American Journal of Tropical Medicine and Hygiene最新文献

Low gestational weight gain (GWG) and prenatal anemia are associated with adverse pregnancy, maternal and infant health outcomes. In a secondary analysis of a single-center, randomized, partially placebo-controlled, outcome assessor-blinded, controlled trial conducted in Malawi from 2003 to 2006, when antiretroviral treatment (ART) for HIV was not widely available, we studied whether GWG can be increased and the prevalence of maternal anemia decreased during pregnancy and at 1 month postpartum through the intermittent preventive treatment in pregnancy (IPTp) of maternal malaria and reproductive tract infections. The participants (≥15-year-old women with uncomplicated second trimester single pregnancies) received either sulfadoxine (1,500 mg) and pyrimethamine (75 mg; SP) twice (control group, n = 433), monthly SP (n = 439), or monthly SP and azithromycin (1,000 mg) twice (AZI-SP, n = 441) during pregnancy. The mean weekly GWG in the sample was 256 g/week. The participants in the monthly SP group gained, on average (95% CI), 4 g (-13 to 20; P = 0.671), and those in the AZI-SP group gained 25 g (8-41; P = 0.003) more weight per week than control group participants. Among HIV-positive participants (12%), the differences were larger and also significant between the monthly SP group and control group. Mean hemoglobin and anemia prevalence did not differ between the groups during pregnancy or postnatally. The data support a hypothesis that IPTp with monthly SP and two doses of azithromycin can increase GWG, especially among HIV-positive women who are not on ART, possibly through the reduction of infections, inflammation, and effects on the maternal gut microbiome.

Patients with cystic echinococcosis (CE) regularly undergo surgery in medical centers in endemic countries. Our understanding of the challenges patients face on the pathway toward the final diagnosis and treatment of CE is poor. The present study was conducted to evaluate the medical care-seeking pathway and the underlying causes of the delayed surgical treatment of CE. Information related to 68 CE patients who underwent surgery in Kerman, Southeast Iran, was collected through face-to-face visits or telephone calls. All the patients were interviewed, and the medical records of each patient were reviewed. The pathway taken by the patient to seek care, the workups performed for diagnosis and management, and the length of time between the onset of symptoms and definitive diagnosis and surgery were evaluated. The patients were visited by at least two physicians; the median number of physicians was four. A total of 47% of the patients were referred to a general practitioner on their first visit. The mean times between the first visit and CE diagnosis and surgery were 1.5 and 3.2 months, respectively. A definitive diagnosis of CE was made for 35.3% of the patients in less than 1 month after the first visit. However, it took 4 months or more for 51.4% of the patients to receive hydatid surgery. The fear of anesthesia and surgery, the cost of management, unsuccessful chemotherapy for CE patients, pregnancy, and issues related to immigrant patients and refugees are among the factors involved in the protraction of CE diagnosis and treatment. Establishing practice guidelines for CE diagnosis and treatment, continuing education for healthcare professionals, and improving access to diagnostic facilities for endemic communities are required to address challenges in the management of CE in endemic regions.

Bangladesh is a well-known epidemic zone for dengue fever. Several epidemiological and geographical factors influence the transmission and severity of dengue infection. This study aimed to determine the epidemiological and geographical factors that contributed to the severity of the dengue outbreak in Bangladesh in 2023. This hospital-based cross-sectional study investigated 1,313 dengue patients admitted to public hospitals in Dhaka, Chattogram and Kishoreganj, Bangladesh, between July and December 2023. Multiple logistic regression analyses were conducted to identify the independent risk factors for severe dengue infection. The average age of respondents was 29.5 years, with individuals aged 20-40 accounting for 59.5%. Of the 1,313 dengue patients, 19.3% (254) were diagnosed with severe dengue infection. Patients with low monthly income and those lacking awareness of dengue's spread from clogged rooftop water were respectively 2.35 (adjusted odds ratio [aOR] 2.35; P <0.05; 95% CI: 1.08-5.07) and 2.23 (aOR 2.23; P <0.05; 95% CI: 1.20-4.14) times more likely to develop severe dengue. The dengue outbreak has become a serious public health issue in Bangladesh, with factors such as low family income and lack of awareness contributing to the development of severe cases. These findings provide valuable evidence for policymakers to guide and implement preventive measures and raise awareness.

Oncomelania hupensis, the sole intermediate host of Schistosoma japonicum, plays an essential role in the transmission of schistosomiasis. In 1985, snails were eliminated throughout Shanghai city. However, snail-infested sites have continuously emerged since the 1990s. The resurgence of snail habitats may signal the recurrence of schistosomiasis. Therefore, implementing continuous monitoring measures for snails is crucial, and predicting potential habitats for snails in Shanghai is essential for enhancing surveillance effectiveness, providing early warnings to health authorities, optimizing resource allocation, maintaining the elimination status of schistosomiasis in Shanghai, and ultimately, advancing the goal of eliminating schistosomiasis in China. Our research developed an ensemble model to predict the current and future distributions of snails in Shanghai by collecting emerging snail-infested records from 1991 to 2020 and integrating them with 19 environmental variables, including climate, geography, and socioeconomics. The ensemble model identified the annual average surface temperature as the most significant factor influencing snail occurrence. The highly suitable areas were primarily located in the northwestern part of Jinshan District and the southern part of Songjiang District. In the future, the southwestern part of Shanghai will continue to provide suitable habitats for snails in the long term. Therefore, even in areas where schistosomiasis has been eliminated, surveillance of snails and the disease should not be relaxed, and ongoing monitoring in these areas is necessary.

The socioecological conditions of Mexican regions are conducive to the spread of vector-borne diseases. Although there are established treatment guidelines for dengue and rickettsiosis, diagnosis is complicated. The objective of this work was to identify epitopes of Rickettsia and dengue virus that could be used in serology screening against vector-borne diseases. For this, epitopes with high histocompatibility complex class II binding efficiency of OmpB protein of Rickettsia rickettsii and NS2B protein of dengue virus were identified in silico through a reverse vaccinology strategy. The selected epitopes were grouped into multipeptide sequences that were synthesized and immobilized in a nitrocellulose membrane to evaluate the reactivity sera from patients previously infected with dengue or Rickettsia. The evaluation of the sequences of the NS2B and OmpB proteins was performed with 60 sera previously diagnosed as positive or negative by the respective gold standard techniques. The dot blot technique was used for the antigenic evaluation of the peptides against these serum samples. Dot blot analysis correctly identified 85% of sera positive for rickettsiosis and 75% of sera positive for dengue. Experimental evidence from multipeptide sequences suggests their potential use in the development of diagnostic tests for dengue and rickettsiosis.

The burden of pathogenic enteric protozoa and soil-transmitted helminths among impoverished populations living on the Texas-Mexico border is unclear. We conducted a cross-sectional study on an ongoing longitudinal cohort of 616 adults residing in Starr County, Texas. A total of 359 adults were screened for four protozoa and five soil-transmitted helminths by using real-time polymerase chain reaction. This analysis identified 48 (13.4%) participants who tested positive for Blastocystis sp., three (0.8%) who tested positive for Giardia intestinalis, and one (0.3%) who tested positive for Strongyloides stercoralis and was also coinfected with Blastocystis sp. Infection was significantly associated with age, a lack of health insurance, and living outside of a colonia. We recommend additional epidemiologic investigations to examine risk factors contributing to protozoa and soil-transmitted helminth disease transmission in border counties.

The phylogeographic inference approach aims to connect genomic data with epidemiology to understand the spread and evolution of pathogens using visualization of spatiotemporal reconstructions. Orthohantavirus hantanense (HTNV), the causative agent of hemorrhagic fever with renal syndrome (HFRS), represents a significant global public health concern. Here, we introduce a localized Nextstrain platform for HTNV, offering a comprehensive resource for facilitating spatiotemporal genomic surveillance and the study of evolutionary dynamics of viral genomes. Nextstrain enables web-based visualization and simple sharing of graphic and numeric data through unique web addresses. The Nextstrain build for HTNV stands out for its user-friendly interface and is readily accessible online at https://nextstrain.org/community/KU-MV/Hantavirus. This study provides valuable insights into genomic surveillance, viral phylodynamics, and the evolutionary history of orthohantaviruses for the development of public health policies against endemic HFRS outbreaks.

Malnutrition in the early days of life is a global public health concern that affects children's growth. It results from a variety of factors, including pathogenic infections. Enterocytozoon bieneusi is a microsporidian parasite that can cause diarrhea and malnutrition in children. The study aimed to assess the impact of E. bieneusi on child growth. The MAL-ED study, a multicountry birth cohort research project, investigated the relationship between enteric infections and malnutrition in participating children from eight countries. A customized real-time polymerase chain reaction-based TaqMan array card was used in this study to identify enteropathogens from stool samples, where E. bieneusi was one of the target pathogens. The impacts of E. bieneusi infection on growth measures were assessed. Mixed-effect linear models were used to investigate the relationship between E. bieneusi and growth outcomes, including length-for-age (LAZ), weight-for-age (WAZ), and weight-for-length (WLZ) Z scores. At the endpoint (last month of measurement), the infected group had significantly lower scores than the noninfected group for all outcomes. The adjusted difference-in-difference (D-in-D) values were -0.53 (95% CI: -0.67 to -0.38) for LAZ, -0.38 (95% CI: -0.52 to -0.23) for WAZ, and -0.22 (95% CI: -0.38 to -0.06) for WLZ. Enterocytozoon bieneusi infection has been identified as a factor associated with reduced linear growth, weight gain, and weight gain relative to linear growth in children, underscoring the importance of treating this infection.