American Journal of Tropical Medicine and Hygiene最新文献

Guangdong, China, has experienced several dengue epidemics involving thousands of confirmed cases in recent decades, and elderly individuals suffered severe dengue (SD) most seriously. However, the clinical characteristics and risk factors for SD among elderly patients in Guangdong have not been investigated. Patients older than 65 years were recruited and divided into a dengue fever (DF) group and an SD group according to the 2009 Dengue Guidelines of the WHO. We analyzed the clinical manifestations of the elderly patients with dengue and then assessed the risk factors for SD. Of a total of 1,027 patients, 868 patients were diagnosed as having DF and 159 as having SD. Of the 159 elderly patients with SD, 129 (81%) had comorbidities, with hypertension being the most common. Severe organ impairment (SOI) (115, 54%) was the most common presentation in SD patients, followed by severe plasma leakage (52, 24.4%) and severe hemorrhage (46, 21.6%). The most common symptom of SOI was kidney injury, followed by heart injury and central nervous system injury. Furthermore, multivariate regression revealed that the presence of chronic obstructive pulmonary disease (COPD), a lower red blood cell (RBC) count (≤3.5 × 1012/L; odds ratio [OR], 0.35; 95% CI, 0.17-0.55; P <0.001), lower serum albumin (ALB) (≤35 U/L; OR, 0.18; 95% CI, 0.09-0.32; P <0.001), and hyperpyrexia (body temperature ≥39°C; OR, 1.8; 95% CI, 1.2-2.6, P <0.001) were risk factors for SD. Severe organ impairment was the predominant manifestation in elderly individuals with SD characterized by kidney injury. The potential risk factors of SD such as presence of COPD and hyperpyrexia and lower RBC and ALB levels might help clinicians identify patients with SD early.

Zika virus (ZIKV) infection in pregnancy is associated with severe abnormalities of the brain and eye and other adverse outcomes. Zika en Embarazadas y Niños was a prospective cohort study conducted in multiple Colombian cities that enrolled pregnant women in their first trimester. Specimens collected from pregnant women (n = 1,519) during February 2017-September 2018 and their infants (n = 1,080) during June 2017-March 2019 were tested for prenatal ZIKV infection by nucleic acid amplification tests or IgM antibody testing. Zika virus infection in pregnancy was present in 3.2% of pregnant women (incidence rate [IR] per 1,000 person-months = 5.9, 95% CI: 4.3-7.8). Presumptive ZIKV infection was present in 0.8% of infants (IR = 1.6, 95% CI: 0.7-2.9). Five percent of infants with prenatal ZIKV exposure or infection presented with Zika-associated abnormalities; 4.7% were small for gestational age. Understanding the risk of ZIKV infection during pregnancy and associated adverse outcomes can help inform counseling efforts.

Bovine tuberculosis (bTB) is a zoonotic bacterial disease of animals that causes substantial economic losses in underdeveloped countries such as Ethiopia. A cross-sectional study was conducted from May 2021 to August 2021 in the Wolaita zone, southern Ethiopia using a designed questionnaire to assess risk, perception, and protective behavior against bTB. For this purpose, a total of 250 randomly chosen meat handlers working at six main, purposively selected abattoirs were interviewed, and the data were analyzed using STATA v. 13 software. Of the total participants interviewed, 37.0% (57/152) of the respondents strongly agreed that contracting bTB would prevent them from coming to work, whereas 32.4% (44/136) of them stayed in bed for an extended period. Knowledge-based analysis revealed that butcher house men were more aware than abattoir workers about factors related to the spread of bTB from animals to humans (73.3%), that healthy-looking meat contains bTB-causing pathogens (67.5%), and that consumption of contaminated meat can be a source of infection in humans (65.6%). These findings revealed that abattoir and butcher house employees are at higher risk of bTB exposure and a lack of understanding about the nature and transmission of the infection. Thus, abattoir and butcher house workers should be encouraged to pursue regular medical follow-ups and should be provided with better personal protective equipment.

The single onchocerciasis-endemic focus in the remote Amazon rainforest is shared by Brazil and Venezuela and affects primarily the indigenous Yanomami people. Regional elimination of onchocerciasis is challenged by the magnitude and inaccessibility of this area. In Brazil, 272 onchocerciasis-endemic communities are operationally organized through 21 health centers ("polos bases"). Mass drug administration of ivermectin began in 1995, with 36 effective biannual rounds (≥85% coverage of the eligible population) through 2022. The national on chocerciasis program maintains community-level monitoring to prioritize treatment activities and epidemiological surveys. The Onchocerciasis Elimination Program for the Americas and the WHO onchocerciasis elimination guidelines have helped Brazil move toward its goal of stopping ivermectin treatment by 2025 and verifying transmission elimination by 2030. Additional challenges to the Brazilian onchocerciasis program include cross-border movements and insecurity due to illegal mining and inter-community conflicts. The new government in Brazil offers hope given its commitment to the equity of indigenous people and preservation of the Amazon environment.

In 2022, the Pan American Health Organization recommended the intralesional application (IL) of pentavalent antimonials in adult patients with localized cutaneous leishmaniasis (CL) caused by Leishmania (Viannia) braziliensis. Other guidelines differ from that recommendation, considering that infections caused by a Leishmania species that can be associated with increased risk for mucosal leishmaniasis, in particular L. (V.) braziliensis, should not be eligible for intralesional treatment. This was a prospective interventional study carried out with eight patients diagnosed with CL residing in northeast Brazil during the period from 2019 to 2022. To our knowledge, this is the first prospective study on the subject conducted in the northeast region, which has the second-highest number of cases in the country. In our sample, clinical cure was achieved with the use of intralesional treatment in all cases, and there were no serious adverse events or mucosal involvement during the 1-year follow-up period. We emphasize the importance of using the right criteria for choosing this therapeutic modality and highlight the advantages of intralesional treatment due to the lower risk of adverse events and cost reduction to health services.

Over the past few years, a recalcitrant dermatophytosis has been observed on the Indian subcontinent, including Sri Lanka, which has caused a major public health issue in the region. An emerging species, Trichophyton indotineae, first described as Trichophyton mentagrophytes ITS genotype VIII, is thought to be responsible for this fast-spreading, mostly terbinafine-resistant dermatophytosis. Recalcitrant dermatophytosis is a challenge to dermatologists, and knowing the causative species and antifungal sensitivity in the earlier stage of management would be invaluable. We report a case series of patients with dermatophytosis caused by T. indotineae in Sri Lanka. This is the first detection of this highly terbinafine-resistant strain in Sri Lanka, and existence of this species should be taken seriously by dermatologists and healthcare policymakers for better management of tinea infections and antifungal stewardship in the country.

Bangladesh experienced the largest and deadliest dengue outbreak in 2023, after the virus had reappeared in the country 2 decades earlier. A total of 1,705 people died in Bangladesh, representing the highest case fatality rate (0.5%) due to dengue in the world for that year. The severity of dengue infection is to some extent related to the emergence of new circulating serotypes. To identify the possible predominant serotype in 2023, the reverse transcription polymerase chain reaction-based identification technique was used on stored serum samples of suspected dengue patients during the period between July and December 2023. The overall result of molecular serotyping showed that dengue virus (DENV-2) reappeared as the predominant serotype (74.1%), followed by a moderate number of samples with DENV-1 (19.8%) and DENV-3 (6.1%), in 2023. However, DENV-1 was found to be dominant in a few rural areas of Cox's Bazar districts. During the 2019 outbreak, DENV-3 was the dominant serotype, which seemed to be replaced by the DENV-2 serotype; this may have impacted the increased case fatality in 2023.

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infection with a high case fatality rate. The serious clinical features need to be further defined. We performed a retrospective analysis among SFTS patients in South Korea during 2016-2021 to update the current status. The basic epidemiology of all reported cases was analyzed, and the detailed clinical data of the subjects were further collected from study hospitals selected in terms of their geographic location and capability of SFTS care. Cases of SFTS were reported across the country and were greatly increased since the initial endemic phase, even under the passive surveillance system. The case fatality rate remained at approximately 16.8%. Coinfections at admission were present in 7.8% of the patients. Major complications included bleeding (15.2%), hemophagocytic lymphohistiocytosis (6.7%), bacteremia or candidemia (4.0%), and invasive pulmonary aspergillosis (1.7%). It took a median 4 days from the onset of illness to hospital admission. Rapid clinical deterioration was observed with a median 1 day for intensive care unit admission, 3 days for mechanical ventilation, 4 days for renal replacement therapy, and 5 days for death, all after the hospitalization. Multivariate analysis showed that the fatality was associated with older age, bacteremia, or candidemia during hospitalization, and the presence of several variables at admission such as fever, altered mentality, aspartate aminotransferase >200 IU/L, serum creatinine level >1.2 mg/dL, and prolonged prothrombin time and activated partial thromboplastin time. Treatment options to improve clinical outcomes are limited, despite best supportive care. Specific treatment is urgently needed to change the fatal course.

Pure neuritic leprosy (PNL) often remains underdiagnosed due to the lack of simple, reliable diagnostic tools to detect Mycobacterium leprae. This study aimed to investigate the utility of multiplex polymerase chain reaction (MPCR) in easily accessible and less invasive biopsy sites, including skin biopsy samples and nasal swabs (NSs), to detect M. leprae. A total of 30 (N = 30) clinically suspected and untreated patients with PNL were recruited. Nasal swabs and skin biopsy samples from the innervation territory of an "enlarged nerve" were collected. DNA was extracted and subjected to MPCR (targeting leprae-specific repetitive element [RLEP], 16S rRNA, and SodA genes) and RLEP-PCR (individual gene PCR). The PCR products were analyzed by 3% agarose gel electrophoresis. In 30 patients with clinically suspected PNL, 60% (N = 18) of skin biopsy samples and 53% (N = 16) of NSs were found positive for M. leprae DNA by MPCR, whereas only 23.3% (N = 7) of skin biopsy samples and 10% (N = 3) of NSs were found positive by RLEP-PCR. MPCR demonstrated a greater positivity rate than did RLEP-PCR for detection of M. leprae. Serologic positivity for anti-natural disaccharide-octyl conjugated with bovine serum albumin (ND-O-BSA) antibodies was 80% (16/20), including 35% (7/20) of PNL patients for which the skin MPCR was negative. Both serologic positivity and skin MPCR positivity were observed in 65% of patients (N = 20). Multiplex polymerase chain reaction is a useful tool for detection for M. leprae in skin biopsy samples and NSs in clinically suspected cases of PNL, with the added advantages of being less invasive and technically easier than nerve biopsy.

Loiasis is a rarely imported infectious disease that is often difficult to diagnose and treat. Here we describe clinical features and treatment outcomes of 11 patients with imported loiasis seen at a German reference center between 2013 and 2023. Clinical presentations varied by patient origin, with eye-worm migration and ophthalmological symptoms being more common among patients from endemic areas and Calabar swelling, subcutaneous swelling, and pruritus more prevalent among returning travelers from nonendemic regions. Eosinophil counts were higher in returning travelers. Diethylcarbamazine was most commonly used for treatment either as monotherapy in combination with ivermectin or with albendazole and ivermectin, respectively. In one patient, long-term follow-up indicated treatment failure after the first course of treatment. Another traveler was prescribed chemoprophylaxis with diethylcarbamazine after experiencing repeated infections due to long-term residence in a high-risk region in Cameroon.