bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence and Predictive Factors for Orthopedic Surgery in Patients with Psoriatic Arthritis
Authors: Nystad Tone Wikene , Husum Yngvil Solheim , Furnes Ove Nord , Fevang Bjørg-Tilde Svanes
Published: September 2018

Objective.

To investigate the incidence of orthopedic procedures in patients with psoriatic arthritis (PsA), and how patient characteristics, time of diagnosis, and treatment affect the need for surgery.

Methods.

We reviewed the medical history of 1432 patients with possible PsA at Haukeland University Hospital in Bergen, Norway. There were 590 patients (mean age 49 yrs, 52% women) who had sufficient journal information and a confirmed diagnosis of PsA, and who were included in the present study. Relevant orthopedic procedures were obtained from the hospital’s administrative patient records. Survival analyses were completed to evaluate the effect of different factors such as year of diagnosis, age, sex, radiographic changes, disease activity, and treatment, on the risk of surgery.

Results.

There were 171 procedures (25% synovectomies, 15% arthrodesis, and 53% prostheses) performed on 117 patients. These factors all increased the risk of surgery: female sex [relative risk (RR) 1.9, p = 0.001], age ≥ 70 years at diagnosis (RR 2.4, p = 0.001), arthritis in initial radiographs (RR 2.2, p = 0.006), and maximum erythrocyte sedimentation rate 30–59 mm/h (RR 1.6, p = 0.026). Time period of diagnosis had no effect on the outcome. In a subanalysis of surgery exclusive of hip and knee arthroplasty, diagnosis in earlier years (1954–1985 vs 1999–2011) was a risk factor (RR 2.1, p = 0.042). Antirheumatic treatment changed significantly over time.

Conclusion.

There were 20% of patients with PsA who needed surgery. We found that the prognosis of patients with PsA did not change regarding the risk of orthopedic surgery, despite the change in treatment. A possible explanation is the increase in large joint replacements in the general population.
Traduire le régionalisme : le destin américain des pièces de Reinhold Solger
Authors: Massnick Thomas O.
Published: September 2018

Cet essai entend explorer les conséquences, politiques, génériques, du transfert d’une pièce régionaliste depuis l’Europe jusqu’en Amérique, à l’heure des Révolutions démocratiques du milieu du xix e  siècle. Der Reichstags-Professor , farce locale écrite par Reinhold Solger (1817-1866), dramaturge et homme politique révolutionnaire, lors de son exil en Suisse, use de jeux de dialecte pour souligner des rapports de classe. The Hon. Anodyne Humdrum: or, The Union Must and Shall be Preserved , version anglaise de la pièce, n’en est pas seulement une traduction : le décor n’est plus le Berlin post-révolutionnaire mais la Virginie d’avant la guerre de Sécession, et le dialecte y prend une autre signification, départageant les races plus que les classes. Cet essai reconsidère donc le rôle de la traduction et de la politique des genres dans la relocalisation géo-politique de la pièce régionale.
Heimat en errance dans les Histoires villageoises de la Forêt-Noire de Berthold Auerbach
Authors: Gauthier Cécile
Published: September 2018

La Heimat , dans le premier volume des Histoires villageoises de la Forêt-Noire (1843) de B. Auerbach, est plus globalisée que ne le laisserait penser son traditionnel ancrage dans le local : les mutations de la modernité ont atteint le village et la Heimat naît de la crainte de sa prochaine disparition. Ce qui émerge alors est une Heimat en errance, Heimat nomade, délocalisée voire relocalisable. Cet article étudie les mutations de l’expérience de la Heimat à travers deux histoires villageoises, et le parcours de deux personnages : Tolpatsch, qui émigre et réimplante son village souabe outre-mer, découvrant là-bas sa germanité tout en devenant progressivement américain ; et Ivo, double autobiographique de l’auteur, qui choisit le village d’à côté, signe, peut-être, d’une impossible Heimkehr , mais signe aussi d’une réinvention de la Heimat , et donc de soi, par l’expérience de l’écart.
« Je suis maîtrisé par mon imagination » : le cas Chénier
Authors: Genand Stéphanie
Published: September 2018

La poésie d’André Chénier accorde une importance particulière à l’imagination : conçue comme une dépossession de soi, elle s’apparente, par sa violence et l’autonomie dont la dote le poète rendu passif par ses assauts, à une crise qui invalide la raison. Transport, élans, désorganisation des facultés, ses symptômes la rattachent à la folie qui s’empare des esprits au moment 1800 : de la recherche d’une syntaxe plus souple, capable d’épouser les élucubrations des âmes poétiques, à la vogue des « folles » au théâtre, en passant par les convulsions politiques qui égarent les contemporains, les signes abondent d’un dérèglement et d’une perte des repères au tournant du siècle. Chénier, pleinement inscrit dans ce contexte, y joue un rôle moteur en tendant le miroir de ses textes aux excès et aux stupeurs des imaginations, amoureuses, familiales ou politiques, qui nourrissent son inspiration. Et si son œuvre se voulait, par ses fractures et ses lacunes, la partition la plus à l’écoute des chants inquiétants qui surgissent autour de lui ?
Qu’est-ce qu’un doute raisonnable ?
Authors: Vorms Marion
Published: September 2018

Un aspect particulier de l’irrationalité théorique concerne les croyances qu’il faudrait suspendre ou ne pas accepter : le doute raisonnable. Faute de pouvoir déterminer avec certitude ce qu’il est rationnel de croire en certaines circonstances, notamment lorsque, comme dans le cas d’un procès criminel, on ne peut avoir un accès direct ni garanti à la vérité, il est commun de recourir à un critère moins exigeant que celui de rationalité, à savoir celui du raisonnable, qui est d’essence politique et sociale, autant qu’épistémologique. Qu’est-ce qu’un doute raisonnable, tel qu’on l’entend dans la tradition juridique de la common law , et qu’est-ce qui fixe le seuil au-delà duquel le jury est autorisé à considérer que les preuves fournies établissent effectivement la culpabilité du prévenu ?
L’aveuglement volontaire
Authors: Bandini Aude
Published: September 2018

La notion d’aveuglement volontaire constitue un objet de perplexité pour la philosophie de la connaissance. Étroitement apparentée à celle de déni, elle semble présupposer qu’un même sujet pourrait voir ce qui est et pourtant réussir, volontairement, à ne pas le voir. On soutient que ce paradoxe n’est que de surface, et qu’il est non seulement parfois possible de s’aveugler volontairement, mais qu’il même parfois tout à fait rationnel de le faire. Dans tous les cas cependant, l’agent doit assumer la responsabilité des croyances et des actes qu’il fonde sur cette base.
DIOCTOPHYMA RENALE EM TESTÍCULO DE CÃO NO MUNICÍPIO DE CURITIBANOS, SC, BRASIL – RELATO DE CASO
Authors: Da Rocha Marilise França , Padilha Vanessa Sasso , Córdova Renata Alves , Marcondes Maysa Bonades
Published: September 2018

Dioctophyma renale, é o maior nematódeo parasita de animais domésticos, é chamado de “o verme gigante do rim. O seu ciclo de vida é incompleto e heteroxêmico, apresentando como hospedeiros definitivos os canídeos e, raramente, os bovinos, os equinos, os suínos, os gatos, alguns animais silvestres e o homem. Como hospedeiro intermediário (HI) tem anelídeos oligoquetas (Lumbriculus variegatus), que parasitam brânquias de crustáceos. Ainda pode ter hospedeiros paratênicos ou acidentais (HP) como rãs ou peixes. Sendo que o hospedeiro definitivo se infecta através da ingestão de hospedeiros intermediários ou paratênicos, e estes através dos ovos eliminados na urina do hospedeiro definitivo. O parasito é encontrado frequentemente no rim direito, porém pode ser observado em rim esquerdo, em tecido subcutâneo, livre na cavidade abdominal, em glândula mamária, em cavidade torácica, em ureteres, em bexiga e mais raramente em testículo de cão. Foi recebido para orquiectomia eletiva na Clínica Veterinária Toca dos Bichos, em Curitibanos, SC, um cão, macho, de aproximadamente dois anos de idade, sem raça definida, pesando 10,5kg. O tutor informou que recolheu o animal da rua há aproximadamente um ano. Durante o procedimento cirúrgico, foi observado que o testículo esquerdo estava alterado, com menor tamanho e consistência amolecida em relação ao testículo direito. Ao incidir a cápsula externou-se o verme, havendo intensa destruição do parênquima testicular e conteúdo sanguinolento no interior da mesma. O tutor foi orientado à realização de exames complementares para diagnosticar o parasitismo em outros órgãos do animal, bem como realizar exame nos outros animais que possui.
PERCEPTIONS OF BED NETS AND MALARIA PREVENTION BEFORE AND AFTER A RANDOMIZED CONTROLLED TRIAL OF PERMETHRIN-TREATED BED NETS IN WESTERN KENYA
Authors: ALAII JANE A. , VAN DEN BORNE H. W. , KACHUR S. PATRICK , MWENESI HALIMA , VULULE JOHN M. , HAWLEY WILLIAM A. , MELTZER MARTIN I. , NAHLEN BERNARD L. , PHILLIPS-HOWARD PENELOPE A.
Published: September 2018

A study of mothers’ perceptions regarding bed nets and malaria was conducted before and after a randomized controlled trial of insecticide (permethrin)-treated bed nets (ITNs) in western Kenya. Awareness about the trial and the rationale for bed net use increased by the end of the trial. Knowledge that mosquitoes caused malaria also increased; however, a higher proportion of mothers from control, rather than intervention villages, cited this (44.4% versus 27.9%; P < 0.001). Mothers from intervention villages were more knowledgeable about the use and maintenance of bed nets and re-treatment with insecticide. Both groups specified advantages of ITNs. Mothers from intervention villages noted practical advantages such as protection against bedbugs and falling roof debris. Few (< 1%) mothers indicated that ITNs protected children against malaria. Intervention homes used significantly fewer mosquito coils, insect spray, medicines, and burned cow dung less often compared with those in control villages. Mothers were willing to pay approximately U.S. $ 4.5 for a regular bed net, but only U.S. 10.5 cents (intervention) and 0.036 (control) for re-treating a bed net. This study suggests that, despite two years of experience of use, bed nets and insecticides would not be purchased as a household priority in this impoverished rural community.
SEROTYPE-SPECIFIC DENGUE VIRUS CIRCULATION AND DENGUE DISEASE IN BANGKOK, THAILAND FROM 1973 TO 1999
Authors: NISALAK ANANDA , ENDY TIMOTHY P. , NIMMANNITYA SUCHITRA , KALAYANAROOJ SIRIPEN , THISAYAKORN USA , SCOTT ROBERT M. , BURKE DONALD S. , HOKE CHARLES H. , INNIS BRUCE L. , VAUGHN DAVID W.
Published: September 2018

Dengue virus circulation and association with epidemics and severe dengue disease were studied in hospitalized children with suspected dengue at the Queen Sirikit National Institute of Child Health in Bangkok, Thailand, from 1973 to 1999. Dengue serology was performed on all patients and viral isolation attempted on laboratory-confirmed patients. Acute dengue was diagnosed in 15,569 children and virus isolated from 4,846. DEN-3 was the most frequent serotype in primary dengue (49% of all isolates), DEN-2 in secondary and in dengue hemorrhagic fever (37% and 35%, respectively). The predominant dengue serotype varied by year: DEN-1 from 1990–92, DEN-2 from 1973–86 and 1988–89; DEN-3 in 1987 and 1995–99; and DEN-4 from 1993–94. Only DEN-3 was associated with severe outbreak years. Our findings illustrate the uniqueness of each serotype in producing epidemics and severe disease and underscore the importance of long-term surveillance of dengue serotypes in understanding the epidemiology of these viruses.
TRANSMISSION OF MIXED PLASMODIUM SPECIES AND PLASMODIUM FALCIPARUM GENOTYPES
Authors: AREZ ANA PAULA , PINTO JOÃO , PÅLSSON KATINKA , SNOUNOU GEORGES , JAENSON THOMAS G. T. , DO ROSÁRIO VIRGÍLIO E.
Published: September 2018

We studied malaria transmission by comparing parasite populations in humans and mosquito vectors at the household level. Blood samples were collected from all inhabitants for microscopic detection of gametocytes and polymerase chain reaction analysis. The next morning, blood-fed resting mosquitoes were collected inside the bed nets used by the individuals surveyed the previous afternoon. After 8 days of maintenance, mosquitoes were dissected, and midguts and salivary glands were recovered for polymerase chain reaction analysis. Results showed that parasite distribution was the same in the 2 hosts when compared at each household but was different when whole populations were analyzed. Different associations of Plasmodium species seem to occur in humans (Plasmodium falciparum/Plasmodium malariae) and mosquitoes (P. falciparum/Plasmodium ovale). Regarding P. falciparum infections, a higher proportion of single-genotype infections and less allele diversity are observed in mosquitoes than in humans.
SHORT REPORT: TREATMENT FAILURE IN HANSEN’S DISEASE
Authors: MURRAY CLINTON K. , JOYCE M. PATRICIA , LONGFIELD ROBERT N.
Published: September 2018

Areas of low endemicity of Hansen’s disease, such as Texas, California, and Hawaii, exist due to immigration and rare autochthonous infections. Managing this disease in these areas of low endemicity is difficult, especially in observing for relapse. The accurate diagnosis of relapse is imperative so that appropriate therapy can be promptly reinstituted and unnecessary treatment can be avoided. To assess treatment failures in an area of low endemicity, we retrospectively evaluated 113 patients with Hansen’s disease treated in southern Texas. Of 57 patients who completed therapy, 11 were later restarted on medications for this disease for presumed relapse. However, nine of the 11 were found not to have true relapses of Hansen’s disease. The accurate diagnosis of relapse of this disease is essential not only in the individual patient but also for prospective treatment trials to establish best practices.
RELATIONSHIPS BETWEEN WUCHERERIA BANCROFTI MICROFILARIA COUNTS IN HUMAN BLOOD AND PARASITE UPTAKE AND MATURATION IN CULEX PIPIENS, WITH OBSERVATIONS ON THE EFFECTS OF DIETHYLCARBAMAZINE TREATMENT ON THESE PARAMETERS
Authors: FARID HODA A. , HAMMAD RAGAA E. , SOLIMAN DOAA A. , EL SETOUHY MAGED A. , RAMZY REDA M. R. , WEIL GARY J.
Published: September 2018

This study examined relationships between blood microfilaria (MF) counts and parasite uptake and maturation in Culex pipiens fed on Egyptian volunteers with bancroftian filariasis. Uptake of MF and production of infective larvae (L3) were more closely correlated with MF counts in finger prick blood than in venous blood. Only a minority of ingested MF developed into L3. Few MF were ingested, and very few L3 were produced by mosquitoes that fed on infected subjects who were amicrofilaremic by 50 μL thick blood smear; the contribution of such carriers to filariasis transmission in Egypt is probably negligible. These results suggest that filariasis elimination programs should aim to achieve MF smear rates of zero. Single-dose diethylcarbamazine therapy reduced MF counts by 87.9% 6–7 months after treatment; similar reductions were observed for MF uptake, MF/mosquito, infectivity, and L3/mosquito. Thus, single-dose diethylcarbamazine had a major impact on MF ingestion and L3 production by mosquitoes.
ANTIBODIES TO SCHISTOSOMA MANSONI IN HUMAN CEREBROSPINAL FLUID
Authors: MAGALHÃES-SANTOS ISIS F. , LEMAIRE DENISE C. , ANDRADE-FILHO ANTONIO S. , QUEIROZ ARISTIDES C. , CARVALHO OTÁVIO M. , CARMO THEOMIRA M. A. , SIQUEIRA ISADORA C. , ANDRADE DÉBORA M. , REGO MICHELY F. , GUEDES ANA PAULA T. , REIS MITERMAYER G.
Published: September 2018

Cerebrospinal fluid (CSF) and serum samples from patients suspected of having neuroschistosomiasis (NS) were evaluated by an enzyme-linked immunosorbent assay. Monoclonal antibodies of various immunoglobulin isotypes (IgM, IgA, IgE, total IgG, IgG1, IgG2, IgG3, and IgG4) were used to detect antibodies against Schistosoma mansoni soluble egg antigen (SEA) and soluble worm adult preparation (SWAP). Of the 83 CSF samples tested, 55% were reactive to SEA (26% were reactive only to SEA and 29% to both SEA and SWAP), 34% were reactive to SWAP (5% only to SWAP and 29% to both SEA and SWAP), and 40% were not reactive with any antigen. Cases that tested positive for SWAP in CSF and negative in serum were not found. Samples with high specific IgG antibody titers were selected for immunoglobulin isotype profiling. In the CSF samples, the antibodies against SEA and SWAP were mainly IgM, IgG1, and IgG4, although other immunoglobulins were also detected. Interestingly, nine patients had high levels of IgG1 only in the CSF. These results suggest that there is local synthesis of IgG1, and that this isotype could be an important immunologic marker in the diagnosis of NS.
RESISTANCE OF AEDES AEGYPTI TO ORGANOPHOSPHATES IN SEVERAL MUNICIPALITIES IN THE STATE OF RIO DE JANEIRO AND ESPíRITO SANTO, BRAZIL
Authors: LIMA JOSÉ BENTO PEREIRA , DA-CUNHA MARCELLA PEREIRA , DA SILVA JÚNIOR RONALDO CARNEIRO , RIBEIRO GALARDO ALLAN KARDEC , DA SILVA SOARES SIDINEI , BRAGA IMA APARECIDA , RAMOS RICARDO PIMENTEL , VALLE DENISE
Published: September 2018

Chemical insecticides have been widely used in Brazil for several years. This exposes mosquito populations to an intense selection pressure for resistance to insecticides. In 1999, the Brazilian National Health Foundation started the first program designed to monitor the resistance of Aedes aegypti to insecticides. We analyzed populations from 10 municipalities (from 84 selected in Brazil) in the states of Rio de Janeiro and Espírito Santo. Exposure of larvae to a diagnostic dose of temephos showed in alterations in susceptibility in all populations. Mosquitoes from eight municipalities exhibited resistance, with mortality levels ranging from 74% (Campos dos Goytacazes, Rio de Janeiro) to 23.5% (São Gonçalo, Rio de Janeiro). The resistance ratios of mosquitoes from three municipalities ranged from 3.59 to 12.41. Adults from only one municipality (Nova Iguaçu, Rio de Janeiro) remained susceptible to both fenitrothion and malathion. These results are being used to define new local vector control strategies.
FEAR OF INJECTIONS IN YOUNG ADULTS: PREVALENCE AND ASSOCIATIONS
Authors: NIR YAEL , PAZ ALONA , SABO EDMOND , POTASMAN ISRAEL
Published: September 2018

Fear of injections may interfere with receipt of vaccines. The frequency, associations, and precipitators of fear-provoking factors of 400 travelers visiting a travel health clinic were evaluated. The median age of this group was 25, 7% were medical staff members, and 2.8% were regular injectors (insulin). Eighty-five (21.7%; 95% confidence interval, 17.3–25.6%) of the travelers indicated that they were afraid of injections, and in 8.2%, the fear was unreasonably intense. Multivariate analysis revealed that watching other people being vaccinated, fear of pain, needle size, and a history of fainting were highly and independently associated with injection phobia. The sensitivity, specificity, and discrimination accuracy of this model were 79.5%, 78.0%, and 78.3%, respectively. Injection phobia and a bad past vaccination experience were significantly associated with fainting. Perceived empathy, on the other hand, was a significant protective factor. Fear of injections was common in this cohort and was highly associated with past fainting after vaccination.
SIGNIFICANT LINKAGE DISEQUILIBRIUM AND HIGH GENETIC DIVERSITY IN A POPULATION OF PLASMODIUM FALCIPARUM FROM AN AREA (REPUBLIC OF THE CONGO) HIGHLY ENDEMIC FOR MALARIA
Authors: DURAND P. , MICHALAKIS Y. , CESTIER S. , OURY B. , LECLERC M.C. , TIBAYRENC M. , RENAUD F.
Published: September 2018

A study based on 28 microsatellite loci was performed on 32 isolates of Plasmodium falciparum from Pointe Noire (Republic of the Congo) and compared with a cosmopolitan sample of 21 isolates collected from different countries in Africa, Latin America, and Asia. The Pointe Noire population exhibited very high genetic diversity (A = 7.8 ± 2.6, He = 0.79 ± 0.11). Significant linkage disequilibria were observed in 28 of 378 pairs of microsatellite loci. This result could be explained by two non-exclusive hypotheses: 1) uniparental propagation (i.e., selfing), leading to non-panmictic associations, and/or 2) a Wahlund effect (i.e., spatial population genetic heterogeneity). These observations are in agreement with data previously obtained from isozyme loci of the same isolates, but contrast with other population genetic analyses conducted in other hyperendemic zones.
A RETROSPECTIVE EXAMINATION OF MOSQUITO INFECTION ON HUMANS INFECTED WITH PLASMODIUM FALCIPARUM
Authors: COLLINS WILLIAM E. , JEFFERY GEOFFREY M.
Published: September 2018

A retrospective examination was made of archival data collected between 1940 and 1963 on the infection of mosquitoes with Plasmodium falciparum. Patients were undergoing malariatherapy for the treatment of neurosyphilis. A total of 913 lots of Anopheles quadrimaculatus and An. albimanus were fed on 173 patients. Mosquito infection continued to occur in a few patients beyond 200 days of patent parasitemia. The primary period of mosquito infection occurred during the first 20 days of gametocytemia. Of the 311 lots of mosquitoes fed during this period, 209 (67.20%) were infected, and of these, 163 had greater than 50% of the mosquitoes in the lots infected with at least one oocyst. During secondary periods of gametocytemia, 293 (78.76%) of 372 lots of mosquitoes were infected. The highest percentages of mosquitoes were infected from four days before to four days following peak gametocyte density. Mosquito infection rates were similar to those seen in studies with splenectomized Aotus monkeys experimentally infected with P. falciparum.
THE MORTALITY CONSEQUENCES OF THE CONTINUED USE OF CHLOROQUINE IN AFRICA: EXPERIENCE IN SIAYA, WESTERN KENYA
Authors: ZUCKER JANE R. , RUEBUSH TRENTON K. , OBONYO CHARLES , OTIENO JULIANA , CAMPBELL CARLOS C.
Published: September 2018

In spite of increasing resistance, chloroquine remains the primary drug for treatment of malaria in most sub-Saharan African countries. We evaluated the effect of drug treatment policy on the case-fatality rates of children, adjusting for differing distributions of malaria and severe anemia. In 1991, 63% of children were treated with chloroquine while the remaining 37% were treated with a regimen that would eliminate and clear parasitemia. Case-fatality rates were 13% and 4.1%, respectively; the proportion of deaths attributable to chloroquine treatment was 69%. The trend in case-fatality rates for malaria decreased as an increasing proportion of children received an effective treatment regimen; adjusted malaria case-fatality rates were 5.1%, 3.6%, and 3.3% in 1992, 1993, and 1994, respectively, when 85% of children in 1992 and 97% of children in 1993–1994 received effective therapy. These 4 years of data provide strong evidence that continued use of chloroquine in areas with resistance is contributing to excess Plasmodium falciparum-related deaths.
IDENTIFICATION OF THE PEOPLE FROM WHOM ENGORGED AEDES AEGYPTI TOOK BLOOD MEALS IN FLORIDA, PUERTO RICO, USING POLYMERASE CHAIN REACTION-BASED DNA PROFILING
Authors: DE BENEDICTIS JOHN , CHOW-SHAFFER ESTHER , COSTERO ADRIANA , CLARK GARY G. , EDMAN JOHN D. , SCOTT THOMAS W.
Published: September 2018

We used polymerase chain reaction-based DNA profiling to construct allelic profiles for residents and visitors of 22 houses in Florida, Puerto Rico, and human DNA from blood meals in Aedes aegypti that were collected in those homes. Complete profiles were obtained for ≤ 2 days after blood ingestion. Eighteen percent of the meals came from two different people. There was no evidence of meals from ≥ 2 people. Eighty percent of the meal sources were identified, > 70% were taken from residents of the collection house, and > 90% were from residents of the study community. Across the community, feeding was non-random with a bias towards young adults and males. Three people accounted for 56% of the meals. Our results confirm that multiple feeding on different people is an important component in the role of Ae. aegypti in dengue virus transmission and help explain the spatial distribution of dengue cases in a previous epidemic in Florida, Puerto Rico.
PREVALENCE OF RELATIVE BRADYCARDIA IN ORIENTIA TSUTSUGAMUSHI INFECTION
Authors: ARONOFF DAVID M. , WATT GEORGE
Published: September 2018

We investigated 100 febrile patients infected with Orientia tsutsugamushi (the etiologic agent of scrub typhus) for the presence of relative bradycardia, defined as in increase in heart rate of < 10 beats/minutes/1°C increase in temperature. The median heart rate response for the entire febrile scrub typhus population was 9.3 beats/minute/°C and the prevalence of relative bradycardia was 53%. The occurrence of relative bradycardia was independent of patient age or gender. There were no differences in median basal temperature or febrile temperature between those patients exhibiting relative bradycardia and those with a normal febrile pulse increase. However, febrile patients with relative bradycardia had a significantly higher resting pulse rate following recovery from infection than did patients who had a normal pulse increase during their illness. These data demonstrate that relative bradycardia frequently accompanies mild infection with O. tsutsugamushi and that baseline cardiovascular parameters may affect the febrile heart rate response to scrub typhus.
ENZOOTIC TRANSMISSION OF THE AGENT OF HUMAN GRANULOCYTIC EHRLICHIOSIS AMONG COTTONTAIL RABBITS
Authors: GOETHERT HEIDI K. , TELFORD SAM R.
Published: September 2018

To determine whether the agent of human granulocytic ehrlichiosis (HGE) (Anaplasma phagocytophilum) may be maintained in a parallel enzootic cycle between cottontail rabbits and their ticks, we sampled these hosts from a zoonotic site during five transmission seasons. Evidence of infection was sought by microscopy and polymerase chain reaction from rabbit blood or splenic tissue, and from ticks collected from rabbits or from vegetation. Approximately 27% of all rabbits sampled contained evidence of active infection, and 66% were seropositive. The vectorial capacity of Ixodes dentatus was demonstrated by xenodiagnosis studies; in addition, 2% of host-seeking nymphs were infected. Haemaphysalis leporispalustris was not a competent vector. Because of their propensity to densely inhabit peridomestic sites, and because I. dentatus may be transported by birds, a parallel cycle of transmission in cottontail rabbits would facilitate introduction and perpetuation of the agent of HGE.
SENSITIVITY AND SPECIFICITY OF ULTRASOUND DETECTION AND RISK FACTORS FOR FILARIAL-ASSOCIATED HYDROCELES
Authors: TOBIAN AARON A. R. , TARONGKA NANDAO , BAISOR MOSES , BOCKARIE MOSES , KAZURA JAMES W. , KING CHRISTOPHER L.
Published: September 2018

To better understand risk factors for hydrocele as a consequence of Wuchereria bancrofti infection, 342 men more than 15 years of age in an endemic area in Papua New Guinea were evaluated. Thirty-four subjects (9.9%) had hydrocele by physical examination. Ultrasound examination detected hydroceles in 57 men (16.7%). Compared with ultrasonography, the sensitivity of physical examination was 44.3%, the specificity was 98.2%, and the positive predictive value was 73.5%. Hydrocele was independently associated with age (odds ratio [OR] = 3.3, P < 0.01) and intensity of infection as determined by filarial antigenemia (OR = 2.3, P = 0.07). Dilation of spermatic cord lymphatics detectable by ultrasound did not correlate with hydrocele, but was associated with the presence of infection. These observations suggest that filarial pathology of the male genitalia is under-reported when evaluated by physical examination alone and that duration and intensity of infection are risk factors for hydrocele.
DENGUE FEVER WITH ACUTE ACALCULOUS CHOLECYSTITIS
Authors: WU KENG-LIANG , CHANGCHIEN CHI-SIN , KUO CHUNG-MOU , CHUAH SENG-KEE , LU SHENG-NAN , ENG HOCK-LIEW , KUO CHUNG-HUANG
Published: September 2018

Dengue fever (DF) with acute acalculous cholecystitis is rarely reported. To investigate the incidence, treatment, and prognosis of acute acalculous cholecystitis in DF patients, we retrospectively studied 10 patients with DF and acute acalculous cholecystitis. From October 2001 to July 2002, 131 patients were diagnosed with DF. Ten of 131 DF patients (7.63%) had complications of acute acalculous cholecystitis. Two patients underwent cholecystectomy and one underwent percutaneous transhepatic gallbladder drainage due to poor resolution of acute acalculous cholecystitis. We found acute acalculous cholecystitis in a small proportion of patients with DF. In our experience, closely monitoring vital signs to avoid shock and correct thrombocytopenia to avoid bleeding could be adequate for most patients. In some cases, surgical treatment may be needed for DF fever patients with complications of diffuse peritonitis.
CENTRAL NERVOUS SYSTEM INVOLVEMENT IN EXPERIMENTAL INFECTION WITH LEISHMANIA (LEISHMANIA) AMAZONENSIS
Authors: ABREU-SILVA A. L. , CALABRESE K. S. , TEDESCO R. C. , MORTARA R. A. , DA COSTA S. C. GONÇALVES
Published: September 2018

We describe the pathologic alterations of the central nervous system (CNS) observed in experimental tegumentary leishmaniasis in BALB/c and Swiss mice. The mice were subcutaneously infected with 104 amastigotes of Leishmania (Leishmania) amazonensis. Animals were killed and brains were removed for histologic and immunocytochemical studies. Histologic examination showed that 66.6% of infected mice had a discrete hyperemia and inflammatory infiltrate in the meninges, composed of mononuclear cells and neutrophils with no detectable parasites. However, parasitized macrophages were detected in the cerebral parenchyma, as well as mast cells, lymphocytes, and polymorphonuclear cells. Necrosis in the cerebral parenchyma was also observed. Confocal fluorescence microscopy showed that CD8+ T lymphocytes are the major component of the inflammatory infiltrate in the CNS. In addition to these cells, CD4+, CD11b, and dendritic cells are present, in small numbers, in the inflammatory processes of the CNS. Thus, L. amazonensis is able to cross the blood-brain barrier and cause significant pathologic changes in the CNS.
LARGE GENETIC DIFFERENTIATION AND LOW VARIATION IN VECTOR COMPETENCE FOR DENGUE AND YELLOW FEVER VIRUSES OF AEDES ALBOPICTUS FROM BRAZIL, THE UNITED STATES, AND THE CAYMAN ISLANDS
Authors: DE OLIVEIRA RICARDO LOURENÇO , VAZEILLE MARIE , DE FILIPPIS ANA MARIA BISPO , FAILLOUX ANNA-BELLA
Published: September 2018

We conducted a population genetic analysis of Aedes albopictus collected from 20 sites in Brazil, the United States (Florida, Georgia, and Illinois), and the Cayman Islands. Using isoenzyme analysis, we examined genetic diversity and patterns of gene flow. High genetic differentiation was found among Brazilian samples, and between them and North American samples. Regression analysis of genetic differentiation according to geographic distances indicated that Ae. albopictus samples from Florida were genetically isolated by distance. Infection rates with dengue and yellow fever viruses showed greater differences between two Brazilian samples than between the two North American samples or between a Brazilian sample and a North American sample. Introductions and establishments of new Ae. albopictus populations in the Americas are still in progress, shaping population genetic composition and potentially modifying both dengue and yellow fever transmission patterns.
EVALUATION OF BAITS FOR DELIVERY OF ORAL RABIES VACCINE TO DOGS IN GUATEMALA
Authors: CORN JOSEPH L. , MÉNDEZ JAIME R. , CATALÁN EDMUNDO E.
Published: September 2018

Acceptance of oral baits by dogs was evaluated in Guatemala. Eight bait matrix/attractant combinations were produced using commercial materials available in the United States. Two baits were produced using local materials in Guatemala. All baits included a plastic sachet that contained a placebo vaccine (water). Bait trials were conducted February–April, 2002, at five sites using 261 dogs. Bait acceptance ranged from 50.0% to 87.1%, and the combined proportion of sachets either swallowed or punctured ranged from 23.1% to 83.9%. The four bait types with the highest acceptance by dogs were the wax-coated sachet coated with poultry oil and poultry meal (87.1%), the dog meal polymer coated with poultry oil and poultry meal (82.8%), the fish meal polymer coated with poultry oil and poultry meal (77.4%), and the chicken head bait (77.8%). These four bait types were accepted most often as determined both by consumption and combined proportion of sachets swallowed or punctured (P = 0.0001). Future trials should demonstrate efficacy of oral rabies vaccination in Guatemala based on the use of selected bait matrices and the poultry oil/poultry meal attractant.
MOLECULAR EPIDEMIOLOGY OF MALARIA IN CAMEROON. XV. EXPERIMENTAL STUDIES ON SERUM SUBSTITUTES AND SUPPLEMENTS AND ALTERNATIVE CULTURE MEDIA FOR IN VITRO DRUG SENSITIVITY ASSAYS USING FRESH ISOLATES OF PLASMODIUM FALCIPARUM
Authors: BASCO LEONARDO K.
Published: September 2018

In vitro drug sensitivity assay is an important tool for various on-going studies aiming to establish the correlation between candidate molecular markers for drug resistance and drug response in laboratory-adapted strains and field isolates of Plasmodium falciparum. A widespread use of this technique in the field would require a suitable substitute that can replace human serum. In this study, several alternative sources of serum substitutes and supplements were evaluated for their capacity to sustain parasite growth for a single life cycle and their compatibility with in vitro assays for clinical isolates that have not been adapted to in vitro culture. Albumax, a commercial preparation of lipid-enriched bovine albumin, did not support parasite growth as much as human serum and fetal calf serum in several isolates. Other serum supplements (AmnioMax and Ultroser) supported parasite growth relatively well. The 50% inhibitory concentrations (IC50s) of chloroquine and antifolates determined with 0.05% Albumax were generally two or three times higher than with human serum. With 10% fetal calf serum, IC50s for chloroquine and antifolates were approximately two times higher and three times lower than with human serum, respectively. The use of AmnioMax and OptiMAb resulted in a greater than two-fold increase in IC50s and several uninterpretable assays. Despite possible batch-to-batch differences, fetal calf serum may be a suitable substitute for in vitro drug assays while awaiting the results of further studies on other serum substitutes and supplements.
MOLECULAR EPIDEMIOLOGY OF MALARIA IN CAMEROON. XVI. LONGITUDINAL SURVEILLANCE OF IN VITRO PYRIMETHAMINE RESISTANCE IN PLASMODIUM FALCIPARUM
Authors: BASCO LEONARDO K.
Published: September 2018

Clinical observations have shown that pyrimethamine resistance develops rapidly in endemic countries where antifolate drugs are used massively for the treatment of Plasmodium falciparum infections. To analyze this phenomenon, the in vitro response of clinical isolates to pyrimethamine and the dihydrofolate reductase (dhfr) gene sequence were analyzed in 2000–2001 and compared with the results obtained since 1994 in Yaounde, Cameroon. Of 139 samples obtained in 2000–2001, 10 (7.2%) isolates were of the wild-type, 116 had pure mutant alleles (2 [1.4%] with a single mutation, 11 [7.9%] with double mutations, and 103 [74.1%] with triple mutations), and 13 (9.4%) had mixed alleles. With the exception of a single isolate with triple mutations (50% inhibitory concentration [IC50] = 84.3 nM), all isolates with pure wild-type dhfr alleles (IC50 < 100 nM) and those with pure mutant dhfr alleles (between 1 and 3 point mutations; IC50 ≥ 100 nM) were clearly distinguished by in vitro drug sensitivity assays. The results of the two methods are highly correlated, and both methodologic approaches indicate an increasing proportion of pyrimethamine-resistant isolates in Yaounde over the past eight years (42–45% in 1994–1995, 63–67% in 1997–1998, and 88–92% in 2000–2001). At present, clinical isolates carrying triple dhfr mutations predominate in Yaounde. This situation calls for a regular surveillance of the efficacy of antifolate drugs by all available means, including clinical evaluation, in vitro drug sensitivity assays, molecular markers, and pharmacologic studies.
EXPERIMENTAL INFECTION OF THE OLIVE BABOON (PAPIO ANUBIS) WITH PLASMODIUM KNOWLESI: SEVERE DISEASE ACCOMPANIED BY CEREBRAL INVOLVEMENT
Authors: OZWARA HASTINGS , LANGERMANS JAN A. M. , MAAMUN JENNEBY , FARAH IDLE O. , YOLE DORCAS S. , MWENDA JASON M. , WEILER HORST , THOMAS ALAN W.
Published: September 2018

Experimental systems that model some of the complex interactions between parasite and host can be extremely valuable in identifying and developing new prophylactics and therapeutics against human diseases. Because primates have similar immune systems to humans, we have characterized a baboon model for understanding host response to Plasmodium knowlesi. Ten intact olive baboons (Papio anubis) of either sex were experimentally infected with P. knowlesi H strain erythrocytic parasites. The infection in these baboons was either acute or chronic. Animals with acute infection developed multiple system organ dysfunction and cerebral involvement. In chronically infected animals, only the spleen was moderately enlarged. The P. knowlesi parasitemia profile in baboons and rhesus monkeys was comparable. However, some clinical symptoms of the baboons and P. falciparum-infected humans were similar. These studies demonstrate for the first time that P. anubis is a suitable host for P. knowlesi for studying clinical symptoms and pathology.
INCREASING PREVALENCE OF WILDTYPES IN THE DIHYDROFOLATE REDUCTASE GENE OF PLASMODIUM FALCIPARUM IN AN AREA WITH HIGH LEVELS OF SULFADOXINE/PYRIMETHAMINE RESISTANCE AFTER INTRODUCTION OF TREATED BED NETS
Authors: ALIFRANGIS MICHAEL , LEMNGE MARTHA M. , RØNN ANITA M. , SEGEJA METHOD D. , MAGESA STEPHEN M. , KHALIL INSAF F. , BYGBJERG IB C.
Published: September 2018

In Magoda and Mpapayu villages in Tanzania, we have previously found comparable high prevalence of Plasmodium falciparum resistance to sulfadoxine/pyrimethamine (S/P) in vivo and of mutations in the dihydrofolate reductase (dhfr) and dihydropteroate synthetase (dhps) genes of P. falciparum responsible for resistance to S/P. In December 1998, Magoda received insecticide-treated nets (ITNs), whereas ITNs were introduced in Mpapayu in March 2001. We have studied the effect of ITNs on P. falciparum resistance genes by monitoring the prevalence of dhfr and dhps genotypes in children less than five years old living in the villages from 1998 to 2000. In 2000, after two years of bed net use, the prevalence of wild types in codon 51, 59, and 108 of dhfr increased significantly in Magoda compared with previous years. Furthermore, the prevalence of dhfr wild types was significantly higher in Magoda than in Mpapayu in 2000. The impact of ITNs on the transmission intensity seems not only to affect the overall malaria morbidity, but may even facilitate restoration of susceptibility to antimalarial drugs.
SHORT REPORT: PROXIMITY TO MOSQUITO BREEDING SITES AS A RISK FACTOR FOR CLINICAL MALARIA EPISODES IN AN URBAN COHORT OF UGANDAN CHILDREN
Authors: STAEDKE SARAH G. , NOTTINGHAM E. WILLIS , COX JONATHAN , KAMYA MOSES R. , ROSENTHAL PHILIP J. , DORSEY GRANT
Published: September 2018

The impact of geography on incidence of clinical episodes of malaria was investigated in a cohort of children enrolled in a longitudinal clinical trial of antimalarial therapy in Kampala, Uganda. Participant households and the boundaries of local swamps and streams were mapped and incidence of clinical malaria episodes was measured prospectively using passive surveillance during one year of follow-up. Of 316 cohort participants, 305 from 219 households were followed for at least six weeks and were included in the analysis. Incidence of clinical malaria was highly variable, with no episodes occurring in 131 participants, and 367 new episodes of malaria diagnosed in the remaining 174 children. A gradient in incidence of clinical episodes of malaria was observed with distance of residence from a swamp (0.41 episodes per person year for residence >100 meters from a swamp increasing to 2.22 episodes per person year for residence within a swamp), or a stream (0.61 episodes per person year for residence ≥500 meters from a stream versus 1.76 episodes per person year for residence <500 meters from a stream). Multivariate analysis showed that distances of residence from a swamp or from a stream were independent predictors of malaria incidence, controlling for age, use of preventative measures, and primary source of water. Distance from a swamp was the strongest predictor, with an incidence rate ratio of 4.3 (95% confidence interval = 2.6–6.9, P < 0.001) between residence within a swamp and >100 meters from a swamp. In this urban setting, incidence of clinical episodes of malaria was strongly associated with proximity of residence to potential mosquito breeding sites.
IgE ANTIBODIES TO PLASMODIUM FALCIPARUM AND SEVERITY OF MALARIA IN CHILDREN OF ONE ETHNIC GROUP LIVING IN BURKINA FASO
Authors: CALISSANO CARLO , MODIANO DAVID , SIRIMA BIENVENU SODIOMON , KONATE AMADOU , SANOU ISSA , SAWADOGO ALPHONSE , PERLMANN HEDVIG , TROYE-BLOMBERG MARITA , PERLMANN PETER
Published: September 2018

Plasmodium falciparum malaria infection induces elevated blood levels of both total immunoglobulin and anti-plasmodial antibodies belonging to different isotypes. We have previously shown that donors living in areas of malaria transmission develop malaria-specific IgE antibodies that are present at highest concentrations in patients with severe disease, suggesting a role for this isotype in malaria pathogenesis. To establish the possible importance of IgE in the course and severity of this disease, we have analyzed a large and homogenous group of African children (age range = 6 months to 15 years) belonging to one ethnic group (Mossi) living in identical epidemiologic conditions in the same urban area (Ougadougo) of Burkina Faso. While IgG antibodies to P. falciparum increased to high concentrations in very young children and then remained at these levels in older patients, IgE antibodies increased with age, becoming most significantly elevated in children more than four years of age. In older children, those with severe malaria had significantly higher IgE antibody levels than those with non-severe disease. No significant differences between the patient groups were seen for IgG antibodies to P. falciparum. However, when the patients with severe malaria were divided into two groups distinguished by the presence of absence of coma, both IgG and IgE antibodies against malaria were lower in the comatous patients than in the non-comatous patients The results support the conclusion that IgE antibodies against malaria, regardless of their possible protectivity, also contribute to disease severity in this large and homogenous group of African children.
ANTIPYRETIC, PARASITOLOGIC, AND IMMUNOLOGIC EFFECTS OF COMBINING SULFADOXINE/PYRIMETHAMINE WITH CHLOROQUINE OR PARACETAMOL FOR TREATING UNCOMPLICATED PLASMODIUM FALCIPARUM MALARIA
Authors: HUGOSSON ELISABETH , TARIMO DONATH , TROYE-BLOMBERG MARITA , MONTGOMERY SCOTT M. , PREMJI ZUL , BJÖRKMAN ANDERS
Published: September 2018

Sulfadoxine/pyrimethamine (SP) is increasingly used against malaria in sub-Saharan Africa because of chloroquine resistance. However, chloroquine may have a beneficial antipyretic effect. We therefore compared the combination of SP plus chloroquine, chloroquine alone, SP alone, and SP plus paracetamol in the treatment of uncomplicated Plasmodium falciparum malaria in 175 Tanzanian children (1–4 years old) in a randomized trial. Outcome variables were axillary temperatures every six hours, daily parasitemias, and serum levels of IgG antibodies to P. falciparum. Lower mean temperatures (6–48 hours) were achieved with SP plus chloroquine or paracetamol than with SP alone (P < 0.001) or chloroquine alone (P < 0.05). All three SP-treated groups showed high and similar parasite reduction (0–48 hours), whereas treatment with chloroquine alone was much less effective. Levels of IgG antibodies to P. falciparum increased significantly (P < 0.001) and similarly in the four treatment groups between days 0, 2. and 3. Thus, the addition of chloroquine or paracetamol to SP improved the clinical outcome, but did not affect the parasitologic response or antibody production.
MOTHER-TO-CHILD TRANSMISSION OF HUMAN IMMUNODEFICIENCY VIRUS TYPE 1 IN RELATION TO THE SEASON IN YAOUNDE, CAMEROON
Authors: AYOUBA AHIDJO , NERRIENET ERIC , MENU ELISABETH , LOBÉ MARCEL MONNY , THONNON JOCELYN , LEKE ROBERT J. I. , BARRÉ-SINOUSSI FRANÇOISE , MARTIN PAUL , CUNIN PATRICK , _ _
Published: September 2018

A public health program to prevent mother-to-child transmission (MTCT) of human immunodeficiency virus type 1 (HIV-1) by treatment with nevirapine has been ongoing in Yaounde, Cameroon since January 2000. After 24 months, plasma samples from 119 children born to HIV-1-positive mothers were tested for HIV-1 RNA between six and eight weeks after birth. Thirteen (10.9%) tested positive (95% confidence interval = 5.2–16.7%). Risk factors associated with MTCT in this study were maternal viral load (P < 0.05), low birth weight (χ2 for trend =8.78, P =0.01), and birth during the second half of the year. A high correlation was repeatedly observed between rainfall in a given month and the risk of MTCT of HIV-1 in children born three months later (r = 0.634, P < 0.001). Although we cannot rule out other tropical infections related to the rainy season, the role of malaria is highly suspected since the interval of three months we observed between the peaks of rainfall and the rate of transmission is consistent with the Plasmodium life cycle.
SHORT REPORT: A DISSEMINATED INFECTION OF LEISHMANIA MEXICANA IN AN EASTERN WOODRAT, NEOTOMA FLORIDANA, COLLECTED IN TEXAS
Authors: MCHUGH CHAD P. , THIES MONTE L. , MELBY PETER C. , YANTIS LOUDON D. , RAYMOND RUSSELL W. , VILLEGAS MARIA D. , KERR SARA F.
Published: September 2018

An eastern woodrat (Neotoma floridana) collected in January 2001 near Bedias, Grimes County, Texas, had extensive lesions of both ears and swollen feet. Impression smears and histologic sections demonstrated the presence of Leishmania in both ears and the one foot that was screened. Polymerase chain reaction screening using species-specific primers detected parasites in both ears and all four feet and indicated the parasites were L. mexicana. The detection of L. mexicana in N. floridana represents a new host record in a new ecologic region and may help explain a human infection acquired outside the previously-known range of the disease. Given the geographic distribution of N. floridana and the two other species of Neotoma found naturally infected, enzootic foci of Leishmania could be present over much of the southern United States.
CHARACTERISTICS OF THE SPATIAL PATTERN OF THE DENGUE VECTOR, AEDES AEGYPTI, IN IQUITOS, PERU
Authors: GETIS ARTHUR , MORRISON AMY C. , GRAY KENNETH , SCOTT THOMAS W.
Published: September 2018

We determine the spatial pattern of Aedes aegypti and the containers in which they develop in two neighborhoods of the Amazonian city of Iquitos, Peru. Four variables were examined: adult Ae. aegypti, pupae, containers positive for larvae or pupae, and all water-holding containers. Adults clustered strongly within houses and weakly to a distance of 30 meters beyond the household; clustering was not detected beyond 10 meters for positive containers or pupae. Over short periods of time restricted flight range and frequent blood-feeding behavior of Ae. aegypti appear to be underlying factors in the clustering patterns of human dengue infections. Permanent, consistently infested containers (key premises) were not major producers of Ae. aegypti, indicating that larvaciding strategies by themselves may be less effective than reduction of mosquito development sites by source reduction and education campaigns. We conclude that entomologic risk of human dengue infection should be assessed at the household level at frequent time intervals.