bluuebunny/crossref_metadata_2025 huggingface dataset:
A New Anti-loxoscelic Serum Produced Against Recombinant Sphingomyelinase D: Results of Preclinical Trials
Authors: de Almeida Daniel Manzoni , Fernandes-Pedrosa Matheus de F. , de Andrade Rute M. Gonçalves , Marcelino José Roberto , Gondo-Higashi Hisako , de Azevedo Inácio de L. M. Junqueira , Ho Paulo Lee , van den Berg Carmen , Tambourgi Denise V.
Published: September 2018

Envenomation by Loxosceles species (brown spider) can lead to local dermonecrosis and to serious systemic effects. The main toxic component in the venom of these spiders is sphingomyelinase D (SMase D) and various isoforms of this toxin are present in Loxosceles venoms. We have produced a new anti-loxoscelic serum by immunizing horses with recombinant SMase D. In the present study, we compared the neutralization efficacy of the new anti-loxoscelic serum and anti-arachnidic serum (the latter serum is used for therapy for loxoscelism in Brazil) against the toxic effects of venoms from spiders of the genus Loxosceles. Neutralization tests showed that anti-SMase D serum has a higher activity against toxic effects of L. intermedia and L. laeta venoms and similar or slightly weaker activity against toxic effects of L. gaucho than that of Arachnidic serum. These results demonstrate that recombinant SMase D can replace venom for anti-venom production and therapy.
Taking Photographs with a Microscope
Authors: Maude Richard J. , Koh Gavin C. K. W. , Silamut Kamolrat
Published: September 2018

We describe a simple, economical, and highly practical technique for taking digital photographs of specimens visualized through a light microscope. Most models of light microscope and compact digital camera, and even some cameraphones, can be used. The technique is quick to learn and can easily be performed in a resource-poor setting. It can be used to assist with diagnosis in remote areas and can be extremely useful for teaching.
Mycobacterial Clearance from Sputum Is Delayed during the First Phase of Treatment in Patients with Diabetes
Authors: Restrepo Blanca I. , Fisher-Hoch Susan P. , Smith Brian , Jeon Sangchoon , Rahbar Mohammad H. , McCormick Joseph B. , _ _
Published: September 2018

Although type 2 diabetes (DM) is a recognized risk factor for development of tuberculosis (TB), the impact on treatment is unclear. Among the few published reports, some suggest that mycobacterial clearance during treatment is delayed in TB patients with DM. Using survival analysis on data from 469 culture-positive TB patients retrospectively identified in south Texas, we found DM to be an independent risk factor for a 5-day delay in mycobacterial clearance within the first 60 days of treatment.
Prevalence of Tuberculosis Suspects and Their Healthcare-seeking Behavior in Urban and Rural Jordan
Authors: Rumman Khaled Abu , Sabra Nadia Abu , Bakri Faris , Seita Akihiro , Bassili Amal
Published: September 2018

To determine the prevalence and healthcare-seeking behavior of tuberculosis (TB) suspects in Middle and South Jordan. A community-based survey was carried out between June–September 2005, whereby 61,730 adult household members were inquired about the presence of persistent cough for more than three weeks to identify TB suspects. These adults were then interviewed and referred to the nearest health center for clinical and sputum smear examination. Of the 61,730 surveyed household members, 1,544 (2.51%) were identified as TB suspects, of these two were sputum smear positive pulmonary TB. The first action with the onset of symptoms was to visit the health centers. Reasons for timely seeking care were accessibility of the facilities and confidence in obtaining a cure, and obstacles were belief that symptoms would resolve and economic constraints in rural residents. Females, rural residents, expatriates, and using private means of transportation were predictors of delay in seeking care for more than three weeks. This study has set the baseline information about the prevalence of TB suspects in Jordan and their healthcare-seeking behavior that shows community preference to seek care at health centers. These should be upgraded and the health workers trained on suspect management to enhance the TB elimination efforts.
National Seroprevalence and Risk Factors for Zoonotic Toxocara spp. Infection
Authors: Won Kimberly Y. , Kruszon-Moran Deanna , Schantz Peter M. , Jones Jeffrey L.
Published: September 2018

To estimate the prevalence of Toxocara spp. infection in a representative sample of the United States population ≥ 6 years of age, sera from participants in the Third National Health and Nutrition Examination Survey (1988–1994) were tested for antibodies to Toxocara. Among the 30,930 persons selected for the survey, 82% (N = 25,733) were interviewed, and 91% (N = 23,527) of those interviewed underwent physical examination of which 87% (N = 20,395) were tested. The age adjusted Toxocara seroprevalence was 13.9% (95% confidence intervals [CI] 12.5, 15.3), and was higher in non-Hispanic blacks (21.2%) than non-Hispanic whites (12%) or Mexican Americans (10.7%; P < 0.001). Increased Toxocara seropositivity was associated with head of household level of education (low versus high) (odds ratio [OR]: 2.2; CI: 1.8, 2.8), poverty (OR: 1.5; CI: 1.3, 1.8), elevated blood lead concentrations (OR: 1.4; CI: 1.1, 1.9), and dog ownership (OR: 1.2; CI: 1.1, 1.4). Toxocara infection is widespread and associated with specific risk groups.
Predictive Spatial Models for Risk of West Nile Virus Exposure in Eastern and Western Colorado
Authors: Winters Anna M. , Eisen Rebecca J. , Lozano-Fuentes Saul , Moore Chester G. , Pape W. John , Eisen Lars
Published: September 2018

In the absence of a vaccine for use in humans against West Nile virus (WNV), mosquito control and personal protection against mosquito bites are the only measures available to prevent disease. Improved spatial targeting is desirable for costly mosquito and WNV surveillance and control schemes. We used a multivariate regression modeling approach to develop spatial models predicting high risk of exposure to WNV in western and eastern Colorado based on associations between Geographic Information System–derived environmental data and zip code of residence for 3,659 human WNV disease cases from 2002 to 2006. Models were robust, with user accuracies for correct classification of high risk areas of 67–80%. The importance of selecting a suitable model development area in an ecologically and climatically diverse environment was shown by models based on data from the eastern plains landscape performing poorly in the mountainous western part of Colorado and vice versa.
Association of Nutritional Status with the Response to Infection with Leishmania chagasi
Authors: Maciel Bruna L. Lima , Lacerda Hênio G. , Queiroz José W. , Galvão Juliana , Pontes Núbia N. , Dimenstein Roberto , McGowan Stephen E. , Pedrosa Lúcia F. C. , Jerônimo Selma M. B.
Published: September 2018

Outcomes of infection with Leishmania chagasi range from self-resolving infection to visceral leishmaniasis (VL). Risk factors determining development of disease are not totally understood, but probably include environmental influences and host genetics. We assessed whether nutrition influenced the outcome of Leishmania infection by comparing relatives of children with VL with either self-resolving Leishmania spp. infection or apparently uninfected households. We observed a decrease in body mass index (P < 0.0005) and mid-upper arm circumference for age (P = 0.022) z-scores for children with VL. Levels of vitamin A were lower in active children with VL as measured by serum retinol (P = 0.035) and the modified-relative-dose-response test (P = 0.009). Higher birth weight (P = 0.047) and albumin concentrations (P = 0.040) protected against disease. Increased breastfeeding time (P = 0.036) was associated with asymptomatic infection. The results indicate that modifiable nutritional aspects are associated with the outcome of Leishmania spp. infection in humans.
Pharmacokinetics of the Antimalarial Drug Piperaquine in Healthy Vietnamese Subjects
Authors: Chinh Nguyen Trong , Quang Nguyen Ngoc , Thanh Nguyen Xuan , Dai Bui , Travers Thomas , Edstein Michael D.
Published: September 2018

We compared plasma maximum concentration (Cmax) and area under the concentration-time curve (AUC) of the antimalarial drug piperaquine in 26 healthy Vietnamese subjects after treatment with either a single oral dose of 500 mg (n = 6) or 1,000 mg (n = 6) of piperaquine phosphate and a three-day course of 500 mg of piperaquine/ day in the fasting state (n = 7) or with food (approximately 17 g fat) (n = 7). The geometric mean plasma Cmax and AUC(0–28) was 2.8-fold (200 ng/mL versus 70 ng/mL) and 1.9-fold (5,736 ng · h/mL versus 2,999 ng · h/mL), respectively, and higher in subjects receiving the 1,000-mg dose than in those receiving the 500-mg dose. The geometric mean Cmax and AUC(0–28) was 1.7-fold (198 ng/mL versus 119 ng/mL) and 1.4-fold (11,187 ng · h/mL versus 7,954 ng · h/mL) higher in the fed state than in the fasting state. Piperaquine AUC was proportional to the two doses tested and a moderate-fat meal enhanced the bioavailability of piperaquine by 41%, which should improve the therapeutic efficacy of this drug.
Characterization of “Yaa Chud” Medicine on the Thailand–Myanmar Border: Selecting for Drug-resistant Malaria and Threatening Public Health
Authors: Newton Paul N. , Hampton Christina Y. , Alter-Hall Krystyn , Teerwarakulpana Thanongsak , Prakongpan Sompol , Ruangveerayuth Ronnatrai , White Nicholas J. , Day Nicholas P. J. , Tudino Mabel B. , Mancuso Natalia , Fernández Facundo M.
Published: September 2018

Multidrug-resistant Plasmodium falciparum malaria is a severe public health problem on the Thailand–Myanmar border. Many villagers buy packets of 4–5 mixed medicines (“yaa chud”) from shops without medical assessment as their first-line malaria treatment. In 2000–2001 a local researcher purchased 50 yaa chud from 44 shops around Mae Sot, Thailand and Myawaddy, Myanmar (Burma), for his wife who was said to be pregnant with fever and drowsiness. The tablets/capsules were provisionally identified by appearance and active ingredients determined in a subset by using mass and atomic spectrometry. The most frequently detected active ingredients were acetaminophen (22%), chlorpheniramine (13.4%), chloroquine (12.6%), tetracycline/doxycycline (11.4%), and quinine (5.1%). Only seven bags contained potentially curative medicine for malaria. A total of 82% of the bags contained medicines contraindicated in pregnancy. Inappropriate, ineffective antimalarial drugs on the Thailand–Myanmar border are likely to increase malaria morbidity, mortality and health costs and engender the emergence and spread of antimalarial drug resistance.
Phase I Clinical Evaluation of rDEN4Δ30-200,201: A Live Attenuated Dengue 4 Vaccine Candidate Designed for Decreased Hepatotoxicity
Authors: McArthur Julie H. , Durbin Anna P. , Marron Jennifer A. , Wanionek Kimberli A. , Thumar Bhavin , Pierro Dennis J. , Schmidt Alexander C. , Blaney Joseph E. , Murphy Brian R. , Whitehead Stephen S.
Published: September 2018

The rDEN4Δ30-200,201 is a live attenuated DENV-4 vaccine candidate specifically designed to further attenuate the rDEN4Δ30 parent virus. In the present study, 28 healthy adult volunteers were randomized to receive either 105 plaque-forming unit (PFU) of vaccine (20) or placebo (8) as a single subcutaneous injection. Volunteers were evaluated for safety every other day for 16 days. Serum neutralizing antibody titer against DEN4 was determined at study day 28, 42, and 180. The vaccine infected all vaccinees and was well tolerated without inducing alanine aminotransferase (ALT) elevations. Although virus was not recovered from the serum of any vaccinee, moderate levels of neutralizing antibody were induced in all volunteers. Thus the restricted replication of rDEN4Δ30-200,201 previously documented in animal models was confirmed in humans. The rDEN4Δ30-200,201 is a promising candidate and can be considered for inclusion in a tetravalent dengue virus (DENV) vaccine.
Three Cases of Intestinal Capillariasis in Lao People’s Democratic Republic
Authors: Soukhathammavong Phonepasong , Sayasone Somphou , Harimanana Aina Nirina , Akkhavong Aphonethip , Thammasack Sivilay , Phoumindr Niranh , Choumlivong Khamloun , Choumlivong Khamla , Keoluangkhot Valy , Phongmany Simmaly , Akkhavong Kongsap , Hatz Christoph , Strobel Michel , Odermatt Peter
Published: September 2018

Capillaria philippinensis is a rare zoonotic intestinal parasite that emerged in the 1960s. The outcome of intestinal capillariasis may be fatal if untreated in due time. We report three cases of intestinal capillariasis in Lao People’s Democratic Republic (Lao PDR). The three patients were unrelated previously healthy young men (24, 26, and 27 years of age) with no underlying disease or immune depression. They had chronic diarrhea, abdominal pain, edema, and severe weight loss. Two of them acquired the infection in Thailand; the other patient had no travel history outside Lao PDR. All patients were seen several times in different hospitals before the diagnosis was made. All had concurrent parasite infections: Giardia lamblia, Entamoeba histolytica, Strongyloides stercoralis, Opisthorchis viverrini, and hookworm. The patients frequently consumed uncooked fish. After treatment with albendazole (400 mg/day for 21–30 days) all patients recovered. In Lao PDR, consumption of raw small freshwater fish is common. Therefore, the possibility of a capillariasis outbreak should be considered.
Rapid Identification of Aedes albopictus, Aedes scutellaris, and Aedes aegypti Life Stages Using Real-time Polymerase Chain Reaction Assays
Authors: Hill Lydia A. , Davis Joseph B. , Hapgood George , Whelan Peter I. , Smith Greg A. , Ritchie Scott A. , Cooper R. D. , van den Hurk Andrew F.
Published: September 2018

In 2005, a widespread infestation of Aedes albopictus was discovered in the Torres Strait, the region between northern Australia and New Guinea. To contain this species, an eradication program was implemented in 2006. However, the progress of this program is impeded by the difficulty of morphologically separating Ae. albopictus larvae from the endemic species Aedes scutellaris. In this study, three real-time TaqMan polymerase chain reaction assays that target the ribosomal internal transcribed spacer 1 region were developed to rapidly identify Aedes aegypti, Ae. albopictus, and Ae. scutellaris from northern Australia. Individual eggs, larvae, pupae, and adults, as well as the species composition of mixed pools were accurately identified. The assay method was validated using 703 field-collected specimens from the Torres Strait.
Identification of Aerobic Gut Bacteria from the Kala Azar Vector, Phlebotomus argentipes: A Platform for Potential Paratransgenic Manipulation of Sand Flies
Authors: Hillesland Heidi , Read Amber , Subhadra Bobban , Hurwitz Ivy , McKelvey Robin , Ghosh Kashinath , Das Pradeep , Durvasula Ravi
Published: September 2018

Visceral leishmaniasis is an understudied parasitic disease responsible for significant global morbidity and mortality. We are presently investigating a method of disease prevention termed paratransgenesis. In this approach, symbiotic or commensal bacteria are transformed to produce anti-Leishmania molecules. The transformed bacteria are delivered back to sand flies to inactivate the parasite within the vector itself. In this study, we identified 28 distinct gut microorganisms from Phlebotomus argentipes trapped from four visceral leishmaniasis–endemic sites in India. A significant percent of Staphylococcus spp., environmental bacteria, and Enterobacteriaceae were identified. Two non-pathogenic organisms, Bacillus megaterium and Brevibacterium linens, were also isolated. Both organisms are also used extensively in industry. Our results indicate that B. megaterium and B. linens are possible candidates for use in a model of paratransgenesis to prevent transmission of Leishmania.
Human Hydatid Disease in Peru Is Basically Restricted to Echinococcus granulosus Genotype G1
Authors: Santivañez Saul J. , Gutierrez Ariana M. , Rosenzvit Mara C. , Muzulin Patricia M. , Rodriguez Mary L. , Vasquez Julio C. , Rodriguez Silvia , Gonzalez Armando E. , Gilman Robert H. , Garcia Hector H. , _ _
Published: September 2018

A molecular PCR study using DNA from 21 hydatid cysts was performed to determine which strain type is responsible for human infection in Peru. The mitochondrial cytochrome c oxidase subunit 1 (CO1) gene was amplified in 20 out of 21 samples, revealing that all but 1 sample (19/20, 95%) belonged to the common sheep strain (G1). The remaining samples belonged to the camel strain (G6). The G1 genotype was most frequently found in human cases of cystic hydatid disease (CHD) in Peru. Local control measures should focus primarily on decreasing dog and sheep infection rather than intermediate reservoirs.
Distinguishing Visceral Leishmaniasis from Intolerance to Pegylated Interferon-α in a Thalassemic Splenectomized Patient Treated for Chronic Hepatitis C
Authors: Pagliano Pasquale , Costantini Silvia , Gradoni Luigi , Faella Francesco S. , Spasiano Anna , Mascarella Giuseppe , Prossomariti Luciano , Fusco Ugo , Ricchi Paolo
Published: September 2018

A 37-year-old splenectomized man affected by β-thalassemia and chronic hepatitis, recently treated with pegylated interferon-α (Peg-IFN), was admitted because of elevated fever lasting 3 months and unresponsiveness to broad-spectrum antibiotics. Laboratory studies showed white blood cell and platelet counts within the normal range but lower than observed before Peg-IFN treatment and an elevated erythrocyte sedimentation rate. The blood transfusion rate was reported to be increased compared with the period preceding Peg-IFN treatment. A diagnosis of visceral leishmaniasis (VL) was made after Leishmania amastigotes were identified from Giemsa-stained smears of bone marrow aspirates. Cure occurred after liposomal amphotericin B was administered. Symptoms of VL may be difficult to distinguish from the manifestations of Peg-IFN intolerance. We suggest that VL must be suspected in any immunodepressed patient with an unexplained fever and a history of exposure in an endemic area.
Assessment of Children for Acute Respiratory Infections in Hospital Outpatients in Tanzania: What Drives Good Practice?
Authors: Chandler Clare I. R. , Nadjm Behzad , Boniface Gloria , Juma Kaseem , Reyburn Hugh , Whitty Christopher J. M.
Published: September 2018

Respiratory infections cause significant mortality in developing countries but are frequently undiagnosed. Reasons for this are unclear. We observed 1,081 outpatient consultations with patients less than five years of age in Tanzania. In 554 patients with cough or difficulty breathing, the absolute percentages examined were 5% for respiratory rate counted, 14% chest exposed, and 25% stethoscope used. Decisions to conduct particular examinations did appear to follow clinical logic, with odds ratios of 4.28 for counting respiratory rate (95% confidence interval [CI] = 1.75–10.47), 2.57 for exposing the chest (95% CI = 1.67–3.95), and 18.91 for using a stethoscope (95% CI = 9.52–37.57) in patients with cough or difficulty breathing. Non-clinical variables, including salary level, were also associated with examinations, and history taking was more common among clinicians originating outside the hospital area. Although respiratory examinations are relatively more common in those with cough or difficulty breathing, the absolute rates are low and related to non-clinical and clinical factors.
Human Toxocariasis in Rural Brazilian Amazonia: Seroprevalence, Risk Factors, and Spatial Distribution
Authors: Rubinsky-Elefant Guita , da Silva-Nunes Mônica , Malafronte Rosely S. , Muniz Pascoal T. , Ferreira Marcelo U.
Published: September 2018

This population-based cross-sectional study of 403 rural settlers in Brazilian Amazonia revealed an overall rate of IgG seropositivity to Toxocara canis excretory-secretory larval antigen of 26.8% (95% confidence interval [CI], 22.5–31.4%). Multilevel logistic regression analysis identified current infection with hookworm (odds ratio [OR], 2.32; 95% CI, 1.11–4.86) and residence in the most recently occupied sectors of the settlement (OR, 1.81; 95%CI, 1.3–2.52) as significant risk factors for Toxocara seropositivity; age > 14 years (OR, 0.46; 95% CI, 0.28–0.73) and the presence of cats in the household (OR, 0.57; 95% CI, 0.32–1.02) appeared to be protective. Two significant high-prevalence clusters were detected in the area, together comprising 38.9% of the seropositive subjects; households in the clusters had slightly lower socioeconomic status and were less likely to have cats as pets. The obstacles for controlling human toxocariasis in this and other tropical rural settings are discussed.
Development of a Real-time Quantitative PCR Assay to Enumerate Yersinia pestis in Fleas
Authors: Gabitzsch Elizabeth S. , Vera-Tudela Rommelle , Eisen Rebecca J. , Bearden Scott W. , Gage Kenneth L. , Zeidner Nordin S.
Published: September 2018

A real-time quantitative polymerase chain reaction (qPCR) assay was developed for Yersina pestis. The qPCR assay was developed utilizing a conserved region of the Y. pestis ferric iron uptake regulator gene (fur) to design primers and a fluorescent (FAM-labeled) TaqMan probe. The assay was optimized using cultured Y. pestis (UG05-0454) and was confirmed to work with strains from 3 Y. pestis biovars. The optimized assay was capable of detecting a single organism of cultured Y. pestis and as little as 300 bacteria in infected flea triturates. This qPCR assay enables rapid enumeration of Y. pestis bacterium in laboratory-infected fleas when compared with conventional serial dilution plating.
A Multiplex PCR Assay for Simultaneous Genotyping of kdr and ace-1 Loci in Anopheles gambiae
Authors: Kazanidou Athina , Nikou Dimitra , Grigoriou Maria , Vontas John , Skavdis George
Published: September 2018

The selection of insecticide-resistant genotypes in Anopheles gambiae, the most important malaria vector in Africa, makes disease control problematic in several endemic areas. The early detection and monitoring of resistance associated mutations in field mosquito populations is essential for the application of successful insecticide-based control interventions. Currently, the surveillance of these mutations is performed using individual assays, some of which require sophisticated and expensive equipment. Here we describe a novel multiplex polymerase chain reaction–based assay for detecting simultaneously the five single nucleotide polymorphisms in the voltage-gated sodium channel and the ace-1 genes, which have been associated with the mosquito response to most commonly used insecticides.
Time Course of Hematogenous Dissemination of Francisella tularensis A1, A2, and Type B in Laboratory Mice
Authors: Eisen Rebecca J. , Yockey Brook , Young John , Reese Sara M. , Piesman Joseph , Schriefer Martin E. , Beard C. Ben , Petersen Jeannine M.
Published: September 2018

Tularemia is a tick-borne zoonotic bacterial disease. In the United States, human tularemia infections are caused by Francisella tularensis subspecies tularensis (Type A, clades A1 and A2) or F. tularensis subspecies holarctica (Type B). We developed a mouse model that can be used to study the ability of ticks to acquire and transmit fully virulent strains of F. tularensis (A1, A2, and Type B). We showed that 1) bacteremia was evident by 2 days post-infection (dpi) for A1, A2, and B, 2) bacteremia was expected to reach levels of > 108 cfu/mL by 3 dpi for A1 and A2 but not until 4 dpi for Type B, and 3) illness onset was delayed for mice exposed to Type B compared with A1 and A2. To maximize the likelihood of ticks acquiring infection from laboratory-infected mice before they become moribund and must be euthanized, ticks should be placed on mice so that periods of rapid engorgement occur 3–4 dpi for A1 and A2 and 4–5 dpi for Type B. Rigorous experimental studies of tick vector competence and efficiency conducted under standardized conditions are required to address several significant public health issues related to preventing and controlling tularemia. Our study provides the basis for a mouse model needed as the starting point to address these questions.
Differences in Clinical Profiles of Patients with Protobothrops mucrosquamatus and Viridovipera stejnegeri Envenoming in Taiwan
Authors: Chen Yen-Wen , Chen Min-Hui , Chen Yen-Chia , Hung Dong-Zong , Chen Chien-Kuang , Yen David Hung-Tsang , Huang Chun-I , Lee Chen-Hsen , Wang Lee-Min , Yang Chen-Chang
Published: September 2018

Envenoming by Protobothrops mucrosquamatus and Viridovipera stejnegeri accounts for the majority of venomous snakebites in Taiwan. We conducted a retrospective study to systematically examine the clinical manifestations and responses to antivenom therapy after P. mucrosquamatus and V. stejnegeri envenoming. Information on demographic characteristics, treatments, and systemic/local complications were abstracted from medical charts between 1991 and 2006. One hundred forty-nine patients with P. mucrosquamatus envenoming and 51 with V. stejnegeri envenoming were eligible for the final analysis, and they differed in terms of patient age, bite site, local bruising, proportion of patients needing ≥ 3 vials of antivenom, and mean hospital stay. Univariate analysis revealed that P. mucrosquamatus envenoming had a higher risk of developing rhabdomyolysis, cellulitis, necrosis, and skin graft. Our findings suggested that P. mucrosquamatus envenoming was associated with a greater risk of severe clinical events, and monitoring for major clinical complications would be recommended.
Long-term Follow-up of Imported Gnathostomiasis Shows Frequent Treatment Failure
Authors: Strady Christophe , Dekumyoy Paron , Clement-Rigolet Marina , Danis Martin , Bricaire François , Caumes Eric
Published: September 2018

Gnathostomiasis is increasingly reported among travelers returning from endemic areas. Between 2000 and 2004, thirteen patients were diagnosed with imported gnathostomiasis and followed for at least 6 months after treatment. Nine patients presented with cutaneous signs, two with gastrointestinal signs, and two with neurological signs. The median age was 38 years and the female/male sex ratio was 1.6. The patients had visited South East Asia or Central America. The median interval between symptom onset and treatment (with albendazole in 12 cases and ivermectin in one case) was 3.5 months. Post-treatment follow-up lasted a median of 15 months. Eight patients relapsed, a median of 2 months (1–7 months) after initial treatment. These eight patients had a total of 13 relapses, the last occurring a median of 16 months (2–26 months) after initial treatment. Thus patients with imported gnathostomiasis should be monitored for at least 6 months to detect late treatment failure.
How Much Malaria Occurs in Urban Luanda, Angola? A Health Facility-Based Assessment
Authors: Thwing Julie I. , Mihigo Jules , Fernandes Alexandra Pataca , Saute Francisco , Ferreira Carolina , Fortes Filomeno , de Oliveira Alexandre Macedo , Newman Robert D.
Published: September 2018

We conducted a health facility-based survey of patients with fever during malaria transmission season to determine the proportion with laboratory-confirmed malaria in Luanda, Angola. We enrolled 864 patients at 30 facilities; each underwent a blood film for malaria and a questionnaire. Only 3.6% had a positive blood film. When stratified by distance of the facility to city center (< 15 km and ≥ 15 km), the proportions were 1.5% (9/615) and 8.8% (22/249), respectively (P < 0.0001). Of patients traveling outside Luanda in the preceding 3 months, 6.8% (6/88) had malaria, compared with 3.2% (26/776) not traveling (P = 0.13). Children < 5 years of age were less likely to have malaria (2.4%; 12/510) than children ages 5–14 (8.7%; 9/104) and adults (4.0%; 10/250) (P = 0.03). The prevalence of laboratory-confirmed malaria in febrile patients in Luanda is very low, but increases with distance from the urban center. Prevention and treatment should be focused in surrounding rural areas.
Placental Malaria and Mother-to-Child Transmission of Human Immunodeficiency Virus-1
Authors: Msamanga Gernard I. , Taha Taha E. , Young Alicia M. , Brown Elizabeth R. , Hoffman Irving F. , Read Jennifer S. , Mudenda Victor , Goldenberg Robert L. , Sharma Usha , Sinkala Moses , Fawzi Wafaie W.
Published: September 2018

There are few studies of the association between placental malaria (PM) and mother-to-child transmission (MTCT) of human immunodeficiency virus-1 (HIV-1), and the results of published studies are inconsistent. To determine the association between PM and MTCT of HIV-1, we performed a secondary analysis of data from a clinical trial of antibiotics to reduce chorioamnionitis. Data regarding 1,662 HIV-1–infected women with live born singleton and first-born twin infants with information regarding PM and infant HIV-1 infection status at birth were analyzed. At the time of the study, women did not have access to antiretroviral drugs for treatment of acquired immunodeficiency syndrome but had received nevirapine prophylaxis to reduce the risk of MTCT of HIV-1. Placental malaria was not associated with the infant HIV-1 infection status at birth (P = 0.67). Adjustment for maternal plasma viral load and CD4+ cell count did not change these results (odds ratio = 1.06, 95% confidence interval = 0.51–2.20, P = 0.87). Placental malaria was more likely to be related to HIV-1 infection at birth among women with low viral load at baseline (P for interaction = 0.08). In conclusion, PM was not associated with infant HIV-1 infection status at birth. The interaction of maternal plasma viral load, PM, and MTCT of HIV-1 warrants further studies.
The Santa Lucia Strain of Plasmodium falciparum in Aotus Monkeys
Authors: Collins William E. , Sullivan Joann S. , Williams Allison , Galland G. Gale , Nace Douglas , Williams Tyrone , Barnwell John W.
Published: September 2018

The Santa Lucia strain of Plasmodium falciparum was studied in 150 Aotus lemurinus griseimembra, 30 A. azarae boliviensis, 103 A. nancymaae, and 121 A. vociferans monkeys. All four of these splenectomized hosts supported the production of gametocytes infective to Anopheles freeborni mosquitoes. Transmission through sporozoites from An. freeborni, An. stephensi, An. maculatus, and An. albimanus mosquitoes was successful to all four species of Aotus on a total of 100 occasions with a median pre-patent period of 21 days. For the production of infective mosquitoes for vaccine challenge studies, A. l. griseimembra and A. vociferans were the most predictable hosts.
Distance Threshold for the Effect of Urban Agriculture on Elevated Self-reported Malaria Prevalence in Accra, Ghana
Authors: Stoler Justin , Weeks John R. , Getis Arthur , Hill Allan G.
Published: September 2018

Irrigated urban agriculture (UA), which has helped alleviate poverty and increase food security in rapidly urbanizing sub-Saharan Africa, may inadvertently support malaria vectors. Previous studies have not identified a variable distance effect on malaria prevalence from UA. This study examines the relationships between self-reported malaria information for 3,164 women surveyed in Accra, Ghana, in 2003, and both household characteristics and proximity to sites of UA. Malaria self-reports are associated with age, education, overall health, socioeconomic status, and solid waste disposal method. The odds of self-reported malaria are significantly higher for women living within 1 km of UA compared with all women living near an irrigation source, the association disappearing beyond this critical distance. Malaria prevalence is often elevated in communities within 1 km of UA despite more favorable socio-economic characteristics than communities beyond 1 km. Neighborhoods within 1 km of UA should be reconsidered as a priority for malaria-related care.
Enzyme-linked Immunosorbent Assay for Superoxide Dismutase–Excreted Antigen in Diagnosis of Sylvatic and Andean Cutaneous Leishmaniasis of Peru
Authors: Marín Clotilde , Longoni Silvia S. , Urbano Jesús , Minaya Gloria , Mateo Hector , de Diego Jose A. , Rosales María José , Pérez-Cordón Gregorio , Romero Desiré , Sánchez-Moreno Manuel
Published: September 2018

A superoxide dismutase excreted by promastigote forms of L. (Viannia) peruviana (SODe-Lp), L. (Viannia) brazilensis (SODe-Lb), and L. (L.) amazonensis (SODe-La) is tested to evaluate its potential value as a diagnostic tool of mucocutaneous and Andean cutaneous leishmaniasis. We used 45 sera with mucocutaneous leishmaniasis (SL) and 68 with Andean cutaneous leishmaniasis (ACL). SODe-Lp antigen was recognized by 94% of the serum from ACL patients, and the SODe-Lb antigen was recognized by 93% of the serum from SL patients. Meanwhile, the result for SL and ACL patients with SODe-La antigen was 69% and 43% and SODe-Li was 11% and 9%, respectively. This suggest that antibodies to SODe-Lp undergo further response in patients with ACL and the antibodies to SODe-Lb do so preferentially in patients with SL. The SODe ELISA may be useful in endemic areas for discriminative assays between patients with different forms of leishmaniases and those with other clinical conditions.
Cross-sectional and Longitudinal Epidemiologic Surveys of Human and Canine Leishmania infantum Visceral Infections in an Endemic Rural Area of Southeast Brazil (Pancas, Espírito Santo)
Authors: Falqueto Aloísio , Ferreira Adelson L. , dos Santos Claudiney B. , Porrozzi Renato , da Costa Marcos V. Santos , Teva Antonio , Cupolillo Elisa , Campos-Neto Antonio , Grimaldi Gabriel
Published: September 2018

In an endemic rural area of southeast Brazil, surveys confirmed that dogs serve as peridomestic reservoirs of Leishmania infantum. It is likely that the lack of efficient control is because presently used diagnostic tests miss positive dogs. Overall, 57% of the dogs had specific antibodies, but the canine infection was not uniformly fatal and many seropositive dogs remained asymptomatic or even spontaneously recovered. Furthermore, 42% of the human residents became leishmanin-positive reactors and 47% had positive serology at the initial survey, but our estimates also point at a high recovery rate among the infected population with time. The delayed-type hypersensitivity (DTH) reaction to Leishmania was a good indicator of resistance to infection in this particular epidemiologic situation. The lack of any significant differences in infection rates by gender or age indicate that all of the population was at an equal risk of infection and most people were infected in the peridomestic setting.
Global Etiology of Travelers’ Diarrhea: Systematic Review from 1973 to the Present
Authors: Shah Nipam , DuPont Herbert L. , Ramsey David J.
Published: September 2018

Fifty-one published studies of travelers’ diarrhea (TD) were examined to look for regional differences in pathogens identified. Enterotoxigenic E. coli was detected in 1,678/5,518 (30.4%) of TD cases overall, with rates in Latin America/Caribbean (L. America), Africa, south Asia, and Southeast Asia of 1,109/3,302 (33.6%), 389/1,217 (31.2%), 153/499 (30.6%), and 36/500 (7.2%), respectively (P < 0.001). Enteroaggregative E. coli was the second most common agent in L. America, found in 166/689 (24.1%), compared with 3/165 (1.8%) in Africa and 33/206 (16%) in south Asia (P < 0.001). Other significantly regional differences were seen for enteropathogenic E. coli, diffusely adherent E. coli, Campylobacter, Shigella spp., Salmonella, Aeromonas spp., Plesiomonas, Vibrios, rotavirus, noroviruses, Giardia, and Entoamoeba histolytica. The regional differences in pathogen identification identified will serve as a baseline for antimicrobial therapy recommendations and vaccines strategies.
Marine Bacteria as a Leading Cause of Necrotizing Fasciitis in Coastal Areas of South Korea
Authors: Park Kyung-Hwa , Jung Sook-In , Jung Young-Sun , Shin Jong-Hee , Hwang Jae-Ha
Published: September 2018

Necrotizing fasciitis is a life-threatening soft-tissue infection. It is useful to know the etiology of this disease in each community and region because this information can facilitate early diagnosis and treatment. We reviewed medical records of 217 consecutive patients with necrotizing fasciitis in South Korea. Etiologic organisms were documented in 171 (78.8%) patients. Gram-negative marine bacteria were the most common organisms (68.4%). Seasonal variation in incidence occurred during warmer periods. Liver cirrhosis and alcoholism were common underlying illnesses. Gastrointestinal symptoms were more common in persons infected with gram-negative marine bacteria (56.4% versus 29.6%). Gram-negative bacteria were the predominant pathogens in multiple site involvement. Acute Physiology and Chronic Health Evaluation II scores, marine bacteria, and medical treatment without surgery affected mortality. When necrotic areas included less than three extremities, fasciotomy improved the survival rate. In coastal areas, gram-negative marine bacteria are the most common pathogens associated with necrotizing fasciitis. Fasciotomy can improve survival of patients with necrotic areas that involve less than three sites in necrotizing fasciitis.
Reduced Efficacy of Pyrethroid Space Sprays for Dengue Control in an Area of Martinique with Pyrethroid Resistance
Authors: Marcombe Sébastien , Carron Alexandre , Darriet Frédéric , Etienne Manuel , Agnew Philip , Tolosa Michel , Yp-Tcha Marie Michèle , Lagneau Christophe , Yébakima André , Corbel Vincent
Published: September 2018

In the Caribbean, insecticide resistance is widely developed in Aedes aegypti and represents a serious obstacle for dengue vector control. The efficacy of pyrethroid and organophosphate ultra-low volume space sprays was investigated in Martinique where Ae. aegypti has been shown to be resistant to conventional insecticides. In the laboratory, a wild-field caught population showed high levels of resistance to deltamethrin, organophosphate (naled), and pyrethrum. Simulated-field trials showed that this resistance can strongly reduce the knock-down effect and mortality of deltamethrin and synergized pyrethrins when applied by thermal-fogging. Conversely, the efficacy of naled was high against insecticide-resistant mosquitoes. Chemical analyses of nettings exposed to the treatments showed a decrease in residues over distance from release for the pyrethroids, and naled was not detected. This finding has important implications for dengue vector control and emphasizes the need to develop innovative strategies to maintain effective control of resistant Ae. aegypti populations.
Laboratory Assessment of a Gravity-Fed Ultrafiltration Water Treatment Device Designed for Household Use in Low-Income Settings
Authors: Clasen Thomas , Naranjo Jaime , Frauchiger Daniel , Gerba Charles
Published: September 2018

Interventions to improve water quality, particularly when deployed at the household level, are an effective means of preventing endemic diarrheal disease, a leading cause of mortality and morbidity in the developing world. We assessed the microbiologic performance of a novel water treatment device designed for household use in low-income settings. The device employs a backwashable hollow fiber ultrafiltration cartridge and is designed to mechanically remove enteric pathogenic bacteria, viruses, and protozoan cysts from drinking water without water pressure or electric power. In laboratory testing through 20,000 L (~110% of design life) at moderate turbidity (15 nephelometric turbidity unit [NTU]), the device achieved log10 reduction values of 6.9 for Escherichia coli, 4.7 for MS2 coliphage (proxy for enteric pathogenic viruses), and 3.6 for Cryptosporidium oocysts, thus exceeding levels established for microbiological water purifiers. With periodic cleaning and backwashing, the device produced treated water at an average rate of 143 mL/min (8.6 L/hour) (range 293 to 80 mL/min) over the course of the evaluation. If these results are validated in field trials, the deployment of the unit on a wide scale among vulnerable populations may make an important contribution to public health efforts to control intractable waterborne diseases.
Microbiologic Characterization and Antimicrobial Susceptibility of Clostridium tetani Isolated from Wounds of Patients with Clinically Diagnosed Tetanus
Authors: Campbell James I. , Yen Lam Thi Minh , Loan Huynh Thi , Diep To So , Nga Tran Thi Thu , Van Minh Hoang Nguyen , Son Le Thanh , van Vinh Chau Nguyen , Parry Christopher , Farrar Jeremy J. , Hien Tran Tinh , Baker Stephen
Published: September 2018

Clostridium tetani is the etiologic agent of the muscle-spasming disease tetanus. Despite an effective vaccine, tetanus is an ongoing problem in some developing countries. Diagnosis by bacterial culture is not done because it is generally unnecessary and the entry of route of the bacteria can be inapparent. We attempted to isolate and evaluate C. tetani from the wounds of 84 patients with tetanus. We effectively isolated C. tetani from 45 patients. All strains tested positive by polymerase chain reaction for the gene encoding tetanus neurotoxin. Antimicrobial susceptibilities were determined by disc diffusion and E-test. All C. tetani isolates were susceptible to penicillin and metronidazole but resistant to co-trimoxazole. Despite treatment with high doses of penicillin, C. tetani was isolated after 16 days of intravenous penicillin in two cases. These data show that the intravenous route for penicillin may be inadequate for clearing the infection and emphasizes wound debridement in the treatment of tetanus.
Cost of Dengue Cases in Eight Countries in the Americas and Asia: A Prospective Study
Authors: Suaya Jose A. , Shepard Donald S. , Siqueira João B. , Martelli Celina T. , Lum Lucy C. S. , Tan Lian Huat , Kongsin Sukhontha , Jiamton Sukhum , Garrido Fàtima , Montoya Romeo , Armien Blas , Huy Rekol , Castillo Leticia , Caram Mariana , Sah Binod K. , Sughayyar Rana , Tyo Karen R. , Halstead Scott B.
Published: September 2018

Despite the growing worldwide burden of dengue fever, the global economic impact of dengue illness is poorly documented. Using a common protocol, we present the first multicountry estimates of the direct and indirect costs of dengue cases in eight American and Asian countries. We conducted prospective studies of the cost of dengue in five countries in the Americas (Brazil, El Salvador, Guatemala, Panama, and Venezuela) and three countries in Asia (Cambodia, Malaysia, and Thailand). All studies followed the same core protocol with interviews and medical record reviews. The study populations were patients treated in ambulatory and hospital settings with a clinical diagnosis of dengue. Most studies were performed in 2005. Costs are in 2005 international dollars (I$). We studied 1,695 patients (48% pediatric and 52% adult); none died. The average illness lasted 11.9 days for ambulatory patients and 11.0 days for hospitalized patients. Among hospitalized patients, students lost 5.6 days of school, whereas those working lost 9.9 work days per average dengue episode. Overall mean costs were I$514 and I$1,394 for an ambulatory and hospitalized case, respectively. With an annual average of 574,000 cases reported, the aggregate annual economic cost of dengue for the eight study countries is at least I$587 million. Preliminary adjustment for under-reporting could raise this total to $1.8 billion, and incorporating costs of dengue surveillance and vector control would raise the amount further. Dengue imposes substantial costs on both the health sector and the overall economy.
Prevalence of Antibodies to Japanese Encephalitis Virus among Inhabitants in Java Island, Indonesia, with a Small Pig Population
Authors: Konishi Eiji , Sakai Yohei , Kitai Yoko , Yamanaka Atsushi
Published: September 2018

Japanese encephalitis virus (JEV) is maintained through a transmission cycle between amplifier swine and vector mosquitoes in a peridomestic environment. Thus, studies on natural JEV activities in an environment with a small size of pig population have been limited. Here, we surveyed antibodies against JEV in inhabitants of Jakarta and Surabaya located in Java Island (Indonesia), which has a small swine population. Overall, 2.2% of 1,211 sera collected in Jakarta and 1.8% of 1,751 sera collected in Surabaya had neutralizing antibody titers of ≥ 1:160 (90% plaque reduction). All the samples with titers of ≥ 1:160 against JEV were also examined for neutralizing antibodies against each of four dengue viruses to confirm that JEV antibody prevalences obtained in the present survey were not attributable to serologic cross-reactivities among flaviviruses distributed in Java. These results indicated that people in Java Island are exposed to natural JEV infections despite a small swine population.
Drug Hypersensitivity Syndrome Induced by Meglumine Antimoniate
Authors: Jeddi Fakhri , Caumes Eric , Thellier Marc , Jauréguiberry Stéphane , Mazier Dominique , Buffet Pierre A.
Published: September 2018

We report a case of drug hypersensitivity syndrome (drug reaction with eosinophilia and systemic symptoms [DRESS]) induced by parenteral meglumine antimoniate (Glucantime) in a 40-year-old man who traveled to Bolivia and was treated for mucocutaneous leishmaniasis. Two weeks after starting therapy, the patient had fever, joint pain, a cutaneous eruption, and hypereosinophilia (1,358 cells/mm3). These symptoms resolved after drug withdrawal but reappeared upon reintroduction of the drug. Pentavalent antimonials should be definitively withdrawn in patients with hypereosinophilia > 1,000 cells/mm3 accompanied by systemic manifestations consistent with DRESS.
Dynamic Changes of Hepatocyte Growth Factor in Eosinophilic Meningitis Caused by Angiostrongylus cantonensis Infection
Authors: Tsai Hung-Chin , Huang Yen-Lin , Liu Yung-Ching , Wann Shue-Ren , Lee Susan Shin-Jung , Chen Eng-Rin , Yen Chuan-Min , Tai Ming-Hong , Shi Min-Hon , Chen Yao-Shen
Published: September 2018

Hepatocyte growth factor (HGF) is a member of the angiogenic growth factor family, which exerts a variety of effects on epithelial, endothelial, and neuronal cells by binding to the c-MET receptor tyrosine kinase. It was reported that HGF attenuates cerebral ischemia-induced increase in permeability of the blood-brain barrier (BBB) and decreases in expression of tight junction proteins in cerebral vessels of rats. Studies on the localization of the c-Met/HGF receptor in the rat brain and the interaction with HGF after brain injuries show that HGF plays an important role as a neurotrophic factor in the brain. To assess the role of HGF in patients with eosinophilic meningitis, a retrospective, cohort study was conducted to measure the dynamic changes of HGF in the cerebrospinal fluid (CSF) and blood of nine patients with eosinophilic meningitis. The mean HGFCSF at presentation, 1 week, 2 weeks, and 3 weeks after admission was 539 pg/mL, 540 pg/mL, 376 pg/mL, and 279 pg/mL, respectively. The mean level of HGFCSF at presentation (539 ± 242 pg/mL) and 1 week after admission (540 ± 213 pg/mL) was significantly higher than in controls (162 ± 207 pg/mL)(P = 0.02 and P = 0.01, respectively). The CSF/blood ratio of HGF at presentation (0.61) was higher when compared with physiologic situations in uninfected individuals (0.51). The levels of HGF in CSF were not correlated with the amount of CSF cells or proteins. All patients recovered without neurologic sequelae. These results indicate that high concentrations of HGF in the CSF occur in eosinophilic meningitis, and may have a role in protecting against endothelial injury and reducing BBB dysfunction.