bluuebunny/crossref_metadata_2025 huggingface dataset:
VIVAX MALARIA: A CONTINUING HEALTH THREAT TO THE REPUBLIC OF KOREA
Authors: PARK JAE-WON , KLEIN TERRY A. , LEE HEE-CHOON , PACHA LAURA A. , RYU SEUNG-HO , YEOM JOON-SUP , MOON SEUNG-HWAN , KIM TONG-SOO , CHAI JONG-YIL , OH MYOUNG-DON , CHOE KANG-WON
Published: September 2018

Vivax malaria reemerged in the Republic of Korea in 1993. Most of the cases occurred among soldiers in the region adjacent to the Demilitarized Zone (DMZ) until 1995. To determine the rate of dispersion of vivax malaria, we evaluated its epidemiologic characteristics. Of 13,903 cases of vivax malaria reported in 2000, 40.1% (5,577) were reported among Republic of Korea military personnel, 26.2% (3,641) among veterans discharged less than two years from the military, and 33.7% (4,685) among civilians. Cases of vivax malaria have rapidly increased annually among counties bordering the DMZ, and have spread to approximately 40 km south of the DMZ. Chemoprophylaxis administered to military personnel may have been responsible for the decreasing number of cases among the Republic of Korea military population. The first mosquito-transmitted cases appeared in early June. Therefore, chemoprophylaxis should be instituted in early April to reduce the number of infected mosquitoes. Extensive intervention is warranted to reduce the spread of vivax malaria in the Republic of Korea.
SHORT REPORT: ASSOCIATION BETWEEN CHLOROQUINE AND AMODIAQUINE RESISTANCE AND ALLELIC VARIATION IN THE PLASMODIUM FALCIPARUM MULTIPLE DRUG RESISTANCE 1 GENE AND THE CHLOROQUINE RESISTANCE TRANSPORTER GENE IN ISOLATES FROM THE UPPER NILE IN SOUTHERN SUDAN
Authors: OCHONG’ EDWIN O. , VAN DEN BROEK INGRID V. F. , KEUS KEES , NZILA ALEXIS
Published: September 2018

Amodiaquine, a 4-aminoquinoline compound, is being considered as an alternative to chloroquine and pyrimethamine/sulfadoxine where resistance in Plasmodium falciparum to both drugs has been selected. Although amodiaquine is more potent than chloroquine, its effectiveness is reduced in areas where chloroquine resistance is high. We report an association of the P. falciparum chloroquine resistance transporter (pfcrt) gene and the P. falciparum multiple drug resistance 1 (pfmdr1) gene, two chloroquine resistance markers, with chloroquine and amodiaquine efficacy in vivo in southern Sudan. The data show that the allele of the pfcrt gene with a lysine to threonine change at codon 76 is strongly associated with both chloroquine and amodiaquine resistance. No such association was observed with the pfmdr1 gene.
OUTCOME OF DELIVERY AND CAUSE-SPECIFIC MORTALITY AND SEVERE MORBIDITY IN EARLY INFANCY: A KENYAN DISTRICT HOSPITAL BIRTH COHORT
Authors: ENGLISH MIKE , MUHORO ANN , ALUDA MAURICE , WERE SAM , ROSS AMANDA , PESHU NORBERT
Published: September 2018

It has proven very difficult to determine the causes of early infant mortality and morbidity in Africa. We undertook a two-year, prospective birth cohort study in a rural Kenyan District Hospital to estimate cause-specific mortality and severe morbidity in infants too young to gain benefit from routine immunization approaches. A total of 2,359 infants eligible for the cohort were delivered. Of these, 136 (6%) were stillborn and 77 (3.5%) subsequently died. Prematurity (34%), birth asphyxia (27%), and infection (18.5%) were the predominant causes of death in the first 98 days of life, although infection accounted for 36% of all life-threatening illness episodes in the same period. The data suggest that health system constraints are likely to impede programmatic efforts to reduce early infant mortality and morbidity, and that infection prevention measures offer some promise for mortality reduction. Assessing the cost effectiveness of the latter, particularly for very specific interventions such as further maternal vaccination, will require very large trials.
VALIDATION OF A SIMPLIFIED METHOD FOR USING MOLECULAR MARKERS TO PREDICT SULFADOXINE-PYRIMETHAMINE TREATMENT FAILURE IN AFRICAN CHILDREN WITH FALCIPARUM MALARIA
Authors: KYABAYINZE DANIEL , CATTAMANCHI ADITHYA , KAMYA MOSES R. , ROSENTHAL PHILIP J. , DORSEY GRANT
Published: September 2018

Surveillance of molecular markers for key mutations in Plasmodium falciparum dihydrofolate reductase (DHFR) and dihydropteroate synthetase (DHPS) has been proposed as a means of predicting sulfadoxine/ pyrimethamine (SP) treatment outcomes in Africa. This study assessed the association between DHFR and DHPS mutations and standardized clinical outcomes in children treated with SP for uncomplicated malaria in Kampala, Uganda. Two mutations (DHFR Asn-108 and Ile-51) were too common to be useful predictors. Three other mutations (DHFR Arg-59, DHPS Gly-437, and DHPS Glu-540) were associated with clinical treatment failure after 14 days, although associations were not significant. When follow-up was extended to 28 days and genotyping was used to distinguish recrudescence from new infections, associations were significantly strengthened. The presence of both the DHFR Arg-59 and DHPS Glu-540 mutations had the strongest association with clinical treatment failure (odds ratio = 10.7, P = 0.009). These results support a previously proposed method of predicting clinical outcomes based on the prevalence of these two mutations.
THE COMPLEX ECOLOGY OF HANTAVIRUS IN PARAGUAY
Authors: CHU YONG-KYU , OWEN ROBERT D. , GONZALEZ LIZA M. , JONSSON COLLEEN B.
Published: September 2018

Following an outbreak of hantavirus pulmonary syndrome (HPS) in the Paraguayan Chaco in 1995, Calomys laucha was identified as the rodent host for the hantavirus associated with these cases. To explore the possibility of additional hantaviruses in Paraguay, we collected 636 mammals from 10 of the 17 departments. Plasma from 27 animals in Alto Paraguay and Boquerón in the Chaco and Ñeembucú and Itapúa in the eastern region had antibody to Andes virus antigens. Of these 27, five individuals (among four species) were positive for hantavirus RNA. Sera were collected from indigenous people in eastern Paraguay to ascertain whether persons were being infected with hantavirus outside of the Chaco. Seventeen percent were antibody-positive. These results suggest that several different hantaviruses are co-circulating in Paraguay, and that HPS cases occurring in eastern Paraguay may result from exposure to hantaviruses that are distinct from those in the Chaco.
HEPATITIS B INFECTION IN RURAL VIETNAM AND THE IMPLICATIONS FOR A NATIONAL PROGRAM OF INFANT IMMUNIZATION
Authors: HIPGRAVE DAVID B. , VAN NGUYEN THU , HUONG VU MINH , LONG HOANG THUY , DAT DO TUAN , TRUNG TRAN NAM , JOLLEY DAMIEN , MAYNARD JAMES E. , BIGGS BEVERLEY-ANN
Published: September 2018

To ascertain hepatitis B virus (HBV) infection rates for Vietnam, we surveyed HBV markers in two districts of Thanh Hoa province. We randomly selected 536 infants (9– ≤ 18 months old), 228 children (4 to ≤ 6 years old), 219 adolescents (14 to ≤ 16 years old), and 596 adults (25 to ≤ 40 years old). On questioning, none of those surveyed had received vaccine against HBV. Hepatitis B virus surface antigen (HBsAg) and total HBV core antibody (anti-HBc) were measured in all specimens, and HBV e antigen (HBeAg) in those positive for HBsAg, and HBV surface antibody (anti-HBs) were measured in all others. Current infection (HBsAg+) rates were infants = 12.5%, children = 18.4%, adolescents = 20.5%, and adults = 18.8%. Current or previous infection (HBsAg+, anti-HBc+, or anti-HBs+) increased with age (infants = 19.6%, children = 36.4%, adolescents = 55.3%, adults = 79.2%). Rates of HBeAg among those HBsAg+ were infants = 85.1%, children = 88.1%, adolescents = 71.1%, and adults = 30.4%. The epidemiology of HBV in Vietnam resembles that of many southeast Asian nations before introduction of vaccine. Immunization of newborns will have enormous impact on HBV-related morbidity and mortality there.
APONOMMA HYDROSAURI, THE REPTILE-ASSOCIATED TICK RESERVOIR OF RICKETTSIA HONEI ON FLINDERS ISLAND, AUSTRALIA
Authors: STENOS JOHN , GRAVES STEPHEN , POPOV VSEVOLOD L. , WALKER DAVID H.
Published: September 2018

Rickettsia honei is the etiologic agent of Flinders Island (Australia) spotted fever. The tick Aponomma hydrosauri is associated with reptiles and is the arthropod reservoir for this rickettsia on Flinders Island. The rickettsia appears to be maintained in the tick via vertical transmission. Of 46 ticks examined, 29 (63%) were positive for spotted fever group rickettsiae by detection of the citrate synthase gene by a polymerase chain reaction (PCR). From the positive tick samples, seven were sequenced and found to be 100% homologous with R. honei. Of 17 reptiles examined, none had evidence of rickettsiae by PCR or culture of blood.
HIGH PREVALENCE OF STRONGYLOIDES STERCORALIS AMONG FARM WORKERS ON THE MEDITERRANEAN COAST OF SPAIN: ANALYSIS OF THE PREDICTIVE FACTORS OF INFECTION IN DEVELOPED COUNTRIES
Authors: ROMÁN-SÁNCHEZ P. , PASTOR-GUZMÁN A. , MORENO-GUILLÉN S. , IGUAL-ADELL R. , ER-GENEROSO S. SUÑ , TORNERO-ESTÉBANEZ C.
Published: September 2018

Strongyloidiasis is a parasitosis characterized by persistent infection before dissemination and the development of potentially fatal disease. Since diagnosis is difficult, knowledge of the prevalence and geographic distribution of the disease is of practical importance. A study was made of Strongyloides stercoralis infection in a random and representative sample of farm workers in a tourist region in Spain based on the detection of larvae of triple stool samples. The prevalence of infection was 12.4% (95% confidence interval [CI] = 8.4–16.4). None of the 26 clinical or epidemiologic variables analyzed were found to be predictive of infection. Only eosinophilia (> 400 eosinophils/mm3 ) was significantly greater among the infected individuals (odds ratio = 73.4, 95% CI = 16.3–327.0), with a sensitivity of 93.5% and a specificity of 93.1%. A screening program is proposed to detect eosinophilia, to provide treatment without stool examinations, and thus afford a cost-effective policy for preventing the development of severe forms of the disease among specific risk groups where the prevalence of other parasitoses is low.
DEPENDENCE OF MALARIA DETECTION AND SPECIES DIAGNOSIS BY MICROSCOPY ON PARASITE DENSITY
Authors: McKENZIE F. ELLIS , SIRICHAISINTHOP JEERAPHAT , MILLER R. SCOTT , GASSER ROBERT A. , WONGSRICHANALAI CHANSUDA
Published: September 2018

Giemsa-stained blood smears from each of 2,190 patients from Thai government-operated clinics on the Thailand-Myanmar border were independently examined by the on-duty microscopists at the clinics and by 2–3 research microscopists, each blinded to the clinics’ and each other’s reports. Using a strictly defined protocol, a consensus reference-standard blood smear interpretation for each sample was produced by the research microscopists. This result was compared with the clinic’s diagnostic interpretation for the corresponding sample with respect to detection of parasitemia and diagnosis of infecting species. Reference-standard results reported parasitemia in 13.2% of the samples reported negative by the clinic. Reference-standard results were negative in 24.3% of the samples reported parasite-positive by the clinic. For samples in which both the reference-standard result and the clinic result reported parasitemia, species identification differed for 13.7% of the samples. The likelihood of parasite detection and correct diagnosis at the clinic varied in accordance with the reference-standard estimates of parasite density.
SEROPREVALENCE AND RISK FACTORS FOR TRYPANOSOMA CRUZI INFECTION IN THE AMAZON REGION OF ECUADOR
Authors: GRIJALVA MARIO J. , ESCALANTE LUIS , PAREDES RODRIGO A. , COSTALES JAIME A. , PADILLA ALBERTO , ROWLAND EDWIN C. , AGUILAR H. MARCELO , RACINES JOSE
Published: September 2018

Trypanosoma cruzi infection in the Ecuadorian Amazon region has recently been reported. A seroepidemiologic survey conducted in four provinces in this region indicates a seroprevalence rate of 2.4% among the 6,866 samples collected in 162 communities. Among children ≤10 years of age, 1.2% were seropositive. Risk factors for T. cruzi seropositivity were having been born and remaining in the Ecuadorian Amazon provinces, age, living in a house with a thatch roof and open or mixed wall construction, recognizing the vector insects, and reporting being bitten by a triatomine bug. These data suggest active transmission of Chagas’ disease in the Ecuadorian Amazon region is associated with poor housing conditions, and highlight the need for further studies aimed at understanding the biology of the insect vectors, reservoir species, and the clinical impact of T. cruzi infection as the basis for future educational and control programs in this region.
FREQUENCY AND VIRULENCE PROPERTIES OF DIARRHEAGENIC ESCHERICHIA COLI IN CHILDREN WITH DIARRHEA IN GABON
Authors: PRESTERL ELISABETH , ZWICK RALPH H. , REICHMANN SONJA , AICHELBURG ALEXANDER , WINKLER STEFAN , KREMSNER PETER G. , GRANINGER WOLFGANG
Published: September 2018

To investigate the presence of diarrheagenic Escherichia coli in Lambaréné, Gabon, 150 children with diarrhea were screened for enteroaggregative E. coli (EAEC), enterotoxigenic E. coli (ETEC), enteropathogenic E. coli (EPEC), enterohemorrhagic E. coli (EHEC), and enteroinvasive E. coli (EIEC) using polymerase chain reaction and an HEp-2 cell culture techniques. Isolates of EAEC were detected in 57 children, two thirds of them between six months and two years of age, and isolates of ETEC were detected in seven patients. Isolates of EPEC, EHEC, and EIEC were not present in this population. Among the EAEC, the pCVD432 plasmid, a heat stable (ST)-like (ST-like) enterotoxin (EAST), and a plasmid-encoded heat-labile toxin (PET) were detected in 19, 34, and 42 cases, respectively. Detection of pCVD432, EAST, and PET were significantly associated with EAEC identified by the HEp-2 cell assay. Although detected only in 16 patients, the presence of the fimbriae AAF I (aagA) and AAF II (aafA) were more likely to occur in EAEC than in non-EAEC (odds ratio [OR] = 4.1, 95% confidence interval [CI] = 0.5–38.6, and OR = 2.3, 95% CI = 1.0–5.3, respectively). The EAEC isolates exhibited decreased susceptibility for ampicillin, tetracycline, and trimethoprim.
ENZOOTIC TRANSMISSION OF BABESIA DIVERGENS AMONG COTTONTAIL RABBITS ON NANTUCKET ISLAND, MASSACHUSETTS
Authors: GOETHERT HEIDI K. , TELFORD SAM R.
Published: September 2018

Specific ticks seem to locally serve as vector for characteristic microbial assemblages (guilds) comprising spirochetes, piroplasms, ehrlichiae, and arboviruses. Borrelia andersoni and Anaplasma phagocytophilum are intensely transmitted between cottontail rabbits. To test the hypothesis that a piroplasm may also be maintained in rabbits, we sampled these hosts from Nantucket Island, Massachusetts and tested their blood and tissues by a polymerase chain reaction for evidence of infection. Surprisingly, the agent of bovine redwater and of European human babesiosis, Babesia divergens, was detected in 16% of the rabbits sampled during 1998–2002 (>99% sequence similarity in the 18S ribosomal DNA). The vector of B. divergens on Nantucket appears to be Ixodes dentatus, a rabbit- and bird-feeding tick that may feed on humans. Although the risk of human infection appears to be minimal, an autochthonously acquired Kentucky case due to this rabbit agent was recently reported. Physicians should entertain the diagnosis of babesiosis due to B. divergens for severe hemolytic febrile syndromes in American patients exposed to sites where rabbits are common.
ECONOMIC AND SOCIAL IMPACTS OF LA CROSSE ENCEPHALITIS IN WESTERN NORTH CAROLINA
Authors: UTZ J. TODD , APPERSON CHARLES S. , MACCORMACK J. NEWTON , SALYERS MARTHA , DIETZ E. JACQUELIN , MCPHERSON J. TODD
Published: September 2018

La Crosse encephalitis (LACE), a human illness caused by a mosquito-transmitted virus, is endemic in western North Carolina. To assess the economic and social impacts of the illness, 25 serologically confirmed LACE case patients and/or families were interviewed to obtain information on the economic costs and social burden of the disease. The total direct and indirect medical costs associated with LACE over 89.6 life years accumulated from the onset of illness to the date of interview for 24 patients with frank encephalitis totaled $791,374 (range = $7,521–175,586), with a mean ± SD per patient cost of $32,974 ± $34,793. The projected cost of a case with lifelong neurologic sequelae ranged from $48,775 to $3,090,798 (n = 5). For the 25 LACE patients, 55.15 (54.83%) of the 100.59 cumulative life years (CLYs) were impaired to some degree. Disability adjusted life years (DALYs) were calculated to measure the productive life years lost to LACE. Approximately 13.00 DALYs were accumulated over 100.59 CLYs of study. Projected DALYs for case patients (n = 5) with lifelong neurologic sequelae ranged from 12.90 to 72.37 DALYs. An Impact of La Crosse Encephalitis Survey (ILCES) was used to measure the social impact of LACE over time for case patients and their families. The ILCES scores demonstrated that the majority of the social burden of the illness is borne by the five patients with lifelong neurologic sequelae. The socioeconomic burden resulting from LACE is substantial, which highlights the importance of the illness in western North Carolina, as well as the need for active surveillance, reporting, and prevention programs for the infection.
AN OUTBREAK OF LEPTOSPIROSIS AMONG PERUVIAN MILITARY RECRUITS
Authors: RUSSELL KEVIN L. , GONZALEZ MARCO A. MONTIEL , WATTS DOUGLAS M. , LAGOS-FIGUEROA ROBERTO C. , CHAUCA GLORIA , ORE MARIANELA , GONZALEZ JOSE E. , MORON CECILIA , TESH ROBERT B. , VINETZ JOSEPH M.
Published: September 2018

Acute undifferentiated febrile illnesses are common in tropical developing countries but are difficult to diagnose on clinical grounds alone. Leptospirosis is rarely diagnosed, despite evidence that sporadic cases and epidemics continue to occur worldwide. The purpose of this study was to diagnose an outbreak of acute undifferentiated febrile illness among Peruvian military recruits that developed after a training exercise in the high jungle rainforest of Peru. Of 193 military recruits, 78 developed an acute febrile illness with varied manifestations. Of these, 72 were found to have acute leptospirosis by a microscopic agglutination test (MAT). An enzyme-linked immunosorbent assay using Leptospira biflexa antigen was insensitive for the detection of anti-leptospiral IgM antibodies compared with the MAT (20 of 72, 28%). This outbreak of acute undifferentiated febrile illness among Peruvian military recruits was due to leptospirosis. High clinical suspicion, initiation of preventative measures, and performance of appropriate diagnostic testing is warranted in similar settings to identify, treat, and prevent leptospirosis.
TRANSMISSION-BLOCKING ACTIVITY OF TAFENOQUINE (WR-238605) AND ARTELINIC ACID AGAINST NATURALLY CIRCULATING STRAINS OF PLASMODIUM VIVAX IN THAILAND
Authors: PONSA NARONG , SATTABONGKOT JETSUMON , KITTAYAPONG PATTAMAPORN , EIKARAT NANTANA , COLEMAN RUSSELL E.
Published: September 2018

The sporontocidal activity of tafenoquine (WR-238605) and artelinic acid was determined against naturally circulating isolates of Plasmodium vivax in western Thailand. Primaquine was used as a negative control and a dihydroacridine-dione (WR-250547) was used as a positive control. Laboratory-reared Anopheles dirus mosquitoes were infected with P. vivax by allowing mosquitoes to feed on blood (placed in an artificial-membrane feeding apparatus) collected from gametocytemic volunteers reporting to local malaria clinics in Tak province, Thailand. Four days post-infection, mosquitoes were refed on uninfected mice treated 90 minutes earlier with a given drug. Drug activity was determined by assessing oocyst and sporozoite development. Neither primaquine nor artelinic acid affected oocyst or sporozoite development at a dose of 100 mg of base drug/kg of mouse body weight. In contrast, tafenoquine and WR-250547 affected sporogonic development at doses as low as 25.0 and 0.39 mg/kg, respectively. The potential role of these compounds in the prevention of malaria transmission is discussed, as are alternative strategies for the use of transmission-blocking antimalarial drugs.
MALARIA-ASSOCIATED CYTOKINE CHANGES IN THE PLACENTA OF WOMEN WITH PRE-TERM DELIVERIES IN YAOUNDE, CAMEROON
Authors: SUGUITAN AMORSOLO L. , CADIGAN TIMOTHY J. , NGUYEN THU A. , ZHOU AINONG , LEKE ROBERT J. I. , METENOU SIMON , THUITA LUCY , MEGNEKOU ROSETTE , FOGAKO JOSEPHINE , LEKE ROSE G. F. , TAYLOR DIANE WALLACE
Published: September 2018

The prevalence of pre-term deliveries (PTDs) is increased in women who become infected with Plasmodium falciparum during pregnancy. Because prematurity is a risk factor for newborns, it is important to identify conditions that contribute to malaria-associated PTDs. Plasmodium falciparum–infected erythrocytes sequester in the placenta and attract activated mononuclear cells that secrete pro-inflammatory cytokines. Increased inflammatory cytokine levels in other microbial infections are associated with PTDs. To determine if such is the case in women with placental malaria, concentrations of interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α), interleukin-4 (IL-4), and IL-10 were measured in placental plasma of 391 malaria-infected and -uninfected Cameroonian women with premature and full-term deliveries. Risk factors for malaria-associated PTDs included peripheral and placental parasitemias greater than 1%, maternal anemia, elevated IL-10 levels, and low TNF-α:IL-10 ratios due to over-expression of IL-10. Alterations in cytokine levels may contribute to PTDs through the induction of anemia and/or altering cellular immune responses required for eliminating placental parasites.
VISCERAL LEISHMANIASIS: CONSEQUENCES OF A NEGLECTED DISEASE IN A BANGLADESHI COMMUNITY
Authors: AHLUWALIA INDU B. , BERN CARYN , COSTA CRISTIANE , AKTER TANGIN , CHOWDHURY RAJIB , ALI MUSTAKIM , ALAM DIDARUL , KENAH EBEN , AMANN JOSEF , ISLAM MEGHLA , WAGATSUMA YUKIKO , HAQUE RASHIDUL , BREIMAN ROBERT F. , MAGUIRE JAMES H.
Published: September 2018

Visceral leishmaniasis, or kala azar (KA), affects the rural poor, causing significant morbidity and mortality. We examined the epidemiologic, social, and economic impact of KA in a village in Bangladesh. A population-based survey among 2,348 people demonstrated a KA incidence of 2% per year from 2000 to 2002, with a case-fatality rate of 19% among adult women, compared with 6–8% among other demographic groups. Kala azar cases were geographically clustered in certain sections of the village. Anti-leishmanial drug shortages and the high cost of diagnosis and treatment caused substantial emotional and economic hardship for affected families. Communities wanted to learn more about KA, and were willing to take collective action to confront the problems it causes. To decrease the KA burden in endemic areas, community efforts should be supplemented with effective treatment programs to ensure access to appropriate and affordable diagnosis and case management.
HOST-RANGE RESTRICTION OF CHIMERIC YELLOW FEVER-WEST NILE VACCINE IN FISH CROWS (CORVUS OSSIFRAGUS)
Authors: LANGEVIN STANLEY A. , ARROYO JUAN , MONATH THOMAS P. , KOMAR NICHOLAS
Published: September 2018

We evaluated a recombinant virus chimera, ChimeriVax-WN, in which the West Nile virus (WNV) surface protein genes (pre-membrane [prM] and envelope [E]) are substituted into the genome of the 17D vaccine strain yellow fever virus (YF-17D), as a vaccine candidate for protection of birds from WNV disease. Using fish crows (Corvus ossifragus) as a model, we found that none of eight crows that received two high doses of vaccine (approximately 100,000 plaque-forming units [PFU]) developed viremia and only one developed WNV-neutralizing antibodies. When challenged with subcutaneous injection of 2,000 PFU of WNV (NY99 strain), all eight developed viremia levels similar to unvaccinated control birds (n = 4). Two of the vaccinated birds died of the infection, compared with no mortality in the four controls. To further investigate the failure of the vaccine, we inoculated chickens with both the vaccine and YF-17D and found no evidence of replication with either of these viruses. These data indicate that this vaccine candidate failed to protect birds from the morbidity and mortality attributed to WNV infections. However, if used in mammals, this recombinant viral vaccine is unlikely to inadvertently enter a natural transmission cycle with birds as amplifying hosts.
THE USE OF SHORT-COURSE ZIDOVUDINE TO PREVENT PERINATAL TRANSMISSION OF HUMAN IMMUNODEFICIENCY VIRUS IN RURAL KENYA
Authors: SONGOK ELIJAH M. , FUJIYAMA YOSHIHIDE , TUKEI PETER M. , VULULE JOHN M. , KIPTOO MICHAEL K. , ADUNGO NICHOLAS O. , KAKIMOTO KAZUHIRO , KOBAYASHI NOBUYOSHI , GENGA ISAIAH O. , MPOKE SOLOMON , ICHIMURA HIROSHI
Published: September 2018

To determine the feasibility of using short-course zidovudine (ZDV) to prevent mother-to-child transmission of human immunodeficiency virus (HIV) in a breastfeeding population in a rural area in Kenya, pregnant mothers attending clinics in seven health centers in western Kenya between 1996 and 1998 were requested to volunteer for participation in this study. The HIV-infected mothers were given a daily dose of 400 mg of ZDV starting at 36 weeks of gestation and another 300 mg every three hours intrapartum. After delivery, mothers and their children were followed-up and clinically monitored every 3–4 months for two years, and child and mother mortality rates were analyzed. Of the 825 mothers who consented, 216 (26.2%) were infected with HIV. Of those infected, 51 (23.6%) took the full prescribed dose, 69 (31.9%) took only the prenatal dose, and the remaining 96 (44.4%) did not take any dose. Failure to take ZDV was attributed mainly to delivery occurring earlier than expected, while non-compliance to the intrapartum dose was due to mothers giving birth at home and fear of traditional birth attendants. By the end of the second year, 75 HIV-exposed children (34.7%) and 33 HIV-infected mothers (15.3%) had died. The HIV-free survival of children at 24 months was significantly associated with mother survival (P < 0.001) and prenatal ZDV compliance (P < 0.003). Our findings suggest that implementation of programs for prevention of mother-to-child transmission of HIV in rural areas of Africa need to consider the various socioeconomic and cultural barriers that may prevent successful uptake of antiretroviral prophylaxes. Similarly, the rapid disease progression in mothers may eliminate the increase in child survival due to ZDV prophylaxis.
FOREST MALARIA IN VIETNAM: A CHALLENGE FOR CONTROL
Authors: ERHART ANNETTE , THANG NGO D. , HUNG NGUYEN Q. , TOI LE V. , HUNG LE X. , TUY TRAN Q. , CONG LE D. , SPEYBROECK NICO , COOSEMANS MARC , D’ALESSANDRO UMBERTO
Published: September 2018

Forest malaria is a complex but common phenomenon occurring in southeast Asia. We studied its epidemiology through a prospective community-based study in central Vietnam. A total of 585 individuals were followed for two years by active case detection and biannual cross-sectional surveys. The prevalence of antibodies to Plasmodium falciparum was constantly about 20% across surveys and the incidence rate of clinical episodes of P. falciparum malaria was 0.11/person-year. Multivariate analysis showed that regular forest activity was the main risk factor for clinical malaria and malaria infections. Untreated bed nets had a significant protective effect (60%), except for people regularly sleeping in the forest. The population-attributable fraction for regular forest activity was estimated to be 53%. Our results confirm the major role played by forest activity on the malaria burden in this area and provide the basis for targeting control activities to forest workers. New interventions based on insecticide-treated materials need to be urgently evaluated.
PHARMACOKINETIC STUDY OF ARTEMISININ AFTER ORAL INTAKE OF A TRADITIONAL PREPARATION OF ARTEMISIA ANNUA L. (ANNUAL WORMWOOD)
Authors: RÄTH KARIN , TAXIS KATJA , WALZ GITTA , GLEITER CHRISTOPH H. , LI SHU-MING , HEIDE LUTZ
Published: September 2018

Artemisia annua L. (annual wormwood) contains the antimalarial artemisinin. Aqueous preparations of the dried herb are included in the pharmacopoeia of the People’s Republic of China for treatment of fever and malaria. Fourteen healthy male volunteers received one liter of tea prepared from nine grams of Artemisia annua leaves. Blood samples were taken and artemisinin was detected by reversed phase high-performance liquid chromatography. The mean ± SD maximum plasma concentration of artemisinin was 240 ± 75 ng/mL and the mean ± SD area under the plasma concentration-time curve was 336 ± 71 ng/mL × hr. Artemisinin was absorbed faster from herbal tea preparations than from oral solid dosage forms, but bioavailability was similar. One liter of an aqueous preparation of nine grams of Artemisia annua contained 94.5 milligrams of artemisinin (approximately 19% of the usually recommended daily dose). Artemisinin plasma concentrations after intake of this herbal tea are sufficient for clinical effects, but insufficient to recommend such preparations as equivalent substitutes for modern artemisinin drugs in malaria therapy.
TRYPANOSOMA CRUZI DNA IN CARDIAC LESIONS OF ARGENTINEAN PATIENTS WITH END-STAGE CHRONIC CHAGAS HEART DISEASE
Authors: SCHIJMAN ALEJANDRO G. , VIGLIANO CARLOS A. , VIOTTI RODOLFO J , BURGOS JUAN M. , BRANDARIZ SILVIA , LOCOCO BRUNO E. , LEZE MARIA I. , ARMENTI HECTOR A. , LEVIN MARIANO J.
Published: September 2018

The extent of inflammation, fibrosis, and progression of chronic Chagas heart disease (cChHD) was associated with persistence of parasite DNA in cardiac lesions of necropsies or explants from Argentinean cChHD patients. A Trypanosoma cruzi-based polymerase chain reaction showed a positive result in 1) 15% of cardiac sections with less than 10 mononuclear inflammatory cells/high-power field (440×) (MNC/HPF), 89% with 10–19 MNC/HPF, and 100% with more than 20 MNC/HPF (P < 0.0001); 2) 33% with less than 10% fibrosis, 79% with 10–19% fibrosis, and 100% with more than 20% fibrosis (P < 0.01); 3) 25% of specimens from patients classified in Kuschnir groups 0 and I, 70% in group II and 90% in group III (P < .001); and 4) 45% and 90% of the specimens from cChHD patients without or with heart failure, respectively (P < 0.01). These findings stress the role of the parasite in pathogenesis and disease progression of cChHD.
DETERMINATION OF THE PREVALENCE OF ENTAMOEBA HISTOLYTICA AND E. DISPAR IN THE PERNAMBUCO STATE OF NORTHEASTERN BRAZIL BY A POLYMERASE CHAIN REACTION
Authors: PINHEIRO SANDRA M. B. , CARNEIRO ROSA M. , ACA IVANISE S. , IRMÃO JOÃO I. , MORAIS MARCOS A. , COIMBRA MARIA R. M. , CARVALHO LUIZ B.
Published: September 2018

Previous studies using methods varying from traditional serologic tests to molecular biology techniques have shown that in northeastern Brazil, Entamoeba dispar was more prevalent than E. histolytica. In this study, the prevalence was established by using E. histolytica stool antigen detection kits and a polymerase chain reaction (PCR) with genomic DNA extracted from cultured trophozoites in all four-nuclei, amoeba-positive samples from a population living in Macaparana in northeastern Brazil. Among 1,437 stool samples analyzed, only 59 (4.1%) were positive for four nuclei amoeba. However, all of these samples were negative in an immunoenzymatic assay for the presence of E. histolytica-specific galactose adhesin. Of 59 cultivated samples, only 31 showed trophozoites. Extraction of DNA from these 31 samples, followed by the PCR, showed that 23 samples (74.19%) were positive for E. dispar and no amplification was observed for pathogenic E. histolytica. The remaining eight samples were negative for both species. These findings are consistent with those previously reported.
HUMAN BERTIELLA STUDERI (FAMILY ANOPLOCEPHALIDAE) INFECTION OF PROBABLE SOUTHEAST ASIAN ORIGIN IN MAURITIAN CHILDREN AND AN ADULT
Authors: BHAGWANT S.
Published: September 2018

Morphologic studies on preserved and recently collected Bertiella specimens obtained from Mauritian children and an adult indicate that human infection is caused by Bertiella studeri instead of B. mucronata. This cestode might have been accidentally introduced onto the island of Mauritius from the Southeast Asia along with monkeys in the 17th century. We present information that will help identify B. studeri and provide a correct diagnosis. The case reports indicate gastrointestinal disturbances in human bertiellosis. Human infection with Bertiella studeri is reported for the first time in a Mauritian adult.
WIDESPREAD OCCURRENCE OF THE PLASMODIUM FALCIPARUM CHLOROQUINE RESISTANCE TRANSPORTER (PFCRT) GENE HAPLOTYPE SVMNT IN P. FALCIPARUM MALARIA IN INDIA
Authors: VATHSALA P. G. , PRAMANIK A. , DHANASEKARAN S. , DEVI C. USHA , PILLAI C. R. , SUBBARAO S. K. , GHOSH S. K. , TIWARI S. N. , SATHYANARAYAN T. S. , DESHPANDE P. R. , MISHRA G. C. , RANJIT M. R. , DASH A. P. , RANGARAJAN P. N. , PADMANABAN G.
Published: September 2018

The Plasmodium falciparum chloroquine resistance transporter (Pfcrt) K76T mutation and haplotype (amino acids 72–76) and the P. falciparum multidrug resistance 1 (Pfmdr1) mutation (N86Y) were analyzed as markers of chloroquine resistance in the DNAs of 73 blood samples from patients with P. falciparum malaria in India. Seventy of the 73 DNAs had the Pfcrt K76T mutation. Of these, 66 had the SVMNT haplotype and four had CVIET, the African/Southeast Asian haplotype. Only 20 of 69 DNAs had the Pfmdr1 N86Y mutation. It is surprising that the Pfcrt haplotype in India is predominantly SVMNT, rather than that seen in Southeast Asia. The widespread prevalence of the Pfcrt K76T mutation is a cause for concern.
RAPID ASSAYS FOR IDENTIFICATION OF MEMBERS OF THE CULEX (CULEX) PIPIENS COMPLEX, THEIR HYBRIDS, AND OTHER SIBLING SPECIES (DIPTERA: CULICIDAE)
Authors: SMITH JULIE L. , FONSECA DINA M.
Published: September 2018

Mosquitoes in the Culex (Culex) pipiens complex of species, known as vectors of periodic filariasis and deadly encephalitides, have recently emerged as important vectors of West Nile virus in the United States. Highly conserved morphology but marked differences in potential vectorial capacity require the development of polymerase chain reaction (PCR)-based tests that unambiguously distinguish among the different species. We introduce and describe a series of PCR-based assays that use polymorphisms in the second intron of the acetylcholinesterase-2 (ace-2) locus for the identification of members of the Cx. pipiens complex (Cx. pipiens, Cx. quinquefasciatus, Cx. p. pallens, Cx. australicus), two other species that are commonly mislabeled as Cx. pipiens (Cx. torrentium and Cx. pervigilans), as well as hybrids between Cx. pipiens and Cx. quinquefasciatus.
POLYMORPHISM OF THE PLASMODIUM FALCIPARUM MULTIDRUG RESISTANCE AND CHLOROQUINE RESISTANCE TRANSPORTER GENES AND IN VITRO SUSCEPTIBILITY TO AMINOQUINOLINES IN ISOLATES FROM THE PERUVIAN AMAZON
Authors: HUAMAN MARIA CECILIA , RONCAL NORMA , NAKAZAWA SHUSUKE , LONG TON THAT AI , GERENA LUCIA , GARCIA CORALITH , SOLARI LELY , MAGILL ALAN J. , KANBARA HIROJI
Published: September 2018

In vitro drug sensitivity to chloroquine (CQ), mefloquine (MQ) and quinine was investigated in 60 culture-adapted Plasmodium falciparum isolates from malaria patients in Padrecocha, a village in the Amazonian Department of Loreto, Peru. All isolates showed resistance to CQ, decreased susceptibility to quinine, and sensitivity to MQ. These isolates were examined for mutations in the P. falciparum multidrug resistance 1 (pfmdr1) and chloroquine resistance transporter (pfcrt) genes previously linked to CQ resistance. The mutations N86Y and D1246Y, two of the five mutations commonly observed in the pfmdr1 gene of CQ-resistant clones, were not found. The pfcrt mutation K76T, associated with CQ resistance, was identified in all the isolates tested. Sequence analysis of codons 72–76 in the pfcrt gene showed the haplotypes SVMNT and CVMNT.
TUBERCULOUS PERITONITIS IN DIFFERENT DIALYSIS PATIENTS IN SOUTHERN TAIWAN
Authors: HUNG YAO-MIN , CHAN HOI-HUNG , CHUNG HSIAO-MIN
Published: September 2018

Eleven cases of tuberculous peritonitis (TBP) in hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients at the Kaohsiung Veterans General Hospital in Kaohsiung, Taiwan between 1991 and 2000 were studied retrospectively (six cases in the HD group and five cases in the CAPD group) The diagnosis of TBP was established by either positive ascite tuberculosis (TB) culture or biopsy-proven chronic granulomatous inflammation. Fever and abdominal pain were the most common symptoms, while leukocytosis and unexplained hypercalcemia were the most common laboratory findings. Ascite analysis showed a lymphocyte predominance in all HD patients, but in only 40% of the CAPD patients. The mean duration of a diagnosis by ascite TB cultures was six weeks, while a diagnosis confirmed by laparascopic biopsy took one week. All four fatal cases were diagnosed by TB cultures. Laparoscopic biopsy provided a rapid diagnosis and resulted in low morbidity and mortality in our patients. Based on our review of all possible abstracts found in a Medline search from 1966 to 2002 using the keywords tuberculosis, peritonitis, uremia, and dialysis, this may be the first study of TBP in different dialysis patients.
A LONGITUDINAL STUDY OF IMPACT OF REPEATED MASS IVERMECTIN TREATMENT ON CLINICAL MANIFESTATIONS OF ONCHOCERCIASIS IN IMO STATE, NIGERIA
Authors: EMUKAH EMMANUEL C. , OSUOHA EDITH , MIRI EMMANUEL S. , ONYENAMA JUDE , AMAZIGO UCHE , OBIJURU CHRISTOPHER , OSUJI NKEIRU , EKEANYANWU JOSEPHINE , AMADIEGWU STANLEY , KORVE KENNETH , RICHARDS FRANK O.
Published: September 2018

We conducted a cohort study on impact of effects of eight years of annual ivermectin mass treatment administered in eight villages in Imo State, Nigeria. Physical and visual acuity examinations carried out in 462 persons in 1995, prior to the launching of mass drug administration with ivermectin, were compared with re-examinations of 411 (89%) of these same individuals in 2002. We found that gross visual impairment decreased from 16% to 1%, nodule prevalence decreased from 59% to 18%, and papular dermatitis was reduced from 15% to 2%. No change was seen in leopard skin rates (14%). The only incident lesions were three subjects from a single community having the appearance of new nodules (e.g., nodules not identified in the 1995 examinations). Differences in community coverage did not appear to influence the benefit from treatment of individual residents.
WEST NILE VIRUS IN MOSQUITOES OF NORTHERN OHIO, 2001–2002
Authors: MANS NICOLE Z. , YURGIONAS SASHA E. , GARVIN MARY C. , GARY RICHARD E. , BRESKY JOHN D. , GALAITSIS ALEXANDER C. , OHAJURUKA OJIMADU A.
Published: September 2018

From June 14 to August 30, 2001 and June 10 to August 22, 2002, the mosquitoes of Oberlin, Ohio were surveyed and tested for West Nile virus (WNV). Mosquitoes were trapped weekly using gravid traps and CO2-baited Centers for Disease Control light traps at seven sites in 2001 and eight sites in 2002 in woodlots within the city limits. A total of 12,151 mosquitoes, representing 14 species and one species group, were collected in gravid traps, with Culex pipiens/restuans being the most abundant, followed by Ochlerotatus triseriatus. In light traps, 12,510 mosquitoes were collected, with Aedes vexans being the most abundant, followed by Culex pipiens/restuans. All gravid trap collections were tested for WNV via reverse transcriptase-polymerase chain reaction. West Nile virus was first detected in July 2002. Of all species tested, the Cx. pipiens/restuans species group exhibited the highest minimum infection rate (MIR) and the greatest percentage of positive pools. Both the MIR and percent of positive pools increased significantly with the date, although abundance of Cx. pipiens/restuans in gravid trap collections did not.
THE EFFECT OF REPEATED HALF-YEARLY DIETHYLCARBAMAZINE MASS TREATMENT ON WUCHERERIA BANCROFTI INFECTION AND TRANSMISSION IN TWO EAST AFRICAN COMMUNITIES WITH DIFFERENT LEVELS OF ENDEMICITY
Authors: SIMONSEN PAUL E. , MEYROWITSCH DAN W. , MUKOKO DUNSTAN A. , PEDERSEN ERLING M. , MALECELA-LAZARO MWELE N. , RWEGOSHORA RWEHUMBIZA T. , OUMA JOHN H. , MASESE NAFTAL , JAOKO WALTER G. , MICHAEL EDWIN
Published: September 2018

The effect of repeated half-yearly mass treatment with diethylcarbamazine (DEC, 6 mg/kg body weight) on infection and transmission of Wuchereria bancrofti was assessed and compared in communities with high and low endemicity in eastern Africa, with pretreatment microfilaria (mf) and circulating filarial antigen (CFA) prevalences of 29.4% and 53.2% in the high endemicity community and 3.1% and 18.7% in the low endemicity community, respectively. Human infection was monitored by repeated cross-sectional surveys, and transmission by weekly light trap collection of vector mosquitoes in selected houses in each community. Treatments resulted in a progressive decrease in microfilaremia and circulating antigenemia in both communities, with relative reductions being considerably higher for mf than for CFA. Among pretreatment mf-positive individuals, more than 60% were diagnosed as mf negative and mean mf intensities were reduced by 99% in both communities after two treatment rounds. In contrast, only moderate reductions were seen in circulating antigenemia among pretreatment CFA-positive individuals, with mean intensities still being 24–39% of pretreatment values after two treatment rounds. Among the pretreatment mf/CFA-positive individuals, clearance to a CFA-negative status was negligible. Complete CFA clearance was only observed among pretreatment CFA-positive but mf negative individuals who also had much lower initial mean CFA levels than the mf-positive individuals. After treatment, the intensity of transmission decreased in the high-endemicity community, but this appeared mainly to be a consequence of a drought-induced reduction in vector density rather than to reduced mf load in the human population, since the proportion of mosquitoes carrying infective larvae was not reduced. No change in transmission or mosquito infectivity was observed after treatment in the low-endemicity community. Implications of these observations for the control of Bancroftian filariasis are discussed.
A RETROSPECTIVE EXAMINATION OF THE EFFECT OF FEVER AND MICROGAMETOCYTE COUNT ON MOSQUITO INFECTION ON HUMANS INFECTED WITH PLASMODIUM VIVAX
Authors: COLLINS WILLIAM E. , JEFFERY GEOFFREY M. , ROBERTS JACQUELIN M.
Published: September 2018

A retrospective examination was made of archival data collected between 1940 and 1963 on the infection of mosquitoes with the St. Elizabeth strain of Plasmodium vivax. Patients were undergoing malariatherapy for the treatment of neurosyphilis. A total of 845 lots of Anopheles quadrimaculatus mosquitoes were fed during primary infections and 76 during secondary infections. Average percentage infection during the primary infection was 56.55% versus 49.83% during the secondary infection. There appeared to be no relationship between microgametocye density, asexual parasite count, and percentage infection. However, very high fevers appear to have a significant effect on infection rates. Persons with fever ≥ 105°F showed the lowest rates of infectivity regardless of parasitemia; persons with moderate (101–104.8°F) fever produced somewhat higher rates, and persons with no fever had the highest levels of infection at all parasitemia levels greater than 1,500/μL
REDUCING DIARRHEA THROUGH THE USE OF HOUSEHOLD-BASED CERAMIC WATER FILTERS: A RANDOMIZED, CONTROLLED TRIAL IN RURAL BOLIVIA
Authors: CLASEN THOMAS F. , BROWN JOSEPH , COLLIN SIMON , SUNTURA OSCAR , CAIRNCROSS SANDY
Published: September 2018

Ceramic water filters have been identified as one of the most promising and accessible technologies for treating water at the household level. In a six-month trial, water filters were distributed randomly to half of the 50 participating households in a rural community in Bolivia; the remaining households continued to use customary water handling practices and served as controls. In four rounds of sampling following distribution of the filters, 100% of the 96 water samples from the filter households were free of thermotolerant coliforms compared with 15.5% of the control household samples. Diarrheal disease risk for individuals in intervention households was 70% lower than for controls (95% confidence interval [CI] = 53–80%; P < 0.001). For children less than five years old, the reduction in risk was 83% (95% CI = 51–94%; P < 0.001). These results show that affordable ceramic water filters enable low-income households to treat and maintain the microbiologic quality of their drinking water.
EVIDENCE OF WATERBORNE TRANSMISSION OF BLASTOCYSTIS HOMINIS
Authors: LEELAYOOVA SAOVANEE , RANGSIN RAM , TAAMASRI PAANJIT , NAAGLOR TAWEE , THATHAISONG UMAPORN , MUNGTHIN MATHIRUT
Published: September 2018

A cross-sectional study was performed in February 2001 to evaluate the prevalence and risk factors of Blastocystis hominis infection in army personnel who resided in an army base in Chonburi, Thailand. A total of 904 army personnel were enrolled in this study. Short-term in vitro cultivation was used to detect B. hominis in stool samples. In this population, B. hominis was the parasite most frequently found, and was identified in 334 of 904 stool specimens (36.9%). A significant association between B. hominis infection and symptoms was identified that might emphasize the role of B. hominis as a human pathogen. After adjustment for potential confounders, significantly increased risk of being infection with B. hominis was associated with being a private, working in a specific unit, and consuming unboiled drinking water. Thus, waterborne transmission of B. hominis infection was indicated at this army base. However, other modes of transmission cannot be ruled out.
ASSOCIATION OF A SEX-RELATED DIFFERENCE OF STRONGYLOIDES STERCORALIS–SPECIFIC IgG4 ANTIBODY TITER WITH THE EFFICACY OF TREATMENT OF STRONGYLOIDIASIS
Authors: SATOH MASAO , TOMA HIROMU , KIYUNA SUSUMU , SHIROMA YOSHIYUKI , KOKAZE AKATSUKI , SATO YOSHIYA
Published: September 2018

It is difficult to completely eradicate strongyloidiasis, a human intestinal nematode infection with Strongyloides stercoralis with drugs, especially in males. To find host factors involved in the response to treatment, patients infected with S. stercoralis were examined for S. stercoralis-specific antibody titers and the effect of treatment with albendazole on these titers were determined. The cure rate was slightly but not significantly lower in males than in females (P = 0.108). However, a significantly higher titer of S. stercoralis-specific IgG4 antibody was observed in males than in females (P = 0.0097), and the S. stercoralis-specific IgG4 antibody titer was significantly higher in the male non-cured group than in the cured group (P = 0.035). These results suggest that elevation of the S. stercoralis-specific IgG4 antibody titer is associated with resistance to treatment of S. stercoralis infection, especially in males.
PREVALENCE OF WEST NILE VIRUS IN TREE CANOPY–INHABITING CULEX PIPIENS AND ASSOCIATED MOSQUITOES
Authors: ANDERSON JOHN F. , ANDREADIS THEODORE G. , MAIN ANDY J. , KLINE DANIEL L.
Published: September 2018

Culex pipiens was the dominant mosquito captured in a West Nile virus (WNV) focus in Stratford, Connecticut. More Cx. pipiens were captured in Centers for Disease Control miniature light traps baited with CO2, quail/hamster traps, and mosquito magnet experimental (MMX) traps placed in the tree canopy than in similar traps placed near the ground. Significantly more Cx. pipiens were captured in MMX traps placed in the canopy than in the other traps tested. Ninety-two percent and 85% of the 206 and 68 WNV isolations were from Cx. pipiens in 2002 and 2003, respectively; 5% and 12% were from Cx. salinarius. Eighty-five percent and 87% of the isolates were from mosquitoes captured in the canopy in each of the two years. The significantly larger numbers of WNV isolates from Cx. pipiens captured in the canopy are attributed to the significantly larger numbers of Cx. pipiens captured in the canopy in comparison to those captured in traps near the ground.