bluuebunny/crossref_metadata_2025 huggingface dataset:
THE MALARIA GAP
Authors: MALANEY PIA , SPIELMAN ANDREW , SACHS JEFFREY
Published: September 2018

Although the correlation between malaria and poverty is apparent, the nature of the linkages in terms of directions and mechanisms of causation is less so, and different methodologic approaches provide widely divergent perspectives concerning the impact of the disease. Certain macroeconomic studies find that in highly endemic countries, malaria may be responsible for reducing economic growth by more than one percentage point a year. Microeconomic studies, which aggregate the cost per case, find a considerably smaller impact, generally less than one percent of annual per capita gross domestic product. The large gap between these estimates suggests economic externalities associated with malaria that make the burden much greater than the sum of the costs of individual cases. Both the magnitude of the burden and the channels through which malaria affects reduces income are important for policymakers. We explore this gap, examining diverse mechanisms through which malaria can affect long-term economic development.
ANALYSIS OF RECOMBINANT DENGUE VIRUS POLYPEPTIDES FOR DENGUE DIAGNOSIS AND EVALUATION OF THE HUMORAL IMMUNE RESPONSE
Authors: SANTOS FLAVIA BARRETO DOS , MIAGOSTOVICH MARIZE PEREIRA , NOGUEIRA RITA MARIA RIBEIRO , SCHATZMAYR HERMANN GONÇALVES , RILEY LEE W. , HARRIS EVA
Published: September 2018

Dengue is a serious cause of morbidity and mortality in tropical areas worldwide. We cloned and expressed recombinant polypeptides spanning the entire genome of a Brazilian dengue virus type 2 (DENV-2) strain in contiguous segments to generate antigens for dengue diagnosis and evaluation of the human humoral immune response. When analyzed by Western blot and an enzyme-linked immunosorbent assay (ELISA) using human sera, the most reactive polypeptide (pD2-3(E)) was located in the N-terminal portion of the envelope protein. The sensitivity of an IgG-ELISA using pD2-3(E) versus mouse brain antigen was 100% with convalescent sera and 79% with acute sera, with a specificity of 100%. Sera from patients infected with other DENV serotypes recognized pD2-3(E) equally well, whereas sera positive for yellow fever, rubella, and measles showed little or no reactivity. Using this novel approach, we identified a candidate antigen to facilitate diagnosis of DENV infections and observed a surprising variability in antibody patterns in the clinical response to DENV infections.
CONTRASTING WUCHERERIA BANCROFTI MICROFILARIA RATES IN TWO MANGYAN-POPULATED PHILIPPINE VILLAGES
Authors: RAMIREZ BERNADETTE L. , HERNANDEZ LEDA , ALBERTO FAITH F. , COLLINS MICHAEL , NFONSAM VALENTINE , PUNSALAN TRICIA , KRON MICHAEL A.
Published: September 2018

Lymphatic filariasis caused by infection with Wuchereria bancrofti and Brugia malayi is endemic in 45 of 77 provinces in The Philippines. To prepare the island of Mindoro for mass treatment using diethylcarbamazine and albendazole, complete census data were collected in rural villages. A sample of individuals selected from each of two adjacent villages was examined for microfilaremia. Microfilariae were detected from thin smears in 34 (13%) of 272 patients examined from the village of Bayanan and 10 (3.4%) of 292 in the village of Mangangan (P < 0.01, by chi-square test). In these villages, the majority of those infected were members of the ethnic group known as Mangyans: 33 (97%) of 24 in Bayanan and 7 (70%) of 10 in Mangangan (risk ratio = 89, 95% confidence interval = 33–240, P < 0.001.) In children examined who were less than 10 years of age (n = 165), girls were more commonly infected than boys, even though the proportion of males in the general population was greater. Understanding sociocultural characteristics and related behaviors in future observations among the Mangyan may help to explain local differences in the distribution of filariasis. This information should also be helpful in designing more culturally appropriate strategies for the control of lymphatic filariasis among ethnic minorities in The Philippines.
IDENTIFICATION OF PEPTIDES TARGETING THE SURFACE OF PLASMODIUM FALCIPARUM-INFECTED ERYTHROCYTES USING A PHAGE DISPLAY PEPTIDE LIBRARY
Authors: EDA KEIKO , EDA SHIGETOSHI , SHERMAN IRWIN W.
Published: September 2018

Drastic changes in the plasma membrane of Plasmodium falciparum-infected red blood cells (iRBCs) make the surface of iRBCs distinct from that of the uninfected erythrocyte. To identify small peptides that would specifically recognize the altered surface of iRBCs, we screened a phage display peptide library (PDL) on the surface of iRBCs. After the sixth panning of the PDL, eight phage clones of 18 sequenced clones had the same sequence, LVDAAAL (named P1) and specific binding of P1 to the surface of iRBCs was confirmed using phage expressing P1 peptides and synthetic P1 peptide. When P1 peptide was conjugated with a peptide having moderate hemolytic activity, the peptide conjugate inhibited the growth of intracellular parasites in a dose-dependent manner, whereas control peptides were without effect. Our results demonstrate that the P1 peptide may be a lead compound for the development of anti-malarial agents targeting the surface of iRBCs.
SHORT REPORT: LACK OF PREDICTION OF AMODIAQUINE EFFICACY IN TREATING PLASMODIUM FALCIPARUM MALARIA BY IN VITRO TESTS
Authors: AUBOUY AGNÉS , MAYOMBO JUSTICE , KEUNDJIAN ANNICK , BAKARY MOHAMED , LE BRAS JACQUES , DELORON PHILIPPE
Published: September 2018

Amodiaquine (AQ) is currently a major candidate for new antimalarial combinations, although in vivo and in vitro tests have been rarely simultaneously investigated. The efficacy of AQ was assessed at the dose of 30 mg/kg in treating Plasmodium falciparum malaria attacks in 74 children from southeast Gabon, and the in vitro activity of monodesethylamodiaquine (MdAQ), the main metabolite of AQ, was measured against P. falciparum parasites isolated from these children. Treatment failures were observed in 40.5% of the children, while 5.4% of the isolates showed in vitro resistance to MdAQ. No relationship was observed between in vivo and in vitro susceptibility. The in vitro activities of MdAQ and chloroquine were correlated. The reasons for such disparities between in vivo and in vitro AQ activities are discussed and the issue of the validity of in vitro tests to measure AQ efficacy is raised.
EFFICACY OF POST-EXPOSURE TREATMENT OF YELLOW FEVER WITH RIBAVIRIN IN A HAMSTER MODEL OF THE DISEASE
Authors: SBRANA ELENA , XIAO SHU-YUAN , GUZMAN HILDA , YE MENGYI , TRAVASSOS DA ROSA AMELIA P. A. , TESH ROBERT B.
Published: September 2018

Ribavirin was evaluated as a potential treatment of yellow fever (YF) in a hamster model of the disease. Ribavirin treatment during the first five days after YF virus infection improved survival, reduced tissue damage in target organs (liver and spleen), prevented hepatocellular steatosis, and normalized alanine aminotransferase levels. The results of this study suggest that ribavirin may be effective in the early treatment of YF, and that its mechanism of action in reducing liver pathology in YF virus infection may be similar to that observed with ribavirin in the treatment of chronic hepatitis C virus infection.
SHORT REPORT: POLYMORPHISMS IN THE CHLOROQUINE RESISTANCE TRANSPORTER GENE IN PLASMODIUM FALCIPARUM ISOLATES FROM LOMBOK, INDONESIA
Authors: HUAMAN MARIA CECILIA , YOSHINAGA KAZUMI , SURYANATHA AAN , SUARSANA NYOMAN , KANBARA HIROJI
Published: September 2018

The polymorphisms in the Plasmodium falciparum multidrug resistance 1 (pfmdr1) and P. falciparum chloroquine resistance transporter (pfcrt) genes, which are associated with chloroquine resistance, were examined in 48 P. falciparum isolates from uncomplicated malaria patients from the West Lombok District in Indonesia. The point mutation N86Y in pfmdr1 was present in 35.4% of the isolates and mutation K76T in pfcrt was found in all but one of the samples studied. Identified pfcrt haplotypes were mainly identical to the Papua New Guinea type SagtVMNT (42 of 48, 87.5%), and a few isolates had the Southeast Asia type CVIET (5 of 48, 10.4%). Moreover, one P. falciparum isolate harbored the K76N mutation, giving rise to the haplotype CVMNN, which was not previously reported in field isolates. Our findings suggest that chloroquine resistance in this area might have the same origin as in Papua New Guinea.
CRYPTOSPORIDIOSIS AMONG BANGLADESHI CHILDREN WITH DIARRHEA: A PROSPECTIVE, MATCHED, CASE-CONTROL STUDY OF CLINICAL FEATURES, EPIDEMIOLOGY AND SYSTEMIC ANTIBODY RESPONSES
Authors: KHAN WASIF A. , ROGERS KATHLEEN A. , KARIM MOHAMMAD MAHBUBUL , AHMED SABEENA , HIBBERD PATRICIA L. , CALDERWOOD STEPHEN B. , RYAN EDWARD T. , WARD HONORINE D.
Published: September 2018

We conducted a prospective case-control study to investigate the epidemiology, clinical features, and systemic antibody responses of cryptosporidiosis in Bangladeshi children. Forty-six children presenting to the International Center for Diarrheal Disease Research, Bangladesh in Dhaka, Bangladesh with diarrhea and Cryptosporidium spp. oocysts in the stool were enrolled as cases. Forty-six age-matched children with diarrhea, but without cryptosporidial infection, were enrolled as controls. Thirty cases and 23 controls returned for follow-up three weeks after discharge. Infection with Cryptosporidium spp. occurred most commonly in those less than two years of age, was accompanied by watery diarrhea and vomiting, and was more likely to be associated with persistent diarrhea. Other than duration of diarrhea, there were no significant differences in clinical or epidemiologic features between cases and controls. Cryptosporidium-specific serum IgM levels were significantly higher in cases compared with controls at presentation. In addition, there was a significant increase in serum Cryptosporidium-specific serum IgG levels over the three-week follow-up period in cases compared with controls. Within the case group, there was no difference between children with acute and persistent diarrhea in the change in IgG levels over the follow-up period. However, there was a significant difference between children with acute and persistent diarrhea in changes in both IgA and IgM levels, with persistent diarrhea being associated with a decrease in levels of both antibodies.
PREVALENCE AND PREDICTORS OF HELICOBACTER PYLORI INFECTION IN CHILDREN AND ADULTS FROM THE PENAN ETHNIC MINORITY OF MALAYSIAN BORNEO
Authors: HUANG SIMON SIONG SING , HASSAN ABDUL KARIM RUSS , CHOO KENG EE , IBRAHIM MOHAMAD ISWANDY , DAVIS TIMOTHY M. E.
Published: September 2018

To determine the prevalence of Helicobacter pylori antigen carriage in stool in the Penan ethnic minority in Malaysian Borneo, we studied 295 Penans 0.6–89.0 years of age from 1) the remote Limbang Division, 2) Mulu regional center, and 3) Belaga village. Overall, 37.7% of the subjects tested positive. Peak prevalence was reached by 10 years of age. There were no differences in age, sex, body mass index, and socioeconomic/domestic variables between antigen-positive and antigen-negative subjects. In a logistic regression analysis, subjects from Limbang were least likely to be antigen-positive (odds ratio [OR] = 0.23, 95% confidence interval [CI] = 0.12–0.44 versus other sites, P < 0.001). Availability of a flushing toilet was protective against H. pylori carriage (OR = 0.51, 95% CI = 0.27–0.95, P = 0.031). Infection with H. pylori among the Penan was less than reported in other low socioeconomic groups. The lowest prevalence in the most remote setting suggests that the infection has been a recent arrival in previously isolated communities.
ADHERENCE TO A SIX-DOSE REGIMEN OF ARTEMETHER-LUMEFANTRINE FOR TREATMENT OF UNCOMPLICATED PLASMODIUM FALCIPARUM MALARIA IN UGANDA
Authors: FOGG CAROLE , BAJUNIRWE FRANCIS , PIOLA PATRICE , BIRARO SAMUEL , CHECCHI FRANCESCO , KIGULI JAMES , NAMIIRO PROSCOVIA , MUSABE JOY , KYOMUGISHA AGNES , GUTHMANN JEAN-PAUL
Published: September 2018

Measuring baseline levels of adherence and identifying risk factors for non-adherence are important steps before the introduction of new antimalarials. In Mbarara in southwestern Uganda, we assessed adherence to artemether-lumefantrine (Coartem®) in its latest World Health Organization blister formulation. Patients with uncomplicated Plasmodium falciparum malaria were prescribed artemether-lumefantrine and received an explanation of how to take the following five doses at home. A tablet count was made and a questionnaire was completed during a home visit. Among 210 analyzable patients, 21 (10.0%) were definitely or probably non-adherent, whereas 189 (90.0%) were probably adherent. Age group was not associated with adherence. Lack of formal education was the only factor associated with non-adherence after controlling for confounders (odds ratio = 3.1, 95% confidence interval [CI] = 1.1–9.7). Mean lumefantrine blood levels were lower among non-adherent (n = 16) (2.76 μg/mL, 95% CI = 1.06–4.45) than among adherent (n = 171) (3.19 μg/mL, 95% CI = 2.84–3.54) patients, but this difference was not statistically significant. The high adherence to artemether-lumefantrine found in our study suggest that this drug is likely to be very effective in Mbarara provided that patients receive clear dosage explanations.
COMPARISON OF THE PARASITOLOGIC EFFICACY OF AMODIAQUINE AND SULFADOXINE-PYRIMETHAMINE IN THE TREATMENT OF PLASMODIUM FALCIPARUM MALARIA IN THE BUNGOMA DISTRICT OF WESTERN KENYA
Authors: VREUGDENHIL C. J. , SCHEPER F. Y. , HOOGSTRAATTE S. R. , SMOLDERS M. , GIKUNDA S. , COBELENS F. G. , KAGER P. A.
Published: September 2018

The efficacy of amodiaquine (AQ) and sulfadoxine-pyrimethamine (SP) was assessed in 310 symptomatic children from western Kenya with uncomplicated Plasmodium falciparum malaria. A non-blinded, randomized, 14-day study was performed and parasitologic criteria were used. Of 310 patients included, 238 (77%) completed the study: 120 received AQ and 118 received SP. In those treated with AQ, there were sensitive (S) infections in 107 patients (89.2%, 95% confidence interval [CI] = 82.2, 94.1%), RI resistance in 10 (8.3%, 95% CI = 4.1, 14.8%), RII resistance in 1 (0.8%, 95% CI = 0, 4.6%), and RIII resistance in 2 (1.7%, 95% CI = 0.2, 5.9%). In those treated with SP, there were S infections in 74 patients (62.7%, 95% CI = 53.3, 71.4%), RI resistance in 21 (17.8%, 95% CI = 11.4, 25.9%), RII resistance in 11 (9.3%, 95% CI = 4.7, 16.1%), and RIII resistance in 12 (10.2%, 95% CI = 5.4, 17.1%). Resistance rates were consistently higher in the SP-treated patients (P < 0.001). Resistance to SP in this area has reached such levels that it should no longer be the first-line treatment. Alternative treatment, such as SP plus AQ combination treatment or artemisinin combination treatment, is urgently needed.
CEREBRAL METABOLIC REDUCTION IN SEVERE MALARIA: FLUORODEOXYGLUCOSE-POSITRON EMISSION TOMOGRAPHY IMAGING IN A PRIMATE MODEL OF SEVERE HUMAN MALARIA WITH CEREBRAL INVOLVEMENT
Authors: SUGIYAMA MUNEHIRO , IKEDA EIJI , KAWAI SATORU , HIGUCHI TETSUYA , ZHANG HONG , KHAN NASIM , TOMIYOSHI KATSUMI , INOUE TOMIO , YAMAGUCHI HARUYASU , KATAKURA KEN , ENDO KEIGO , SUZUKI MAMORU
Published: September 2018

Cerebral metabolic changes in Japanese macaques (Macaca fuscata) infected with Plasmodium coatneyi, a primate model of severe human malaria with cerebral involvement, were directly evaluated by fluorodeoxyglucose-positron emission tomography (FDG-PET). We observed diffuse and heterogeneous reduction of metabolism in the cerebral cortex in the acute phase of malaria infection. Neuropathologic examination showed preferential sequestration of parasitized red blood cells in the cerebral microvasculature. However, hemorrhagic change or necrosis was not observed in hematoxylin and eosin-stained and Nissl-stained brain tissues. This suggests that reduction of cerebral metabolism occurs before parenchymal changes appear in the brain. This may be one reason why more than half of the patients with cerebral malaria have no neurologic sequelae after recovery.
UNDERNUTRITION AS AN UNDERLYING CAUSE OF MALARIA MORBIDITY AND MORTALITY IN CHILDREN LESS THAN FIVE YEARS OLD
Authors: CAULFIELD LAURA E. , RICHARD STEPHANIE A. , BLACK ROBERT E.
Published: September 2018

Undernutrition is highly prevalent in many areas in which morbidity and mortality from malaria is unacceptably high. That undernutrition exacerbates diarrhea and respiratory infections is widely demonstrated; however, research suggests that it may exacerbate, palliate, or have little effect on malaria outcomes. This review examines the global burden of malaria associated with various nutrient deficiencies as well as underweight status in children 0–4 years of age. Although the association is complex and requires additional research, improved nutritional status lessens the severity of malaria episodes and results in fewer deaths due to malaria. Deficiencies in vitamin A, zinc, iron, folate, as well as other micronutrients are responsible for a substantial proportion of malaria morbidity and mortality. It is recommended that nutrition programs be integrated into existing malaria intervention programs.
COMPARISON OF GENERIC TO BRANDED PENTAVALENT ANTIMONY FOR TREATMENT OF NEW WORLD CUTANEOUS LEISHMANIASIS
Authors: SOTO J. , VALDA-RODRIQUEZ L. , TOLEDO J. , VERA-NAVARRO L. , LUZ M. , MONASTERIOS-TORRICO H. , VEGA J. , BERMAN J.
Published: September 2018

The cost of generic pentavalent antimony (generic stibogluconate) is approximately one-sixth that of branded pentavalent antimony (stibogluconate in the form of Pentostam® or meglumine antimoniate in the form of Glucantime®). We compared generic stibogluconate to Pentostam and Glucantime for the treatment of cutaneous leishmaniasis patients in Bolivia and Colombia. For all 114 patients, the per-protocol cure rates were 83–91% and the intent-to-treat cure rates were 75–83%. The highest values were in the generic stibogluconate group. The incidence of pancreatic enzyme abnormalities was 48–88% and the incidence of liver enzyme abnormalities was 48–87%. The lowest incidences were in the generic stibogluconate group. The efficacy and tolerance of inexpensive generic stibogluconate appears comparable to branded formulations for the treatment of cutaneous leishmaniasis in these endemic regions.
CHAGAS DISEASE IN RURAL AREAS OF CHACO PROVINCE, ARGENTINA: EPIDEMIOLOGIC SURVEY IN HUMANS, RESERVOIRS, AND VECTORS
Authors: DIOSQUE PATRICIO , PADILLA ANGEL MARCELO , CIMINO RUBÉN OSCAR , CARDOZO RUBÉN MARINO , NEGRETTE OLGA SANCHEZ , MARCO JORGE DIEGO , ZACCA ROSA , MEZA CARLOS , JUAREZ ALIGIO , ROJO HUGO , REY RICARDO , CORRALES ROSA MILAGROS , NASSER JULIO RUBÉN , BASOMBRÍO MIGUEL ANGEL
Published: September 2018

We studied the seroprevalence of antibodies against Trypanosoma cruzi in the human population along with domiciliary infestation by triatomine bugs in an area endemic for Chagas disease in the Chaco Province of Argentina. In addition, we carried out parasitologic surveys in patients, dogs, wild mammals, and vectors. The mean seroprevalence in humans was 27.81% (109 of 392) and 24.14% (63 of 261) in 1–15-year-old children. The minimum domiciliary infestation rate was 13.33%, with certain areas reaching 53.85%. The prevalence was 15.09% (16 of 106) in dogs and 35.71% (10 of 28) in opossums. Infection with T. cruzi was detected in 30.10% (59 of 196) of the Triatoma infestans tested. Compared with nationwide studies, our data suggest that 1) there are zones requiring immediate sanitary action, and 2) nationwide estimates are based on very heterogeneous epidemiologic situations. This heterogeneity emphasizes the importance of in-depth studies of restricted areas to provide additional information for a better understanding of the present status of Chagas disease in Argentina.
SHORT REPORT: BENZNIDAZOLE EFFICACY AMONG TRYPANOSOMA CRUZI-INFECTED ADOLESCENTS AFTER A SIX-YEAR FOLLOW-UP
Authors: ANDRADE ANA LUCIA S. S. , MARTELLI CELINA M. T. , OLIVEIRA RENATO M. , SILVA SIMONNE A. , AIRES ANDRÉA I. S. , SOUSSUMI LEA M. T. , COVAS DIMAS T. , SILVA LUIZ S. , ANDRADE JOÃO G. , TRAVASSOS LUIZ R. , ALMEIDA IGOR C.
Published: September 2018

Data from a six-year follow-up of Trypanosoma cruzi-infected adolescents enrolled in a randomized, double-blind, clinical trial of benznidazole showed successful chemotherapy in 64.7% (95% confidence interval [CI] = 50.2–78.7) and 84.7% (95% CI = 66.8–92.9), respectively, by intention-to treat and by per protocol analysis measured by seronegativity in a chemiluminescent enzyme-linked immunosorbent assay with a purified trypomastigote mucin antigen. No incident case of cardiomyopathy was detected by electrocardiogram assessment in this cohort of adolescents who had been infected in childhood. The persistent and consistently long-term negative serologic reactions suggest the absence of the parasite in the treated patients and reinforces the recommendation of early benznidazole chemotherapy for T. cruzi-infected infants as a public health policy in endemic areas.
SHORT REPORT: DETECTION PROBABILITY OF ARBOVIRUS INFECTION IN MOSQUITO POPULATIONS
Authors: GU WEIDONG , NOVAK ROBERT J.
Published: September 2018

An important component of arbovirus surveillance is monitoring the vector for presence of the pathogen. Intervention and preventive programs need early detection of arboviral activity in mosquito populations. In this report, we examine the factors affecting the probability of detection of mosquito infections. Since arbovirus infection rates in mosquito populations are very low, observations of zero-infected mosquito samples are common. Using statistical models, we describe methods to estimate the probability of detection and upper bounds of confidence intervals of mosquito infection rates as measures of confidence for observations of zero infection. Our results show that detection of low levels of mosquito infections requires large samples (greater than 1,600 individuals) for a high probability (0.8) of detection. Due to focal transmission of arboviruses, grouping samples over different sampling sites and times is often inappropriate for detection of mosquito infection. We emphasize sample size as a key determinant in detection of mosquito infections and recommend intensified entomologic surveys at sentinel sites to detect arboviral activity.
CONSTRUCTION OF YELLOW FEVER/ST. LOUIS ENCEPHALITIS CHIMERIC VIRUS AND THE USE OF CHIMERAS AS A DIAGNOSTIC TOOL
Authors: PUGACHEV KONSTANTIN V. , GUIRAKHOO FARSHAD , MITCHELL FRED , OCRAN SIMEON W. , PARSONS MEGAN , JOHNSON BARBARA W. , KOSOY OLGA L. , LANCIOTTI ROBERT S. , ROEHRIG JOHN T. , TRENT DENNIS W. , MONATH THOMAS P.
Published: September 2018

St. Louis encephalitis (SLE) and West Nile (WN) flaviviruses are genetically closely related and cocirculate in the United States. Virus neutralization tests provide the most specific means for serodiagnosis of infections with these viruses. However, use of wild-type SLE and WN viral strains for laboratory testing is constrained by the biocontainment requirements. We constructed two highly attenuated yellow fever (YF) virus chimeras that contain the premembrane-envelope (prM-E) protein genes from the virulent MSI-7 (isolated in the United States) or the naturally attenuated CorAn9124 (Argentina) SLE strains. The YF/SLE (CorAn version) virus and the previously constructed YF/WN chimera were shown to specifically distinguish between confirmed human SLE and WN cases in a virus neutralization test using patient sera. These chimeras have the potential for use as diagnostic reagents and vaccines against SLE and WN.
PARASITE DIVERSITY IN ADULT PATIENTS WITH CEREBRAL MALARIA: A HOSPITAL-BASED, CASE-CONTROL STUDY
Authors: SHIGIDI MAZIN M. T. , HASHIM RIHAB A. , IDRIS MOHAMED N. A. , MUKHTAR MAOWIA M. , SOKRAB TAG-ELDIN O.
Published: September 2018

Thirty adult patients with cerebral malaria (CM) were recruited for this study. Two clinical groups were used as controls: those with mild malaria (n = 20) and asymptomatic volunteers (n = 20). Thick and thin blood smears were examined for detection of Plasmodium falciparum and estimating infection intensity. A nested polymerase chain reaction (PCR) using allele-specific primers for merozoite surface protein gene was used to determine the parasite diversity of Plasmodium falciparum causing CM. Plasmodium falciparum was detected in blood smears of all malaria patients. No significant difference in parasite count was found between the groups. Thirteen (65%) of the asymptomatic volunteers had a positive PCR for P. falciparum. Multiple alleles were found in 17 (58.6%) patients with CM, but only in 7 (35.6%) with uncomplicated malaria. Multiple alleles were also found in 6 (46.2%) of the 13 PCR-positive asymptomatic individuals. We could not identify a specific strain or strains of P. falciparum that showed a significant association with disease severity. Therefore, we assume that the development of CM in adults residing in endemic areas is more dependent on strain multiplicity rather than on a specific strain or strains of P. falciparum, and that the parasite intensity has no relationship with disease severity. Asymptomatic adults may repeatedly be exposed to low levels of a wide range of different strains during low transmission season and acquire sub-patent parasitemia. This may also confer premunition that renders them relatively resistant to CM.
SHORT REPORT: EVALUATION OF HEPATIC FIBROSIS IN PERSONS CO-INFECTED WITH SCHISTOSOMA MANSONI AND HUMAN IMMUNODEFICIENCY VIRUS 1
Authors: MWINZI PAULINE N. M. , KARANJA DIANA M. S. , KAREKO IRERI , MAGAK PHILLIP W. , ORAGO ALLOYS S. S. , COLLEY DANIEL G. , SECOR W. EVAN
Published: September 2018

To investigate whether infection with human immunodeficiency virus 1 (HIV-1) affects fibrosis development in patients infected with Schistosoma mansoni, we evaluated schistosomiasis-induced pathology in the livers of Kenyan patients co-infected with HIV-1. Compared with persons with schistosomiasis alone (n = 58), there were no significant differences in distribution of ultrasound-detectable pathology in persons with HIV-1 co-infection (n = 23). Similarly, serum aspartate aminotransferase levels were not significantly different in HIV-1+ individuals. Hepatic fibrosis was associated with significantly decreased CD4+ T cell counts, even in the absence of HIV-1 infection. These data suggest that HIV-1 co-infection does not significantly alter the proportion of patients experiencing schistosomiasis-induced fibrosis, but pathology associated with S. mansoni infections leads to CD4+ T cell reductions and thereby may exacerbate the effects of HIV-1 in co-infected individuals.
MALARIA IN PRIMARY SCHOOL CHILDREN AND INFANTS IN KINSHASA, DEMOCRATIC REPUBLIC OF THE CONGO: SURVEYS FROM THE 1980S AND 2000
Authors: KAZADI WALTER , SEXTON JOHN D. , BIGONSA MAKENGO , W’OKANGA BOMPELA , WAY MATEZO
Published: September 2018

Kinshasa, the capital of the Democratic Republic of the Congo, has been a perennial malarious area and has grown almost 14 times from 380,000 people in 1960 to 5,293,000 in 2003. The most complete information on malaria prevalence in Kinshasa was first acquired in 1981–1983. Blood smears were obtained from 25,135 children (ages 5–15 years) from 245 schools in 16 of 24 zones. The mean Plasmodium falciparum parasite rate was 17%; the parasite rate was similar for both sexes and was higher (P < 0.001) in older students. The parasite rate varied from 4% (urban zone) to 46% (peri-urban zone). An infant survey confirmed malaria transmission. During the Roll Back Malaria situational analysis in 2000, malaria prevalence was reassessed by the National Malaria Control Program and its partners in schools from selected health zones. A mean parasite rate of 34% was found among school children 5–9 years old. The parasite rate varied from 14% (central urban zone) to 65% (peri urban zone). Plasmodium falciparum was not the only species found, but accounted for more than 97% of the infections. Malaria incidence may have increased in Kinshasa during the last two decades due to difficulties in provision of control and prevention measures. Along with deployment of insecticide-treated bed nets and improved patient management, currently ongoing, other measures that could impact the disease are being considered, including vector control, water management, and proper urban planning.
TOXOPLASMA GONDII INFECTION IN RURAL GUATEMALAN CHILDREN
Authors: JONES JEFFREY L. , LOPEZ BEATRIZ , MURY MARICRUZ ALVAREZ , WILSON MARIANNA , KLEIN ROBERT , LUBY STEPHEN , MAGUIRE JAMES H.
Published: September 2018

To determine the prevalence and risk factors for Toxoplasma gondii infection in Guatemalan children, in 1999 and 2003 we surveyed caretakers and serologically tested children in the San Juan Sacatepequez area using Platelia Toxo IgG TMB enzyme immunoassay kits. In 1999, of 532 children six months to two years old, 66 (12.4%) were antibody positive. In 2003, in 500 children 3–10 years old antibody prevalence increased from 24% to 43% at age five years then leveled off. By multivariate analysis, drinking well water (relative risk [RR] = 1.78, 95% confidence limit [CL] = 1.00, 3.17, P = 0.05) and not cleaning up cat feces (RR = 2.06, 95% CL = 1.00, 4.28, P = 0.05) increased the risk of T. gondii seropositivity. Most T. gondii infections in children from these villages occurred by age five, but half were still not infected by adolescence. Therefore, it is important to educate girls entering child-bearing age about the risks of acute T. gondii infection and the local risk factors for infection.
SERODIAGNOSIS OF HUMAN FASCIOLIASIS BY A CYSTATIN CAPTURE ENZYME-LINKED IMMUNOSORBENT ASSAY WITH RECOMBINANT FASCIOLA GIGANTICA CATHEPSIN L ANTIGEN
Authors: TANTRAWATPAN CHAIRAT , MALEEWONG WANCHAI , WONGKHAM CHAISIRI , WONGKHAM SOPIT , INTAPAN PEWPAN M. , NAKASHIMA KUNIO
Published: September 2018

Cathepsin L1, a cysteine protease secreted by the gastrodermis of juvenile and adult Fasciola gigantica, was expressed in Escherichia coli as a calmodulin binding peptide fusion protein with a molecular mass of approximately 35 kD. The recombinant cathepsin L1 (rCTL1) was tested for its antigenic potential in a cystatin capture enzyme-linked immunosorbent assay (ELISA) to diagnose human fascioliasis. The ELISA plates were sensitized with chicken egg cystatin and incubated with bacterial lysates containing the recombinant protein before the standard ELISA procedures were performed. Analysis of the sera of 13 patients infected with F. gigantica (group 1), 204 patients with other parasitic infections (group 2), 32 cholangiocarcinoma patients (group 3), and 42 healthy controls (group 4) showed that the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of this ELISA using rCTL1 were 100%, 98.92%, 98.97%, 81.25%, and 100%, respectively. These results indicate that this assay has high sensitivity and specificity in the diagnosis of human fascioliasis. In addition, we have produced sufficient amounts of antigen for use in diagnosis.
PERSISTENT BRADYCARDIA CAUSED BY CIGUATOXIN POISONING AFTER BARRACUDA FISH EGGS INGESTION IN SOUTHERN TAIWAN
Authors: HUNG YAO-MIN , HUNG SHIH-YUAN , CHOU KANG-JU , HUANG NENG-CHYAN , TUNG CHUNG-NI , HWANG DENG-FWU , CHUNG HSIAO-MIN
Published: September 2018

We report an outbreak of ciguatoxin poisoning after barracuda fish ingestion in southern Taiwan. Three members of a family developed nausea, vomiting, watery diarrhea, and myalgias about 1 hour after eating three to ten eggs of a barracuda fish. Numbness of the lips and extremities followed the gastrointestinal symptoms about 2 hours after ingestion. Other manifestations included hyperthermia, hypotension, bradycardia, and hyperreflexia. Bradycardia persisted for several days, and one patient required a continuous infusion of intravenous atropine totaling 40 mg over 2 days. Further follow-up of the patients disclosed improvement of neurologic sequelae and bradycardia, but sensory abnormalities resolved several months later. In conclusion, ciguatoxin poisoning causes mainly gastrointestinal and neurologic effects of variable severity. In two patients with ciguatoxin poisoning after barracuda fish egg ingestion, persistent bradycardia required prolonged atropine infusion.
AVIAN HOSTS FOR WEST NILE VIRUS IN ST. TAMMANY PARISH, LOUISIANA, 2002
Authors: KOMAR NICHOLAS , PANELLA NICHOLAS A. , LANGEVIN STANLEY A. , BRAULT AARON C. , AMADOR MANUEL , EDWARDS ERIC , OWEN JENNIFER C.
Published: September 2018

West Nile virus (WNV) infections in free-ranging birds were studied in Slidell, St. Tammany Parish, Louisiana, after a human encephalitis outbreak peaked there in July 2002. Seroprevalence in resident, free-ranging wild birds in one suburban site was 25% and 24% in August and October, respectively, indicating that most transmission had ceased by early August. Mortality rates, seroprevalence rates, host competence, and crude population estimates were used in mathematical models to predict actual infection rates, population impacts, and importance as amplifying hosts for several common passerine birds. Northern cardinal (Cardinalis cardinalis) and house sparrow (Passer domesticus) were the principal amplifying hosts, but blue jay (Cyanocitta cristata) and northern mockingbird (Mimus polyglottos) also contributed. The blue jay population was reduced by an estimated 47%. A variety of passerine bird species combined to play an important role as amplifying hosts in the WNV transmission cycle.
DIFFERENCES IN DENGUE SEVERITY IN INFANTS, CHILDREN, AND ADULTS IN A 3-YEAR HOSPITAL-BASED STUDY IN NICARAGUA
Authors: HAMMOND SAMANTHA NADIA , BALMASEDA ANGEL , PÉREZ LEONEL , TELLEZ YOLANDA , SABORÍO SAIRA INDIRA , MERCADO JUAN CARLOS , VIDEA ELSA , RODRIGUEZ YORYELIN , PÉREZ MARIA ANGELES , CUADRA RICARDO , SOLANO SORAYA , ROCHA JULIO , IDIAQUEZ WENDY , GONZALEZ ALCIDES , HARRIS EVA
Published: September 2018

To investigate age-related differences in dengue severity, 114 infants, 1,211 children, and 346 adults with laboratory-confirmed dengue virus (DEN) infections presenting to three hospitals in major urban centers in Nicaragua were recruited from 1999 to 2001. The age distribution of dengue cases and the circulating serotype (predominantly DEN2) were representative of national data. Similar results were obtained when either dengue hemorrhagic fever/dengue shock syndrome or its principal manifestations (vascular permeability, internal hemorrhage, marked thrombocytopenia, and/or shock) were analyzed in relation to age and immune status. The burden of disease and of severe dengue was found predominantly in infants 4–9 months of age and in children 5–9 years old, and secondary DEN infection was a risk factor for severity in children. Age-related differences were identified in the prevalence of specific clinical manifestations as well as in their association with a confirmed DEN diagnosis. This represents one of the few comprehensive studies to analyze characteristics of dengue in infants, children, and adults in the same population and highlights age-related differences in dengue severity.
CORRELATION OF HIGH LEVELS OF ANTIBODIES TO MULTIPLE PRE-ERYTHROCYTIC PLASMODIUM FALCIPARUM ANTIGENS AND PROTECTION FROM INFECTION
Authors: JOHN CHANDY C. , MOORMANN ANN M. , PREGIBON DANIEL C. , SUMBA PETER ODADA , MCHUGH MARILYN M. , NARUM DAVID L. , LANAR DAVID E. , SCHLUCHTER MARK D. , KAZURA JAMES W.
Published: September 2018

High levels of antibodies to multiple antigens may be more strongly associated with protection from infection than antibodies to a single antigen. Antibody-associated protection against Plasmodium falciparum infection was assessed in a cohort of 68 adults living in an area of holoendemic malaria in Kenya. Antibodies to the pre-erythrocytic antigens circumsporozoite protein (CSP), liver-stage antigen-1 (LSA-1), thrombospondin-related adhesive protein (TRAP), and blood-stage antigens apical membrane antigen-1 (AMA-1), erythrocyte binding antigen-175 (EBA-175), and merozoite surface protein 1 (MSP-1) were tested. Peptides were used for CSP (NANP repeat) and LSA-1 (central repeat), and recombinant antigens were used for TRAP (aa D48–K394), AMA-1 (ectodomain, non-glycosylated), EBA-175 (non-glycosylated), and MSP-1 (MSP-119). Weekly microscopy testing for P. falciparum infection was performed over a 12-week period after drug-mediated clearance of P. falciparum parasitemia. Individuals with high levels of IgG antibodies (> 2 arbitrary units) to CSP, LSA-1, and TRAP had a 57% decrease in the risk of infection (95% confidence interval = 20–77%, P = 0.016). This decreased risk remained significant after adjustment for age, prior parasitemia, bed net use, sickle cell trait, and village of residence. In contrast, protection against infection did not correlate with high levels of IgG antibodies to blood-stage antigens or IgM antibodies to pre-erythrocytic or blood-stage antigens. High levels of IgG antibodies to CSP, LSA-1, and TRAP may be useful immune correlates of protection against P. falciparum infection in malaria-endemic populations.
EXTENDED INTERHUMAN TRANSMISSION OF MONKEYPOX IN A HOSPITAL COMMUNITY IN THE REPUBLIC OF THE CONGO, 2003
Authors: LEARNED LYNNE A. , REYNOLDS MARY G. , WASSA DEMOLE WASSA , LI YU , OLSON VICTORIA A. , KAREM KEVIN , STEMPORA LINDA L. , BRADEN ZACH H. , KLINE RICHARD , LIKOS ANNA , LIBAMA FRANÇOIS , MOUDZEO HENRI , BOLANDA JEAN DANIEL , TARANGONIA PAUL , BOUMANDOKI PAUL , FORMENTY PIERRE , HARVEY JOSEPH M. , DAMON INGER K.
Published: September 2018

This report describes the first reported outbreak of human monkeypox in the Republic of Congo. Eleven confirmed and probable monkeypox cases were observed during this outbreak, all were less than 18 years old, and most resided on the grounds of the Government Hospital in Impfondo. Molecular, virologic, and serologic, and diagnostic assays were used to detect evidence of monkeypox (or orthopox) virus infection in individuals with striking dermatologic and other clinical manifestations. The majority of cases in this outbreak experienced significant, symptomatic illnesses; there was one death, possibly involving secondary complications, and one instance of profound sequelae. Up to six sequential transmissions of monkeypox virus from person to person are hypothesized to have occurred, making this the longest uninterrupted chain of human monkeypox fully documented to date. The pattern of sustained human-to-human transmission observed during this outbreak may influence our current perception of the capacity for this zoonotic virus to adapt to humans.
IMPACT OF ILLNESS AND NON-COMBAT INJURY DURING OPERATIONS IRAQI FREEDOM AND ENDURING FREEDOM (AFGHANISTAN)
Authors: SANDERS JOHN W. , PUTNAM SHANNON D. , FRANKART CARLA , FRENCK ROBERT W. , MONTEVILLE MARSHALL R. , RIDDLE MARK S. , ROCKABRAND DAVID M. , SHARP TRUEMAN W. , TRIBBLE DAVID R.
Published: September 2018

Historically, non-combat injuries and illnesses have had a significant impact on military missions. We conducted an anonymous cross-sectional survey to assess the prevalence and impact of common ailments among U.S. military personnel deployed to Iraq or Afghanistan during 2003–2004. Among 15,459 persons surveyed, diarrhea (76.8% in Iraq and 54.4% in Afghanistan), respiratory illness (69.1%), non-combat injuries (34.7%), and leishmaniasis (2.1%) were commonly reported. For all causes, 25.2% reported that they required intravenous fluids, 10.4% required hospitalization, and 5.2% required medical evacuation. Among ground units, 12.7% reported that they missed a patrol because of illness, and among air units, 11.7% were grounded because of illness. The incidence of diarrhea and respiratory infections doubled from the pre-combat to combat phases, and the perceived adverse impact of these illnesses on the unit increased significantly during the combat phase. Despite technologic advances in warfare and preventive medicine, illness and non-combat injuries have been common during operations in Iraq and Afghanistan, resulting in frequent transient decreases in operational efficiency.
RISK FACTORS FOR INDIAN KALA-AZAR
Authors: RANJAN ALOK , SUR DIPIKA , SINGH VIJAY P. , SIDDIQUE NIYAMAT A. , MANNA BYOMKESH , LAL CHANDRA S. , SINHA PRABHAT K. , KISHORE KAMAL , BHATTACHARYA SUJIT K.
Published: September 2018

A case-control study was conducted to understand the risk factors associated with kala-azar in disease-endemic areas of Bihar, India. A total of 134 kala-azar cases treated at the Rajendra Memorial Research Institute of Medical Sciences in Patna and 406 healthy controls selected randomly from the neighborhoods of cases in their native villages were included in the study. Univariate analysis showed that education, a history of other diseases in the previous year, a history of kala-azar in the family, type of walls in houses, presence of a granary inside houses, presence of vegetation around houses, bamboo trees near houses, and irregular spraying around houses with DDT were risk factors. Multivariate analysis showed that a history of other diseases in the previous year (odds ratio [OR] = 3.6, P = 0.002), a history of kala-azar in the family (OR = 1.8, P = 0.03), mud-plastered walls in houses, (OR = 2.4, P = 0.0001], a granary inside houses (OR = 4.3, P = 0.0001), presence of bamboo trees around houses (OR = 2.3, P = 0.001), and houses not sprayed with DDT in the past six months (OR = 3.4, P = 0.0001) were significant risk factors for kala-azar. These results will be useful in developing kala-azar control programs for identifying intervention strategies such as better housing, regular and proper insecticide spraying, and promoting health awareness to the community residing in disease-endemic areas for reducing transmission and incidence of this disease.
EPIDEMIOLOGY OF NEUROCYSTICERCOSIS IN HOUSTON, TEXAS
Authors: LA GARZA YAZMIN DEL , GRAVISS EDWARD A. , DAVER NAVAL G. , GAMBARIN KIMBERLEY J. , SHANDERA WAYNE X. , SCHANTZ PETER M. , WHITE A. CLINTON
Published: September 2018

We identified 114 patients with neurocysticercosis admitted to Ben Taub General Hospital in Houston, Texas between January 1994 and June 1997. Most of these patients were born in Mexico (78%) or Central America (16%), but 6% were born in the United States. Review of neurology clinic records identified 54 patients diagnosed with neurocysticercosis, representing 2% of all neurology clinic patients and 16% of all Hispanics diagnosed with seizures. Forty-one patients were interviewed and all reported significant risk factors for infection, including ingestion of undercooked pork, pig husbandry, immigration from and frequent travel to villages in disease-endemic areas, or personal/ family history of taeniasis. Among Mexican immigrants, most were born in rural areas in Central (31%) or north central Mexico (38%). Significantly fewer of the patients were from the border states (15%). The median period from immigration to diagnosis was 58 months, but it was 28 months for the 13 patients who had not left the United States after immigration. Although neurocysticercosis is being diagnosed with increasing frequency in the United States, acquisition of infection is still strongly associated with pig husbandry in rural Latin America, with little evidence of local transmission. Even among urban immigrants to the United States and United States–born cases, there is close ongoing contact with disease-endemic villages.
PREVALENCE AND PREDICTORS OF INTESTINAL HELMINTH INFECTIONS AMONG HUMAN IMMUNODEFICIENCY VIRUS TYPE 1–INFECTED ADULTS IN AN URBAN AFRICAN SETTING
Authors: MODJARRAD KAYVON , ZULU ISAAC , REDDEN DAVID T. , NJOBVU LUNGOWE , FREEDMAN DAVID O. , VERMUND STEN H.
Published: September 2018

Sub-Saharan Africa is disproportionately burdened by intestinal helminth and human immunodeficiency virus (HIV)-1 infection. Recent evidence suggests detrimental immunologic effects from concomitant infection with the two pathogens. Few studies, however, have assessed the prevalence of and predictors for intestinal helminth infection among HIV-1–infected adults in urban African settings where HIV infection rates are highest. We collected and analyzed sociodemographic and parasitologic data from 297 HIV-1–infected adults (mean age = 31.1 years, 69% female) living in Lusaka, Zambia to assess the prevalence and associated predictors of helminth infection. We found at least one type of intestinal helminth in 24.9% of HIV-infected adults. Thirty-nine (52.7%) were infected with Ascaris lumbricoides, and 29 (39.2%) were infected with hookworm. More than 80% were light-intensity infections. A recent visit to a rural area, food shortage, and prior history of helminth infection were significant predictors of current helminth status. The high helminth prevalence and potential for adverse interactions between helminths and HIV suggests that helminth diagnosis and treatment should be part of routine HIV care.
DETECTION AND DIFFERENTIATION OF FILARIAL PARASITES BY UNIVERSAL PRIMERS AND POLYMERASE CHAIN REACTION–RESTRICTION FRAGMENT LENGTH POLYMORPHISM ANALYSIS
Authors: NUCHPRAYOON SURANG , JUNPEE ALISA , POOVORAWAN YONG , SCOTT ALAN L.
Published: September 2018

Filarial nematode parasites are a serious cause of morbidity in humans and animals. Identification of filarial infection using traditional morphologic criteria can be difficult and lead to misdiagnosis. We report on a polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP)–based method to detect and differentiate a broad range of filarial species in a single PCR. The first internal transcribed spacer 1 (ITS1) along with the flanking 18S and 5.8S ribosomal DNA (rDNA) were isolated and cloned from Wuchereria bancrofti, Brugia malayi, and Brugia pahangi. Sequence analysis identified conserved sites in the 18S and 5.8S rDNA sequence that could be used as universal priming sites to generate ITS1-distinctive PCR products that were useful for distinguishing filariae at the genus level. The addition of a digestion of the ITS1 PCR product with the restriction endonuclease Ase I generated a fragment profile that allowed differentiation down to the species level for W. bancrofti, B. malayi, B. pahangi, Dirofilaria immitis, and D. repens. The PCR-RFLP of ITS1 rDNA will be useful in diagnosing and differentiating filarial parasites in human, animal reservoir hosts, and mosquito vectors in disease-endemic areas.
BENEFICIAL EFFECT OF ERYTHROPOIETIN ADMINISTRATION ON MURINE INFECTION WITH TRYPANOSOMA CONGOLENSE
Authors: SUZUKI TOMOKO , UETA YOSHIKO YANAGIMOTO , INOUE NOBORU , XUAN XUENAN , SAITOH HIDEKI , SUZUKI HIROSHI
Published: September 2018

The effect of erythropoietin treatment on Trypanosoma congolense infection in mice was studied. Survival rates of mice were dramatically improved by treatment with recombinant human erythropoietin (r-hu-EPO; 5000 U/kg) when infected with 1,000 cells of T. congolense IL3000 (P < 0.05). All the untreated mice infected with T. congolense IL3000 died by day 9 of infection; however, 100%, 50%, and 25% of the mice treated with r-hu-EPO for 8 days survived to day 20, day 40, and day 60 of the parasitical infection, respectively. Anti-8-hydroxy-2′-deoxyguanosine antibody, a biomarker for oxidative damage of DNA, yielded positive reactions in the cytoplasm of the parasites recovered from the mice treated with r-hu-EPO. These results, taken together, indicate that erythropoietin administration is effective for the treatment of T. congolense infection.