiplex bead assay to determine the seroprevalence of T. solium IgG antibodies to T24H (cysticercosis) and rES33 (taeniasis) for 32,494 children aged <15 years. Positive antibodies against each antigen were detected in children from all states, with an overall antibody seroprevalence of 6.0% for T24H (range, 1.4-19.3%) and 2.8% for rES33 (range, 0.5-5.3%). Despite state-level variations, overall prevalence for each disease was higher in the north than in the south. We found greater odds of cysticercosis seropositivity among individuals with lower socioeconomic status (aOR = 2.07; 95% CI = 1.53-2.80) when comparing lowest to highest wealth quintile; with increasing age, showing higher odds in children aged 5-9 years (aOR = 2.06; 95% CI = 1.77-2.34) and 10-14 years (aOR = 2.58; 95% CI = 2.22-2.99) compared with children aged <5 years; among households with pig ownership (aOR = 1.35; 95% CI = 1.00-1.83) compared with those without pigs; and among individuals living in rural areas (aOR = 1.26; 95% CI = 1.06-1.51) compared with those in urban areas. For taeniasis, we found significant associations for children in the lowest wealth quintile (aOR = 1.89; 95% CI = 1.30-2.76) and those from pig-owning households (aOR = 1.48; 95% CI = 1.01-2.17). Significant taeniasis prevalence rates were identified even in predominantly Muslim populations. Targeted public health strategies to increase awareness of T. solium infections, highlighting hand hygiene and proper sanitation practices, and improved pig management can help reduce transmission.