bluuebunny/crossref_metadata_2025 huggingface dataset:
Zoonotic Filariasis in the Arabian Peninsula: Autochthonous Onchocerciasis and Dirofilariasis
Authors: Hira Parsotam R. , Al-Buloushi Adel , Khalid Nabila , Iqbal Jamshaid , Bain Odile , Eberhard Mark L.
Published: September 2018

We describe zoonotic filariasis in two patients from Kuwait; one with Onchocerca spp. and one with Dirofilaria spp. Case 1, a 12-year-old Kuwaiti woman who had visited Saudi Arabia, initially reported ocular symptoms. She later reported a nodule that appeared in the suprapubic area, which was resected. A coiled worm was observed in histologic sections and was identified as an Onchocerca spp., but could not be definitively identified. This patient represents the 15th reported case of zoonotic onchocerciasis in a country that is not endemic for human onchocerciasis. Case 2, a 34-year-old Indian woman from Kuwait City, reported a moving object in her left eye. A live worm was extracted and tentatively identified as an immature female Dirofilaria (Nochtiella) repens. These two cases bring to four the number of reports of zoonotic filariasis in the Arabian Peninsula and suggest that zoonotic filariasis is not uncommon in the Arabian Gulf region.
In Vivo Effects of Bothrops jararaca Venom on Metabolic Profile and on Muscle Protein Metabolism in Rats
Authors: Gonçalves Dawit A. P. , Silva Érico V. C. M. , Graça Flávia A. , Lira Eduardo C. , Zanon Neusa M. , Mendes Glória E. , Burdmann Emmanuel A. , Migliorini Renato H. , Kettelhut Isis C. , Navegantes Luiz C. C.
Published: September 2018

This study investigated the in vivo effects of the Bothrops jararaca venom (BjV) on general metabolic profile and, specifically, on muscle protein metabolism in rats. The crude venom (0.4 mg/kg body weight, IV) was infused in awake rats, and plasma activity of enzymes and metabolites levels were determined after 1, 2, 3, and 4 hours. BjV increased urea, lactate, and activities of creatine kinase, lactate dehydrogenase, and aspartate aminotransferase after 4 hours. The content of liver glycogen was reduced by BjV. Protein metabolism was evaluated by means of microdialysis technique and in isolated muscles. BjV induced increase in the muscle interstitial-arterial tyrosine concentration difference, indicating a high protein catabolism. The myotoxicity induced by this venom is associated with reduction of protein synthesis and increase in rates of overall proteolysis, which was accompanied by activation of lysosomal and ubiquitin-proteasome systems without changes in protein levels of cathepsins and ubiquitin-protein conjugates.
Estimation of Copy Number using SYBR Green: Confounding by AT-rich DNA and by Variation in Amplicon Length
Authors: Colborn James M. , Byrd Brian D. , Koita Ousmane A. , Krogstad Donald J.
Published: September 2018

Although SYBR Green is used to estimate copy number, its fluorescence varies with amplicon length and adenine/thymine (AT) content. As a result, threshold cycle (Ct) values obtained using real-time polymerase chain reaction (PCR) are lower for longer amplicons (P < 0.001) and amplicons with greater AT content (P < 0.001). In contrast, neither amplicon length nor AT content affects the Ct with TaqMan probes or LUX-labeled primers. Because SYBR Green yields lower Cts with AT-rich templates and longer templates, it overestimates copy number for those templates. Therefore, sequence-specific methods such as TaqMan probes or LUX-labeled primers should be considered when using real-time PCR to estimate copy number if the amplicons generated are AT-rich or vary in length.
Molecular Characterization of Rickettsia rickettsii Isolated from Human Clinical Samples and from the Rabbit Tick Haemaphysalis leporispalustris Collected at Different Geographic Zones in Costa Rica
Authors: Hun Laya , Cortés Ximena , Taylor Lizeth
Published: September 2018

Five strains of spotted fever group (SFG) rickettsiae previously isolated from human clinical cases and from the tick Haemaphysalis leporispalustris were used for molecular characterization in this study to establish their genetic relationship compared with the prototype Rickettsia rickettsii strain Sheila Smith. Samples were tested by polymerase chain reaction (PCR) targeting the rickettsial genes gtlA, ompA, and ompB. PCR products of the latter two genes were DNA sequenced and compared with available sequences in GenBank. The ompA partial sequences of the five Costa Rican isolates showed 100% identity to several R. rickettsii sequences available in GenBank, including the sequence of the virulent reference strain Sheila Smith, whereas the ompB partial sequences of the five Costa Rican isolates showed 99.8–100% identity to R. rickettsii sequences from GenBank. This study showed the first molecular detection of R. rickettsii isolates from Rocky Mountain Spotted Fever patients and from the rabbit tick H. leporispalustris in different geographical zones in Costa Rica.
Haemophilus influenzae Type b Conjugate Vaccine Introduction in Mali: Impact on Disease Burden and Serologic Correlate of Protection
Authors: Sow Samba O. , Tapia Milagritos D. , Diallo Souleymane , Keita Mamadou Marouf , Sylla Mariam , Onwuchekwa Uma , Pasetti Marcela F. , Kotloff Karen L. , Levine Myron M.
Published: September 2018

In Bamako, Mali, where surveillance revealed a high incidence of Haemophilus influenzae type b (Hib) invasive disease, Hib conjugate vaccine was introduced into the Expanded Program on Immunization and the impact assessed. Annual confirmed Hib hospitalizations for infants 0–11 months of age fell from 175/105 to 44/105 (P < 0.001); among infants 6–7 months of age Hib hospitalizations fell from 377/105 to 69/105, (82% decrease, P < 0.001). Invasive Streptococcus pneumoniae hospitalizations remained unchanged. In a baseline serosurvey, only 3/200 infants 6–7 months of age (1.5%) had protective anti-polyribosylribitol phosphate (PRP) titers ≥ 0.15 μg/mL and 1(0.5%) had ≥ 1.0 μg/mL. In serosurveys 18 and 30 months after vaccine introduction, 168/201 (84%) and 184/200 (92%) infants, respectively, had titers ≥ 0.15 μg/mL and 141/201 (70%) and 163/200 (82%) had titers ≥ 1.0 μg/mL. Introduction of Hib vaccine led to rises in anti-PRP seroprevalence, significant reductions in Hib disease, and all-cause hospitalizations, whereas S. pneumoniae disease remained unchanged.
Molecular Characterization of Dengue Viruses Imported Into Taiwan during 2003–2007: Geographic Distribution and Genotype Shift
Authors: Shu Pei-Yun , Su Chien-Ling , Liao Tsai-Ling , Yang Cheng-Fen , Chang Shu-Fen , Lin Chien-Chou , Chang Mei-Chun , Hu Huai-Chin , Huang Jyh-Hsiung
Published: September 2018

We presented our surveillance results on imported dengue cases in Taiwan during 2003–2007. A total of 542 imported dengue patients were identified. The travelers were infected in 17 countries in Southeast Asia, the Indian subcontinent, East African islands, South Pacific islands, and Central America. Most of these imported cases were infected in Southeast Asian countries. Phylogenetic analyses were conducted to examine 288 imported dengue virus (DENV) strains introduced from 13 countries. The results provide an updated view on the geographic distribution and dynamic transmission of epidemic DENV stains circulated in Southeast Asian countries. Although the geographic distributions of genotypes of DENV-3 isolated from Southeast Asian countries remain unchanged, the introductions and local expansions of epidemic DENV-1, DENV-2, and DENV-4 strains into new areas in Asia were observed. These findings highlight the importance to strengthen laboratory-based dengue surveillance for better understanding of transmission dynamics and molecular evolution of DENVs.
Closing Gaps in Antiretroviral Therapy Access: Human Immunodeficiency Virus–Associated Dementia Screening Instruments for Non-Physician Healthcare Workers
Authors: Kvalsund Michelle P. , Haworth Alan , Murman Daniel L. , Velie Ellen , Birbeck Gretchen L.
Published: September 2018

Human immunodeficiency virus–associated dementia (HIV-D) is an indication for antiretroviral therapy (ART), but HIV-D is not routinely screened for in ART clinics in sub-Saharan Africa. Given the dearth of physicians in sub-Saharan Africa, enabling non-physician healthcare workers to identify HIV-D is crucial for early treatment initiation and preventing chronic neurologic disability. Non-physician healthcare workers administered locally adapted screening instruments to 48 persons living with acquired immunodeficiency syndrome (PLWAs), and 15 healthy comparison persons provided normative data. Stage IV PLWAs performed worse than the comparison group on all tests. Overall, 24 (50%) of 48 PLWAs had significant cognitive impairment. Among HIV staging categories, 1 stage II (33%), 6 stage III (42%), and 17 stage IV (55%) patients were identified as cognitively impaired. Our pilot study indicates that screening instruments used by non-physician healthcare workers can identify cognitive impairment in PLWAs and may facilitate appropriate initiation of ART in resource-poor settings.
Malaria in São Tomé and Principe: On the Brink of Elimination after Three Years of Effective Antimalarial Measures
Authors: Teklehaimanot Hailay Desta , Teklehaimanot Awash , Kiszewski Anthony , Rampao Herodes Sacramento , Sachs Jeffrey D.
Published: September 2018

In 2005, São Tomé e Príncipe began an initiative aimed at reducing malaria-related mortality to zero. The program included mass coverage with two antivector intervention methods (indoor residual spraying and long-lasting insecticidal nets), artemisinin-based combination therapy, and intermittent preventive therapy in pregnancy with sulfadoxine-pyrimethamine. At the end of 2007, three years after intensified interventions began, malaria-attributed outpatient consultations, hospitalizations, and deaths decreased by more than 85%, 80%, and 95%, respectively, in all age groups. Mean prevalence of parasitemia and splenomegaly were also significantly reduced to 2.1% (P < 0.0001) and 0.3% (P < 0.0001) after two rounds of spraying from baseline prevalences of 30.5% and 48.8%, respectively. The dramatic reduction in malaria morbidity and mortality now enable serious consideration of new goals and strategies aimed at completely interrupting malaria transmission on these islands. We report evidence of the program’s impact and the feasibility of and potential strategies for eliminating malaria from São Tomé e Príncipe.
Severe Plasmodium vivax Malaria: A Report on Serial Cases from Bikaner in Northwestern India
Authors: Kochar Dhanpat K. , Das Ashish , Kochar Sanjay K. , Saxena Vishal , Sirohi Parmendra , Garg Shilpi , Kochar Abhishek , Khatri Mahesh P. , Gupta Vikas
Published: September 2018

Epidemiologic studies and clinical description of severe Plasmodium vivax malaria in adults living in malaria-endemic areas are rare and more attention is needed to understand the dynamics and its interaction with the immune system. This observational study included 1,091 adult patients admitted to medical wards of S. P. Medical College and associated group of hospitals in Bikaner, India from September 2003 through December 2005. The diagnosis of P. vivax malaria was established by peripheral blood film (PBF), rapid diagnostic test (RDT), and polymerase chain reaction (PCR), and severe malaria was categorized as per World Health Organization guidelines. Of 1,091 patients with malaria, 635 had P. falciparum malaria and 456 had P. vivax malaria. Among patients with severe manifestations, 40 had evidence of monoinfection of P. vivax malaria diagnosed by PBF, RDT, and PCR. Complications observed were hepatic dysfunction and jaundice in 23 (57.5%) patients, renal failure in 18 (45%) patients, severe anemia in 13 (32.5%) patients, cerebral malaria in 5 patients (12.5%), acute respiratory distress syndrome in 4 patients (10%), shock in 3 patients (7.5%), and hypoglycemia in 1 (2.5%) patient. Thrombocytopenia was observed in 5 (12.5%) patients, and multi-organ dysfunction was detected in 19 (47.5%) patients. Further large-scale multicentric epidemiologic studies are needed to define the basic pathology of this less known entity.
Comparison of Chlorproguanil-Dapsone with a Combination of Sulfadoxine-Pyrimethamine and Chloroquine in Children with Malaria in Northcentral Nigeria
Authors: Ogunfowokan Oluwagbenga , Dankyau Musa , Madaki Aboi J. K. , Thacher Tom D.
Published: September 2018

Effective and affordable treatment of malaria is critical in the face of resistance of Plasmodium falciparum to chloroquine (CQ) and sulfadoxine-pyrimethamine (SP). We conducted a randomized controlled trial comparing the efficacy of chlorproguanil-dapsone (CD) with a combination SP plus CQ in children in Nigeria less than five years of age with malaria. Of 264 children enrolled, 122 (89.7%) and 118 (92.2%) completed the study in the SP + CQ and CD groups, respectively. By day 3, 96 (78.7%) and 94 (79.7%) had cleared their parasitemia (P = 0.79), and 107 (87.7%) and 109 (92.4%) were symptom free (P = 0.32) in the SP + CQ and CD groups, respectively. Adequate clinical and parasitologic response at day 14 occurred in 111 (94.1%; 95% confidence interval [CI] = 91.6–95.7%) in the CD group and 113 (92.6%; 95% CI = 89.9–94.3%) in the SP + CQ group (P = 0.85). SP + CQ and CD had similar antimalarial efficacy and still provide affordable treatment of uncomplicated malaria in northcentral Nigeria.
Improvement in Detection of Enterotoxigenic Escherichia coli in Patients with Travelers’ Diarrhea by Increasing the Number of E. coli Colonies Tested
Authors: Galbadage Thushara , Jiang Zhi-Dong , DuPont Herbert L.
Published: September 2018

No cause of one-third of travelers’ diarrhea (TD) cases can be detected despite microbiologic assessment. We propose that these pathogen-negative TD cases include undetected enterotoxigenic Escherichia coli (ETEC). As a standard in diagnostic microbiology, samples of five E. coli colonies were tested to detect ETEC from stool cultures. We compared the sensitivities and the number of ETEC detected by 20 colonies with those of 5, 10, and 15 colonies. The percent detection of ETEC with five E. coli colonies was significantly different from that using 20 E. coli colonies. Of the 116 subjects studied, the number positive for ETEC for 5, 10, 15 and 20 colonies tested were 22 (19.0%), 37 (31.9%), 45 (38.8%) and 46 (39.7%), respectively. Based on our results, we recommend the testing of at least 10 E. coli colonies for optimum detection of ETEC in patients with TD.
Influence of Wasting and Stunting at the Onset of the Rainy Season on Subsequent Malaria Morbidity among Rural Preschool Children in Senegal
Authors: Fillol Florie , Cournil Amandine , Boulanger Denis , Cissé Badara , Sokhna Cheikh , Targett Geoffrey , Trape Jean-François , Simondon François , Greenwood Brian , Simondon Kirsten B.
Published: September 2018

In sub-Saharan Africa, malaria and malnutrition are major causes of morbidity and mortality in children less than five years of age. To explore the impact of malnutrition on subsequent susceptibility to malaria, a cohort of 874 rural preschool children in Senegal was followed-up during one malaria transmission season from July through December. Data on nutritional status and Plasmodium falciparum parasitemia were collected at baseline. Malaria morbidity was monitored through weekly home visits. Wasted children (weight-for-height z-score < −2) were at lower risk of having at least one subsequent clinical malaria attack (odds ratio = 0.33; 95% confidence interval = 0.13–0.81, P = 0.02), whereas stunting (height-for-age z-score < −2) or being underweight (weight-for-age z-score < −2) was not associated with clinical malaria. Although non-biological explanations such as overprotection of wasted children by their mothers should be considered, immunomodulation according to nutritional status could explain the lower risk of malaria attack among wasted children.
Prevalence of Neospora caninum and Toxoplasma gondii Antibodies in Northern Egypt
Authors: Ibrahim Hany M. , Huang Penglong , Salem Tarek A. , Talaat Roba M. , Nasr Mahmoud I. , Xuan Xuenan , Nishikawa Yoshifumi
Published: September 2018

In view of the worldwide importance of Toxoplasma gondii and Neospora caninum and the limited data on the seroprevalence of these parasites in Egypt, this study aimed to estimate the prevalence of anti-T. gondii and anti-N. caninum antibodies in rabbits, cattle, and humans. We used ELISA methods based on surface antigen 2 of T. gondii (TgSAG2t) and surface antigen 1 of N. caninum (NcSAG1t). High seroprevalence of T. gondii (51.49%) was detected in pregnant women, and antibodies to N. caninum were also detected in human samples (7.92%). Anti-T. gondii or N. caninum antibodies were detected in cattle (TgSAG2t: 10.75%; NcSAG1t: 20.43%). In rabbits, only one sample was N. caninum positive (1.85%). The high prevalence of toxoplasmosis and neosporosis in cattle affects the development of the livestock industry and is also an important infective source for human infection in Egypt.
Cutaneous Leishmaniasis with Boggy Induration and Simultaneous Mucosal Disease
Authors: Mings Steven , Beck Jill C. , Davidson Christopher , Ondo Andrew L. , Shanler Stuart D. , Berman Jonathan
Published: September 2018

A woman had cutaneous, mucosal, and possible visceral leishmaniasis simultaneously. Many of her cutaneous lesions consisted of boggy indurations rather than customary papules, nodules, or ulcers. This unusual case was finally cured after four courses of miltefosine, one course of antimony, and two courses of Ambisome.
Tropism of Dengue Virus in Mice and Humans Defined by Viral Nonstructural Protein 3-Specific Immunostaining
Authors: Balsitis Scott J. , Coloma Josefina , Castro Glenda , Alava Aracely , Flores Diana , McKerrow James H. , Beatty P. Robert , Harris Eva
Published: September 2018

Previous attempts to define dengue virus (DENV) tropism in human autopsy tissues have detected DENV antigens that are abundant in circulation during severe dengue, and thus may be present in uninfected cells. To better define DENV tropism, we performed immunostaining for the DENV2 nonstructural protein 3 (NS3) in humans and in a mouse model of DENV infection. In mice, NS3 was detected in phagocytes of the spleen and lymph node, hepatocytes in liver, and myeloid cells in bone marrow. In human autopsy tissues, NS3 was present in phagocytes in lymph node and spleen, alveolar macrophages in lung, and perivascular cells in brain. This protein was also found in hepatocytes in liver and endothelial cells in spleen, although NS3 was not present in endothelium in any other tissue. Thus, NS3-specific immunostaining supports roles for infected phagocytes, hepatocytes, and, to a limited degree, endothelial cells in the pathogenesis of severe dengue.
Skin and Soft Tissue Infections in Returning Travelers
Authors: Hochedez Patrick , Canestri Ana , Lecso Marylin , Valin Nadia , Bricaire François , Caumes Eric
Published: September 2018

Skin and soft tissue infections (SSTI) are a leading cause of cutaneous problems in travelers. Sixty travelers who presented with an SSTI were prospectively included over a 20-month period. Bacterial analysis and research for Panton-Valentine leukocidine (PVL) were performed according to clinical and bacterial presentation. The SSTI appeared abroad in 73% and were predominantly localized on lower limbs (75%). The main clinical forms were impetigo (35%) and cutaneous absess (23%). Insect bites were significantly associated with impetigo and ecthyma. Methicillin-susceptible Staphylococcus aureus (MSSA) was identified in 15 patients (43%), Group A Streptococcus (GAS) in 12 patients (34%), and an association of both in 8 (23%) among the 35 patients for whom bacteria were identified. The MSSA producing PVL were found in 4 patients. Travelers should be advised on how to prevent arthropod exposure and susceptibility testing should be recommended considering that methicillin-resistant S. aureus (MRSA) is increasingly reported, although not identified in our study.
Age-Dependent Acquisition of Protective Immunity to Malaria in Riverine Populations of the Amazon Basin of Brazil
Authors: Ladeia-Andrade Simone , Ferreira Marcelo Urbano , de Carvalho Maria Esther , Curado Izilda , Coura José Rodrigues
Published: September 2018

Five community-based cross-sectional surveys of malaria morbidity and associated risk factors in remote riverine populations in northwestern Brazil showed average parasite rates of 4.2% (thick-smear microscopy) and 14.4% (polymerase chain reaction [PCR]) in the overall population, with a spleen rate of 13.9% among children 2–9 years of age. Plasmodium vivax was 2.8 times more prevalent than P. falciparum, with rare instances of P. malariae and mixed-species infections confirmed by PCR; 9.6% of asymptomatic subjects had parasitemias detected by PCR. Low-grade parasitemia detected by PCR only was a risk factor for anemia, after controlling for age and other covariates. Although clinical and subclinical infections occurred in all age groups, the risk of infection and disease decreased significantly with increasing age, after adjustment for several covariates in multilevel logistic regression models. These findings suggest that the continuous exposure to hypo- or mesoendemic malaria may induce significant anti-parasite and anti-disease immunity in native Amazonians.
Two Different Chitinase Genotypes in a Patient with an Amebic Liver Abscess: A Case Report
Authors: Valenzuela Olivia , Morán Patricia , Ramos Fernando , Cardoza Jorge I. , García Gabriela , Valadez Alicia , Rojas Liliana , Garibay Adriana , González Enrique , Ximénez Cecilia
Published: September 2018

The present work deals with the identification of a patient with two liver abscesses containing two different strains of Entamoeba histolytica, as defined by chitinase gene plymorphisms.
Relapse of Visceral Leishmaniasis after Miltefosine Treatment in a Nepalese Patient
Authors: Pandey Basu Dev , Pandey Kishor , Kaneko Osamu , Yanagi Tetsuo , Hirayama Kenji
Published: September 2018

We report the first case of visceral leishmaniasis (VL) relapse in a healthy individual after complete miltefosine treatment. The patient attended hospital with a history of fever for 2 months, splenomegaly, hepatomegaly, and weight loss. The case was confirmed as VL by microscopical detection of Leishmania parasites in a bone marrow specimen and by a positive result for the immunochromatography-based test targeting the Leishmania donovani rK39 antibody. A polymerase chain reaction (PCR) specific for the Leishmania kinetoplast minicircle gene was positive, and subsequent sequencing of the PCR-amplified product confirmed that this case was a L. donovani infection. The patient was treated with miltefosine for 28 days, during which time the response was good, and the Leishman-Donovan body (LD body) was negative on discharge. Ten months later, however, this patient again developed high fever and splenomegaly, and LD bodies and rK39 antibody were positive, thus indicating a relapse of VL. The patient was subsequently treated with 1 mg/kg of amphotericin B for a total of 14 days and recovered completely.
Seroepidemiology of Giardiasis in Mexico
Authors: Cedillo-Rivera Roberto , Leal Yelda A. , Yépez-Mulia Lilián , Gómez-Delgado Alejandro , Ortega-Pierres Guadalupe , Tapia-Conyer Roberto , Muñoz Onofre
Published: September 2018

Prevalence of antibodies against Giardia duodenalis was determined by enzyme-linked immunosorbent assay in serum samples from a national serologic survey of Mexico that included all geographic areas and socioeconomic and demographic data for each person sampled. The country was divided into four regions on the basis of development (high, medium high, medium low, and low). Of 3,461 serum samples tested, 1,914 (55.3%) were positive for IgG antibodies against Giardia duodenalis. Seropositivity was age-specific; the probability of seropositivity increased 4.9-fold (95% confidence interval [CI] = 3.16–7.64) in adolescents 10–19 years of age, 8.0-fold (95% CI = 5.19–12.53) in young adults 20–39 years of age, and 12.6-fold (95% CI = 7.93–20.28) in adults more than 40 years of age. Giardia duodenalis seropositivity was associated with male sex (odds ratio = 1.40, 95% CI = 1.22–1.61). No association was found between seropositivity and socioeconomic variables or regional development status.
Coliform and Escherichia coli Contamination of Desserts Served in Public Restaurants from Guadalajara, Mexico, and Houston, Texas
Authors: Vigil Karen J. , Jiang Zhi-Dong , Chen Jaclyn J. , Palumbo Kathryn L. , Galbadage Thushara , Brown Eric L. , Yiang Jing , Koo Hoonmo , DuPont Margaret W. , Ericsson Charles , Adachi Javier A. , DuPont Herbert L.
Published: September 2018

Bacterial enteropathogens acquired from contaminated food are the principal causes of travelers’ diarrhea (TD). We evaluated desserts obtained from popular restaurants in the tourist city of Guadalajara, Mexico, and Houston, Texas, to determine coliform and Escherichia coli contamination levels and presence of diarrheagenic E. coli known to be important in TD. Contamination for all organisms was seen for desserts served in Guadalajara restaurants. Desserts should be considered as potentially risky foods for development of TD among international visitors to developing regions of the world.
Increasing Isolations of Neisseria meningitides Serogroup A from Blood and Cerebrospinal Fluid in Dhaka, Bangladesh, 1999–2006
Authors: Hossain M. Anowar , Ahmed Dilruba , Ahmed Tahmeed , Islam Nazrul , Breiman Robert F.
Published: September 2018

During 1999–2006, 156 isolates of Neisseria meningitidis grew from culture of blood or cerebrospinal fluid at International Centre for Diarrhoeal Disease Research, Bangladesh, in Dhaka, Bangladesh. Serogroup A was the most prevalent strain (97.7%); the rest were serogroup B (2.3%). Most cases of invasive meningococcal disease (88.5%) were identified in 2002–2004 and most (87.5%) occurred in children, teenagers, and young adults, which reflected a community-wide increase in meningococcal disease incidence during this period, which was not recognized previously. All isolates were susceptible to penicillin, ampicillin, chloramphenicol, ciprofloxacin, and ceftriaxone. Cotrimoxazole resistance steadily increased from 50% to 100% during 2002–2006. Resistance to azithromycin emerged in 2002 (5%), increased to 31% in 2004, but isolates in 2005–2006 were susceptible. Information from broader hospital settings and population-based data would precisely assess trends and impact to define strategies for optimal prevention and empiric therapy.
Comparison of Culture Techniques at Different Stages of Brucellosis
Authors: Espinosa Benjamin J. , Chacaltana Jesús , Mulder Maximilian , Franco María Pía , Blazes David L. , Gilman Robert H. , Smits Henk L. , Hall Eric R.
Published: September 2018

The lysis centrifugation technique is preferred for culturing Brucella spp. at all stages of brucellosis because it yields 25% more positive results and on average provides results 10 days earlier than the Ruiz-Castaneda method. This lysis method is inexpensive and easier to use and may be used in laboratories with limited expertise or equipment if all safety precautions are taken.
Clinical Characteristics, Risk Factors, and Outcomes in Adults Experiencing Dengue Hemorrhagic Fever Complicated with Acute Renal Failure
Authors: Lee Ing-Kit , Liu Jien-Wei , Yang Kuender D.
Published: September 2018

In a retrospective study, acute renal failure (ARF) was found in 10 (3.3%) among 304 hospitalized adults with dengue hemorrhagic fever (DHF), and 6 (60%) of the 10 patients with ARF died, whereas all 294 patients without ARF (controls) survived (P < 0.001). Compared with the controls, DHF patients with ARF were found to be significantly older (P = 0.002) and male predominant (P < 0.001) and to have higher frequency of previous stroke (P = 0.005), chronic renal insufficiency (P = 0.046), dengue shock syndrome (DSS; P < 0.001), gastrointestinal bleeding (P < 0.001), and concurrent bacteremia (P = 0.009), lower hemoglobin (P = 0.003) and serum albumin levels (P = 0.003), and higher incidences of prolonged prothrombin time (P < 0.001), elevated aspartate aminotransferase (P < 0.001), and alanine aminotransferase levels (P < 0.001). Multivariate analysis showed DSS (odd ratio = 220.0; P < 0.001) was an independent risk factor for development of ARF in DHF patients. The high fatality rate in DHF patients complicated with ARF in our series underscore the importance of clinicians’ alertness to this potentially fatal complication so that initiation of timely appropriate treatment is possible.
Intervention Measures, Turning Point, and Reproduction Number for Dengue, Singapore, 2005
Authors: Hsieh Ying-Hen , Ma Stefan
Published: September 2018

The 2005 dengue outbreak in Singapore cumulated in > 14,000 cases and 27 reported dengue deaths. We fit the single-phase Richards model to weekly dengue notification numbers to detect the turning point for the outbreak, which enables us to study the impact of intervention measures relating to the turning point. The results indicate that turning point had most likely occurred in late August or early September, before large-scale intervention measures were implemented. The “initial” reproduction number for the outbreak is estimated to be ~1.89–2.23 (95% confidence interval: 1.15–3.00). One of the lessons learned from the 2003 severe acute respiratory syndrome (SARS) outbreak is that multiple phases of outbreak were observed in some affected countries when efforts to intensify intervention or to sustain vigilance were compromised. Intensive and continuing efforts in the implementation of control measures are essential in reducing further dengue occurrences during any resurgence of dengue.
Antiretroviral Adherence in Rural Zambia: The First Year of Treatment Availability
Authors: Birbeck Gretchen L. , Chomba Elwyn , Kvalsund Michelle , Bradbury Richard , Mang’ombe Charles , Malama Kennedy , Kaile Trevor , Byers Peter A. , _ _
Published: September 2018

We conducted a retrospective chart review of antiretroviral therapy (ART) clinic patients treated during the first 12 months after clinics opened in rural Zambia and assessed adherence based on clinic attendance, patient report, and staff assessment. We identified 255 eligible patients (mean age, 39.7 years; 44.3% male; 56.5% married; and 45.5% with only primary school education). Twenty percent had partners known to be HIV positive. Twenty percent were widowed. Thirty-seven percent had disclosed their HIV status to their spouse. Disclosure was less likely among women (27.5% versus 49.6%, P = 0.0005); 36.5% had “clinic buddies” to provide adherence support. Adherence rates were good for 59.2%. Disclosure of HIV status to ones’ spouse (P = 0.047), knowing spouses’ HIV status (P = 0.02), and having a clinic buddy (P = 0.01) were associated with good adherence. Social support is a key patient-level resource impacting ART adherence in rural Zambia. Limited spousal disclosure affects women more than men. Clinic buddies are associated with better adherence.
Role of NO Synthase in the Development of Trypanosoma cruzi–Induced Cardiomyopathy in Mice
Authors: Durand Jorge L. , Mukherjee Shankar , Commodari Fernando , De Souza Andrea P. , Zhao Dazhi , Machado Fabiana S. , Tanowitz Herbert B. , Jelicks Linda A.
Published: September 2018

Trypanosoma cruzi infection results in an increase in myocardial NO and intense inflammation. NO modulates the T. cruzi–induced myocardial inflammatory reaction. NO synthase (NOS)1-, NOS2-, and NOS3-null mice were infected with T. cruzi (Brazil strain). Infected NOS1-null mice had increased parasitemia, mortality, and left ventricular inner diameter (LVID). Chronically infected NOS1- and NOS2-null and wild-type mice (WT) exhibited increased right ventricular internal diameter (RVID), although the fold increase in the NOS2-null mice was smaller. Infected NOS3-null mice exhibited a significant reduction both in LVID and RVID. Reverse transcriptase-polymerase chain reaction showed expression of NOS2 and NOS3 in hearts of infected NOS1-null and WT mice, whereas infected NOS2-null hearts showed little change in expression of other NOS isoforms. Infected NOS3-null hearts showed an increase only in NOS1 expression. These results may indicate different roles for NOS isoforms in T. cruzi–induced cardiomyopathy.
Malaria and Intestinal Helminth Co-infection Among Pregnant Women in Ghana: Prevalence and Risk Factors
Authors: Yatich Nelly J. , Yi Jiang , Agbenyega Tsiri , Turpin Archer , Rayner Julian C. , Stiles Jonathan K. , Ellis William O. , Funkhouser Ellen , Ehiri John E. , Williams Jonathan H. , Jolly Pauline E.
Published: September 2018

Both malaria and intestinal helminths are endemic in sub-Saharan Africa, and their co-infection occurs commonly. This cross-sectional study assessed the prevalence of malaria and intestinal helminth co-infection in a sample of > 700 pregnant women in Ghana and identified risk factors for co-infection. The prevalence of malaria infection, intestinal helminth infection(s), and co-infection was 36.3%, 25.7%, and 16.6%, respectively. Women with intestinal helminth infection(s) were 4.8 times more likely to have malaria infection. Young age, low income, being single, and being primigravid were each associated with increased odds of co-infection. These associations were present when assessed separately for primi- and multigravid women, but the strength of associations varied considerably for the two groups of women. Young age had the strongest association among both primigravid (odds ratio = 5.2) and multigravid (odds ratio = 3.2) women. This study shows relatively high prevalence rates of malaria, intestinal helminths, and co-infection in pregnant women in Ghana.
Effect of Malaria Rapid Diagnostic Tests on the Management of Uncomplicated Malaria with Artemether-Lumefantrine in Kenya: A Cluster Randomized Trial
Authors: Skarbinski Jacek , Ouma Peter O. , Causer Louise M. , Kariuki Simon K. , Barnwell John W. , Alaii Jane A. , de Oliveira Alexandre Macedo , Zurovac Dejan , Larson Bruce A. , Snow Robert W. , Rowe Alexander K. , Laserson Kayla F. , Akhwale Willis S. , Slutsker Laurence , Hamel Mary J.
Published: September 2018

Shortly after Kenya introduced artemether-lumefantrine (AL) for first-line treatment of uncomplicated malaria, we conducted a pre-post cluster randomized controlled trial to assess the effect of providing malaria rapid diagnostic tests (RDTs) on recommended treatment (patients with malaria prescribed AL) and overtreatment (patients without malaria prescribed AL) in outpatients ≥ 5 years old. Sixty health facilities were randomized to receive either RDTs plus training, guidelines, and supervision (TGS) or TGS alone. Of 1,540 patients included in the analysis, 7% had uncomplicated malaria. The provision of RDTs coupled with TGS emphasizing AL use only after laboratory confirmation of malaria reduced recommended treatment by 63%-points (P = 0.04), because diagnostic test use did not change (−2%-points), but health workers significantly reduced presumptive treatment with AL for patients with a clinical diagnosis of malaria who did not undergo testing (−36%-points; P = 0.03). Health workers generally adhered to RDT results when prescribing AL: 88% of RDT-positive and 9% of RDT-negative patients were treated with AL, respectively. Overtreatment was low in both arms and was not significantly reduced by the provision of RDTs (−12%-points, P = 0.30). RDTs could potentially improve malaria case management, but we urgently need to develop more effective strategies for implementing guidelines before large scale implementation.
Identification of Flea Blood Meals Using Multiplexed Real-Time Polymerase Chain Reaction Targeting Mitochondrial Gene Fragments
Authors: Woods Michael E. , Montenieri John A. , Eisen Rebecca J. , Zeidner Nordin S. , Borchert Jeff N. , Laudisoit Anne , Babi Nackson , Atiku Linda A. , Enscore Russell E. , Gage Kenneth L.
Published: September 2018

Human plague is found in the West Nile region of Uganda and Democratic Republic of the Congo where flea vectors are often found inhabiting homes. We have developed a multiplexed, real-time polymerase chain reaction assay targeting mitochondrial genes that is capable of detecting blood meal sources in fleas collected off-host in East Africa. Laboratory tests showed that the assay is specific for the intended targets and has a detection limit below one picogram of DNA. Testing of wild-caught fleas from the Democratic Republic of Congo suggests that humans are at significant risk from flea-borne disease and implicates domestic animals including cats, chickens, and the black rat as potential sources of human exposure to fleas and flea-borne diseases. Future application of the assay will help us better define the ecology of plague in East Africa to implement effective control measures to combat the spread of disease.
Voltage-Gated Sodium Channel Polymorphism and Metabolic Resistance in Pyrethroid-Resistant Aedes aegypti from Brazil
Authors: Martins Ademir Jesus , de Andrade Lins Rachel Mazzei Moura , Linss Jutta Gerlinde Birgitt , Peixoto Alexandre Afranio , Valle Denise
Published: September 2018

The nature of pyrethroid resistance in Aedes aegypti Brazilian populations was investigated. Quantification of enzymes related to metabolic resistance in two distinct populations, located in the Northeast and Southeast regions, revealed increases in Glutathione-S-transferase (GST) and Esterase levels. Additionally, polymorphism was found in the IIS6 region of Ae. aegypti voltage-gated sodium channel (AaNaV), the pyrethroid target site. Sequences were classified in two haplotype groups, A and B, according to the size of the intron in that region. Rockefeller, a susceptible control lineage, contains only B sequences. In field populations, some A sequences present a substitution in the 1011 site (Ile/Met). When resistant and susceptible individuals were compared, the frequency of both A (with the Met mutation) and B sequences were slightly increased in resistant specimens. The involvement of the AaNaV polymorphism in pyrethroid resistance and the metabolic mechanisms that lead to potential cross-resistance between organophosphate and pyrethroids are discussed.
Evaluation of Leishmania Species Reactivity in Human Serologic Diagnosis of Leishmaniasis
Authors: Silvestre Ricardo , Santarém Nuno , Teixeira Lúcia , Cunha Joana , Schallig Henk , Cordeiro-da-Silva Anabela
Published: September 2018

The sensitivities and specificities of IgG-ELISA and IgG flow cytometry based techniques using different
Leishmania
species were determined using sera collected from 40 cutaneous or visceral leishmaniasis patients. The flow cytometry technique, using promastigote parasite forms, performed better than total soluble extract IgG-ELISA. At the species level, the use of
Leishmania amazonensis
and
Leishmania major
as antigens in enzyme linked immunosorbent assay (ELISA) decreased the overall sensitivity. To assess the specificity of these tests, sera from malaria, toxoplasmosis, amoebiasis, schistosomiasis, and leprosy patients were used. We also included sera from
Leishmania
non-infected endemic individuals. The cutaneous species displayed a decreased specificity in both assays. Although more sensitive, flow cytometry using promastigote parasite forms generally presented lower levels of specificity when compared with total extract of IgG-ELISA. Overall, the results of the study show the potential of IgG flow cytometry for the diagnosis of leishmaniasis. Although highly sensitive, a refinement of the flow cytometry method should be performed to improve the overall specificity.
AA-Amyloidosis Caused by Visceral Leishmaniasis in a Human Immunodeficiency Virus-Infected Patient
Authors: de Vallière Serge , Mary Charles , Joneberg Jeanna E. , Rotman Samuel , Bullani Roberto , Greub Gilbert , Gillmore Julian D. , Buffet Pierre A. , Tarr Philip E.
Published: September 2018

AA-amyloidosis in the setting of chronic visceral leishmaniasis (VL) has been reported in animal models but documentation in humans is unavailable. Here, we report on a Portuguese man who in 1996 was diagnosed with both human immunodeficiency virus (HIV)-infection and VL. Antiretroviral treatment led to sustained suppression of HIV viremia but CD4+ lymphocytes rose from 8 to only 160 cells/mL. Several courses of antimony treatment did not prevent VL relapses. Renal failure developed in 2006 and renal biopsy revealed AA-amyloidosis. The patient had cryoglobulinemia and serum immune complexes containing antibodies directed against seven leishmanial antigens. Antimony plus amphotericin B, followed by oral miltefosine resulted in a sustained VL treatment response with elimination of circulating Leishmania infantum DNA and CD4+ recovery. The concomitant reduction of serum AA levels and disappearance of circulating leishmanial immune complexes suggests that prolonged VL may lead to AA-amyloidosis in immunocompromised humans.
Seroprevalence of Trypanosoma cruzi Among Teenek Amerindian Residents of the Huasteca Region in San Luis Potosi, Mexico
Authors: Juarez-Tobias Soledad , Vaughan Gilberto , Torres-Montoya Aida , Escobar-Gutierrez Alejandro
Published: September 2018

Scarce information on the seroprevalence of Trypanosoma cruzi among Amerindians is available, and the distribution of this disease in Mexican Indian populations is unknown. In this study, the presence of specific antibodies against T. cruzi among Teenek Amerindians in nine different communities located in San Luis Potosi State was analyzed. An average seroprevalence of 6.5% was found in these populations, suggesting that active transmission of disease occurs in this relatively isolated population in Mexico, and therefore, further studies should be conducted to identify risk factor associated to Chagas disease in other isolated populations across the country to determine the prevalence of Chagas disease in Mexican Amerindians.
Population-Based Multicentric Survey of Hepatitis B Infection and Risk Factor Differences among Three Regions in Brazil
Authors: Pereira Leila M. M. B. , Martelli Celina M. T. , Merchán-Hamann Edgar , Montarroyos Ulisses R. , Braga Maria C. , de Lima Maria L. C. , Cardoso Maria R. A. , Turchi Marília D. , Costa Marcelo A. , de Alencar Luiz C. A. , Moreira Regina C. , Figueiredo Gerusa M. , Ximenes Ricardo A. A. , _ _
Published: September 2018

This multicentric population-based study in Brazil is the first national effort to estimate the prevalence of hepatitis B (HBV) and risk factors in the capital cities of the Northeast, Central-West, and Federal Districts (2004–2005). Random multistage cluster sampling was used to select persons 13–69 years of age. Markers for HBV were tested by enzyme-linked immunosorbent assay. The HBV genotypes were determined by sequencing hepatitis B surface antigen (HBsAg). Multivariate analyses and simple catalytic model were performed. Overall, 7,881 persons were included; < 70% were not vaccinated. Positivity for HBsAg was less than 1% among non-vaccinated persons and genotypes A, D, and F co-circulated. The incidence of infection increased with age with similar force of infection in all regions. Males and persons having initiated sexual activity were associated with HBV infection in the two settings; healthcare jobs and prior hospitalization were risk factors in the Federal District. Our survey classified these regions as areas with HBV endemicity and highlighted the risk factors differences among the settings.
A Comparative Clinical Trial in Multibacillary Leprosy with Long-Term Relapse Rates of Four Different Multidrug Regimens
Authors: Fajardo Tranquilino T. , Villahermosa Laarni , Pardillo Fe Eleanor F. , Abalos Rodolfo M. , Burgos Jasmin , Dela Cruz Eduardo , Gelber Robert H.
Published: September 2018

As a participant in a multicenter trial, we evaluated the relapse rate in 189 multibacillary (MB) leprosy patients treated with four different regimens and followed-up for as many as 12 years after the initiation of treatment. Treatment regimens included 1 year of WHO MDT (a regimen including dapsone, clofazimine, and rifampin), 2 years of WHO MDT, 1 month of daily rifampin and daily ofloxacin, and 1 year of WHO MDT plus an initial 1 month of daily rifampin and daily ofloxacin. Relapse rates after 9 and 12 years from the initiation of therapy in the three regimens that included WHO MDT were 0–3%, whereas relapses occurred in those treated with the 1-month regimen alone at a significantly greater rate (P < 0.05): 11% at 9 years and 25% at 12 years. Relapses occurred late, beginning at 5 years after the initiation of therapy, and were confined to those patients histopathologically borderline lepromatous and polar lepromatous having a high bacterial burden. Prospects for an alternative effective short-course therapy of leprosy are presented.
Resistance to Chloroquine by Plasmodium vivax at Alor in the Lesser Sundas Archipelago in Eastern Indonesia
Authors: Sutanto Inge , Suprijanto Sri , Nurhayati  , Manoempil Paul , Baird J. Kevin
Published: September 2018

The therapeutic response to standard chloroquine therapy against Plasmodium vivax was evaluated in 36 subjects living at Alor in the Lesser Sundas Archipelago of eastern Indonesia. Chloroquine level were measured on 32 individuals, and showed evidence of adequate absorption of standard chloroquine therapy. Three subjects failed treatment by Day 2 or 3, with evidence of rising asexual parasitemia, and two others had stable parasitemia to Day 7. Ten more subjects had recurrent parasitemia by Day 14, two by Day 21, and another one by Day 28. Three subjects had recurrent parasitemia on Days 14 and 28, but with chloroquine < 100 ng/mL. Eleven subjects cleared parasitemia by Day 3 and had no recurrences up to Day 28. In summary, 28-day cumulative incidence of confirmed resistance to chloroquine was 56% of infections evaluated. Chloroquine should not be considered adequate for treatment of acute vivax malaria acquired in this region.
Quantitative Determination of Plasmodium vivax Gametocytes by Real-Time Quantitative Nucleic Acid Sequence-Based Amplification in Clinical Samples
Authors: Beurskens Martijn , Mens Pètra , Schallig Henk , Syafruddin Din , Asih Puji Budi Setia , Hermsen Rob , Sauerwein Robert
Published: September 2018

Microscopic detection of Plasmodium vivax gametocytes, the sexual life stage of this malaria parasite, is insensitive because P. vivax parasitaemia is low. To detect and quantify gametocytes a more sensitive, quantitative real-time Pvs25-QT-NASBA based on Pvs25 mRNA was developed and tested in two clinical sample sets from three different continents. Pvs25-QT-NASBA is highly reproducible with low inter-assay variation and reaches sensitivity approximately 800 times higher than conventional microscopic gametocyte detection. Specificity was tested in 104 samples from P. vivax-, P. falciparum-, P. malariae-, and P. ovale-infected patients. All non-vivax samples were negative in the Pvs25-QT-NASBA; out of 74 PvS18-QT-NASBA positive samples 69% were positive in the Pvs25-QT-NASBA. In a second set of 136 P. vivax microscopically confirmed samples, gametocyte prevalence was 8%, whereas in contrast 66% were positive by Pvs25-QT-NASBA. The data suggest that the human P. vivax gametocyte reservoir is much larger when assessed by Pvs25-QT-NASBA than by microscopy.
The Value of the Otorhinolaryngologic Exam in Correct Mucocutaneous Leishmaniasis Diagnosis
Authors: Boaventura Viviane S. , de Oliveira Jene G. S. , Costa Jackson M. L. , Novais Fernanda O. , de Oliveira Camila I. , Barral-Netto Manoel , Barral Aldina
Published: September 2018

An increase in mucocutaneous leishmaniasis (ML) cases in northern (Brazil) motivated this study. In 44 ML patients with clinical diagnosis, only 13 parasitologically confirmed cases exhibited mucosal lesion suggestive of ML. Other conditions involving nasal manifestations are frequently confounded with ML. Therefore, otorhinolaryngologic examination is important in the clinical management of ML.