bluuebunny/crossref_metadata_2025 huggingface dataset:
PLASMODIUM VIVAX MALARIA IN THE REPUBLIC OF KOREA DURING 2004–2005: CHANGING PATTERNS OF INFECTION
Authors: YEOM JOON-SUP , KIM TONG-SOO , OH SEJOONG , SIM JAI-BONG , BARN JAE-SANG , KIM HYE-JUNG , KIM YOUNG-A , AHN SUN-YOUNG , SHIN MEE-YOUNG , YOO JIE-AE , PARK JAE-WON
Published: September 2018

Vivax malaria re-emerged in the Republic of Korea (ROK) in 1993. The annual incidence of this disease, which had increased rapidly through 2000 with geographic expansion, started to decrease in 2001, reaching 864 cases in 2004; however, the trends changed in 2005 when 1,304 cases were reported. Among 2,168 cases of vivax malaria reported from 2004 through 2005, 389 cases (17.9%) were ROK military personnel, 565 cases (26.1%) were veterans who had been discharged from the military within 2 years of report of infection, and 1,214 cases (56.0%) were civilians. Local transmission might have taken place during this period in the southern side of the Demilitarized Zone. Regional increase of vivax malaria in North Korea, increased local transmissions in ROK, and active transmission by vector mosquitoes during the transmission season might be important factors responsible for the re-increase of vivax malaria in ROK during 2005.
LEPTOSPIROSIS ON OAHU: AN OUTBREAK ASSOCIATED WITH FLOODING OF A UNIVERSITY CAMPUS
Authors: GAYNOR KATE , KATZ ALAN R. , PARK SARAH Y. , NAKATA MICHELE , CLARK THOMAS A. , EFFLER PAUL V.
Published: September 2018

On October 31, 2004, a stream overflowed, flooding the University of Hawaii (UH) campus. On November 19, 2004, a possible flood-related leptospirosis case (Patient 1) was reported to the Hawaii State Department of Health (HDOH). Surveillance for febrile illness was established through an Internet questionnaire. Active case finding was conducted among groups involved in the flood clean-up. Free leptospirosis testing was offered by HDOH. Patient 1’s illness was confirmed as leptospirosis by microscopic agglutination testing. A total of 271 persons responded to the Internet survey, of whom 90 (33%) reported a febrile illness within 30 days of contact with flood water. Forty-eight respondents (18%) were tested for leptospirosis. One additional acute leptospirosis case was identified. Patient 2 was epidemiologically linked to Patient 1. Health care providers should maintain a high level of suspicion for leptospirosis after flooding events, and local public health officials should promote leptospirosis awareness among flood-affected populations.
ACUTE PANCREATITIS IN FATAL ANICTERIC LEPTOSPIROSIS
Authors: SPICHLER ANNE , SPICHLER ETHEL , MOOCK MARCELO , VINETZ JOSEPH M. , LEAKE JOHN A. D.
Published: September 2018

We report a fatal case of anicteric leptospirosis with pancreatitis (acute hyperglycemia and insulin requirement, elevated lipase and amylase levels), pulmonary infiltrates, and refractory shock. In disease-endemic areas, leptospirosis with pancreatitis should be considered in patients with fever and abdominal pain, and serum pancreatic enzymes, blood glucose, and serum electrolytes should be closely monitored.
CUTANEOUS LEISHMANIASIS CAUSED BY LEISHMANIA TROPICA IN BIKANER, INDIA: PARASITE IDENTIFICATION AND CHARACTERIZATION USING MOLECULAR AND IMMUNOLOGIC TOOLS
Authors: KUMAR RAJESH , BUMB RAM AVTAR , ANSARI NASIM A. , MEHTA RAJESH D. , SALOTRA POONAM
Published: September 2018

Identification of new foci of cutaneous leishmaniasis (CL), along with reports of Leishmania donovani causing the disease, is an issue of concern. Clinico-epidemiologic analysis of 98 cases in the endemic regions of Rajasthan state, India, suggested the preponderance of infection in men (62.24%) compared with women (37.75%). Species characterization by internal transcribed spacer 1 (ITS1) polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP), kDNA-PCR, and immunofluorescence assay established L. tropica as the causative organism. When applied directly to 32 clinical samples, kDNA PCR had a sensitivity of 96.6%, whereas ITS1 PCR had a sensitivity of 82.75%, thus facilitating diagnosis and species identification. Either parasite culture or direct microscopy alone detected 48.2% and 65.5% of the positive samples, respectively, whereas culture and microscopy together improved overall sensitivity to 89.3% (25/28). Except for the kDNA PCR, all other assays were 100% specific. This study provides the first comprehensive molecular and immunologic studies of CL in India.
DETECTION AND QUANTIFICATION OF CRYPTOSPORIDIUM IN HCT-8 CELLS AND HUMAN FECAL SPECIMENS USING REAL-TIME POLYMERASE CHAIN REACTION
Authors: PARR JONATHAN B. , SEVILLEJA JESUS EMMANUEL , AMIDOU SAMIE , ALCANTARA CIRLE , STROUP SUZANNE E. , KOHLI ANITA , FAYER RON , LIMA ALDO A. M. , HOUPT ERIC R. , GUERRANT RICHARD L.
Published: September 2018

Cryptosporidium is a significant cause of diarrheal illness worldwide, especially among children and immunocompromised patients. Currently used diagnostic techniques are time-consuming, require skilled technicians, and are not useful for quantification of oocysts in fecal and environmental samples. In this study, we examined the use of a real-time polymerase chain reaction (PCR) assay for detecting and quantifying Cryptosporidium parvum in three distinct and progressively more complex matrices: phosphate-buffered saline (PBS), HCT-8 cells (human ileocecal carcinoma), and human fecal specimens. A reliable standard curve was generated using the PBS samples spiked with pure oocysts, and oocyst starting quantities were calculated for the infected HCT-8 cell and spiked fecal samples. The assay detected Cryptosporidium in samples infected/spiked with ≥103 oocysts/sample and detected both C. hominis and C. parvum in clinical specimens. This assay is useful in a variety of samples in the research laboratory and will likely prove to be a useful tool in the clinical laboratory.
ACUTE NEUROSCHISTOSOMIASIS: TWO CASES ASSOCIATED WITH CEREBRAL VASCULITIS
Authors: JAURÉGUIBERRY STÉPHANE , ANSART SÉVERINE , PEREZ LUCIA , DANIS MARTIN , BRICAIRE FRANÇOIS , CAUMES ERIC
Published: September 2018

Encephalitis and focal neurologic deficits can occur during the acute phase of schistosomiasis. We report two cases in which cerebral imaging showed cerebral vasculitis located in arterial junctional territories. These neurologic complications may be caused by eosinophil-mediated toxicity. Immediate treatment should consist of corticosteroids rather than specific antischistosomal drugs, which may aggravate the disorders.
EVALUATION OF FAS2-ELISA FOR THE SEROLOGICAL DETECTION OF FASCIOLA HEPATICA INFECTION IN HUMANS
Authors: ESPINOZA JOSE R. , MACO VICENTE , MARCOS LUIS , SAEZ SANDRA , NEYRA VICTOR , TERASHIMA ANGELICA , SAMALVIDES FRINE , GOTUZZO EDUARDO , CHAVARRY ELIZABETH , HUAMAN MARIA CECILIA , BARGUES M. DOLORES , VALERO M. ADELA , MAS-COMA SANTIAGO
Published: September 2018

The performance of Fas2-ELISA for the diagnosis of Fasciola hepatica infection in children living in areas of high endemicity for fascioliasis in the Peruvian Andes is analyzed. Fas2-ELISA is based on the detection of circulating IgG antibodies elicited in infected individuals against a F. hepatica antigen termed Fas2. The study was conducted in three Andean localities, Huertas-Julcan in Junin, Asillo in Puno, and Cajamarca, with a total population of 634 children in an age range 1 to 16 years old. Child fascioliasis prevalence was 21.1% in Huertas-Julcan, 25.4% in Asillo, and 24% in Cajamarca, estimated by coprological inspection. The seroprevalence of F. hepatica infection, determined by Fas2-ELISA, was 27.8% in Huertas-Julcan, 44.6% in Asillo, and 29.1% in Cajamarca. The overall sensitivity of Fas2-ELISA was 92.4%, the specificity 83.6%, and the negative predictive value 97.2%. No association between OD450 Fas2-ELISA and infection intensity measured by egg counting was observed. Results show that Fas2-ELISA is a highly sensitive immunodiagnostic test for the detection of F. hepatica infection in children living in human fascioliasis endemic areas.
A DRAMATIC INCREASE IN THE INCIDENCE OF HUMAN TRICHINELLOSIS IN ROMANIA OVER THE PAST 25 YEARS: IMPACT OF POLITICAL CHANGES AND REGIONAL FOOD HABITS.
Authors: BLAGA RADU , DURAND BENOIT , ANTONIU SILVIA , GHERMAN CALIN , CRETU CARMEN M. , COZMA VASILE , BOIREAU PASCAL
Published: September 2018

According to the International Commission on Trichinellosis survey in 2004, Romania has the most cases of trichinellosis in the world. Epidemiologic data for each county were collected and analyzed from two different time periods: before (1980–1989) and after (1990–2004) political changes. Data were analyzed separately for Transylvania and the rest of the Romanian counties. During the past 25 years, 28,293 human cases of trichinellosis were reported with an incidence of 51.0 cases per 106 persons per year. An important increase in the incidence was observed from 1980 to 1989 compared with the 1990–2004 period. For the entire period, the incidence rate obtained for Transylvanian counties (82.2 cases per 106 persons per year) was higher than the incidence rate obtained for the other counties (35.7 cases per 106 persons per year). Hypotheses and facts contributing to the heterogeneity of human trichinellosis cases are discussed.
Malaria Chemoprophylaxis: What Do the Travelers Choose, and How Does Pretravel Consultation Influence Their Final Decision
Authors: Senn Nicolas , D’Acremont Valérie , Landry Pierre , Genton Blaise
Published: September 2018

Three different drugs (mefloquine, atovaquone/proguanil, doxycycline) are recommended for malaria chemoprophylaxis, each with approximately the same efficacy but various adverse event profiles, regimens, and prices. We investigated which medication the travelers would have chosen on the basis of written evidence-based information and the impact that pretravel consultation had on their decision. A prospective study was performed in a travel clinic and private practice, and 1073 travelers were included; 45% chose mefloquine (Lariam or Mephaquine), 21% atovaquone/proguanil (Malarone), 18% doxycycline (Supracycline), 5% “no prophylaxis,” and 11% “do not know.” Lariam was principally chosen because of prior experience (38%), Mephaquine because of low price (34%), and doxycycline and Malarone because of the profile of adverse events (55% and 43%, respectively). Based on objective written information, travelers most frequently chose mefloquine for chemoprophylaxis. This suggests that evidence-based information weighs more heavily than negative publicity. Taking into account the perspective of the user should improve appropriateness of the pretravel advice.
Differences in Presentation of Severe Malaria in Urban and Rural Gabon
Authors: Issifou Saadou , Kendjo Eric , Missinou Michel A. , Matsiegui Pierre Blaise , Dzeing-Ella Arnaud , Dissanami Frédéric A. , Kombila Maryvonne , Krishna Sanjeev , Kremsner Peter G.
Published: September 2018

There are rare comparative studies of the clinical and laboratory features of severe and moderate malaria, including predictors of poor outcome, in rural and urban areas for regions of high malaria transmission. We therefore studied 2,235 children hospitalized for malaria in a rural (Lambaréné) and an urban (Libreville) area in Gabon between January 2001 and December 2002. From children screened, 33% and 48% were hospitalized for malaria in Libreville and Lambaréné, respectively (P < 0.001). Two malaria clinical groups were identified according to the World Health Organization 2000 classification of severe malaria. In both areas, severe malaria was characterized by a high proportion of severe anemia. The case fatality rate was 5-fold lower in Lambaréné than in Libreville (1% versus 5%; P < 0.0001). In both sites, cerebral malaria associated with respiratory distress was the most important predictor of fatal malaria (odds ratio = 10.7, 95% confidence interval = 4.8–23.8 P < 0.0001).
Human Asymptomatic Infection in Visceral Leishmaniasis: A Seroprevalence Study in an Urban Area of Low Endemicity. Preliminary Results
Authors: Barão Sandra C. , de Fonseca Camargo-Neves Vera L. , Resende Mariângela R. , da Silva Luiz J.
Published: September 2018

Many aspects of the human asymptomatic visceral leishmaniasis (VL) remain not elucidated, and moreover, almost all the data come from highly endemic areas. The recent appearance of American VL (AVL) in the northeastern region of the state of São Paulo, Brazil, offered a good opportunity for further understanding. We present the preliminary results from a seroprevalence study on AVL in humans in Araçatuba, São Paulo. This was a cross-sectional survey on a random sample of the population (one-stage simple random sampling) in two areas, using rK39 dipstick tests. The sex ratios and age distributions in the two areas were comparable. Detectable antibodies were found in 23 subjects (20%) in area A1 and in 6 subjects (4.8%) in area A2. There was no significant difference in age distribution of seropositivity between the areas. We observed a difference in asymptomatic infection rates between the two areas, possibly associated with socioeconomic levels and transmission intensity.
Morphologic and Molecular Characterization of Isospora belli Oocysts from Patients in Thailand
Authors: Jongwutiwes Somchai , Putaporntip Chaturong , Charoenkorn Malee , Iwasaki Takuya , Endo Takuro
Published: September 2018

To investigate the extent of genetic heterogeneity in the genus Isospora infecting patients in Thailand, a total of 38 fecal samples containing Isospora oocysts from human immunodeficiency virus/acquired immunodeficiency syndrome patients (n = 30), corticosteroid-treated patients (n = 3) and immunocompetent individuals (n = 5) were recruited for analysis. Remarkable variation in the maximum width and length of oocysts both within and between isolates was observed. However, the average length-width ratio of oocysts was within the range for I. belli (> 1.2). Ex vivo sporogonic development of freshly passed oocysts in feces from three of these isolates was observed longitudinally, showing that 27% of these oocysts underwent complete sporulation. Interestingly, 95% of sporulated oocysts contained two sporocysts in an oocyst with four sporozoites in each sporocyst, and Caryospora-like oocysts, characterized by eight sporozoites enclosed by a single sporocyst, were also detected (5%). The small subunit ribosomal RNA (rRNA), 5.8S rRNA, internal transcribed spacer 1 (ITS-1), and ITS-2 were highly conserved, indicating that there were no cryptic species or extensive strain variation.
FcγRIIa (CD32) Polymorphism and Onchocercal Skin Disease: Implications for the Development of Severe Reactive Onchodermatitis (ROD)
Authors: Ali Magdi M. M. , ElGhazali Gehad , Montgomery Scott M. , Farouk Salah E. , Nasr Amre , Noori Suzan I. A. , Shamad Mahdi M. , Fadlelseed Omar E. , Berzins Klavs
Published: September 2018

The pathologic manifestations of Onchocerca volvulus infection depend on the interplay between the host and the parasite. A genetic single nucleotide polymorphism in the FcγRIIa gene, resulting in arginine (R) or histidine (H) at position 131, affects the binding to the different IgG subclasses and may influence the clinical variations seen in onchocerciasis. This study investigated the relationship between this polymorphism and disease outcome. FcγRIIa genotyping was performed on clinically characterized onchocerciasis patients (N = 100) and healthy controls (N = 74). FcγRIIa genotype R/R131 frequencies were significantly higher among patients with severe dermatopathology (P < 0.001). Increased risk of developing this form was mostly associated with one tribe (Masalit) (OR = 3.2, 95% CI 1–9.9, P = 0.042). The H131 allele was found to be significantly associated with a reduced risk of having the severe form of the disease (adjusted OR = 0.26, 95% CI = 0.13–0.46, P < 0.001). Our findings suggest that the polymorphism influences the clinical outcome of onchocerciasis.
Confirmation of the Protective Effect of Ascaris lumbricoides on Plasmodium falciparum Infection: Results of a Randomized Trial in Madagascar
Authors: Brutus Laurent , Watier Laurence , Hanitrasoamampionona Virginie , Razanatsoarilala Hélène , Cot Michel
Published: September 2018

A controlled randomized trial of anti-helminthic treatment was undertaken in 1996–1997 in a rural area of Madagascar where populations were simultaneously infected with Ascaris lumbricoides, Plasmodium falciparum, and Schistosoma mansoni. Levamisole was administered bimonthly to 107 subjects, whereas 105 were controls. Levamisole was highly effective in reducing Ascaris egg loads in the treated group (P < 10−3 at all visits), whereas it had no effect on schistosomiasis. Subjects 5–14 years of age, treated with levamisole, had a significant increase of their P. falciparum densities compared with controls (P = 0.003). There was no effect of the treatment on children 6 months to 4 years of age, nor on adults > 15 years of age. This study confirms the results of a randomized trial, which showed a negative interaction in those > 5 years of age between Ascaris and malaria parasite density in another Malagasy population, submitted to a higher malaria transmission.
Fatal Systemic Infection with Multifocal Liver and Lung Nodules Caused by Brucella abortus
Authors: Park Keo Woon , Kim Dong-Min , Park Chi Young , Kim Hyun Lee , Jang Sook Jin , Choi Young Sil , Park Mi-Yeoun , Song Hyeon-Je , Lee Seung-Hyun
Published: September 2018

We experienced a fatal case caused by Brucella abortus with multifocal necrosis confirmed by culture and polymerase chain reaction. Our case highlights that the clinician should be aware of the potential for fatality when a patient with brucellosis shows dissemination of abscess or nodules with no calcification in the liver, lung, pleura, and spine.
Endemic Japanese Encephalitis in the Kathmandu Valley, Nepal
Authors: Partridge Jeffrey , Ghimire Prakash , Sedai Tika , Bista Mahendra Bahadur , Banerjee Manas
Published: September 2018

Japanese encephalitis (JE) is endemic in the Terai region of Nepal. There is little information on the occurrence of JE outside the Terai and particularly in the densely populated Kathmandu valley. Acute encephalitis syndrome (AES) cases were detected using a sentinel surveillance system that has been functioning since 2004. JE was confirmed using anti-JE IgM ELISA. All laboratory-confirmed JE cases that occurred in the Kathmandu valley during 2006 were followed up for verification of residence and travel history. JE was confirmed in 40 residents of the Kathmandu valley, including 30 cases that had no history of travel outside the valley during the incubation period. Incidence was 2.1/100,000 and the case fatality was 20% (8/40). Currently, JE prevention is focused on the Terai region in Nepal; given the evidence, this should be reviewed for the possible inclusion of the Kathmandu valley in the national JE prevention and control program.
Prevalence of Antibodies against Orthopoxviruses among Residents of Likouala Region, Republic of Congo: Evidence for Monkeypox Virus Exposure
Authors: Lederman Edith R. , Reynolds Mary G. , Karem Kevin , Braden Zachary , Learned-Orozco Lynne A. , Wassa-Wassa Demole , Moundeli Omba , Hughes Christine , Harvey Joseph , Regnery Russell , Mombouli Jean-Vivien , Damon Inger K.
Published: September 2018

Monkeypox virus is a zoonotic orthopoxvirus (OPX) of west and central sub-Saharan Africa. We conducted a cross-sectional serosurvey in Likouala region, Republic of Congo to assess exposure to OPX. Whole blood was collected using Nobuto blood filter strips (NBFS). Titers of IgM and IgG to OPX were assessed using an enzyme-linked immunosorbent assay. Demographic and clinical characteristics were compared with serostatus using the chi-square test or Fisher’s exact test. Multivariate logistic regression was performed to evaluate factors for independent association with serostatus. A total of 994 specimens were analyzed; the overall seroprevalence for OPX IgM was 1.7%. Age < 25 years reduced the likelihood of OPX exposure, and persons living in Ngangania village had independently higher odds (odds ratio = 33.5, 95% confidence interval = 7.2–166). Blood collection for serosurveys using NBFS is feasible and practical. Adult activities such as hunting and carcass preparation may play an important role in exposure to Monkeypox virus.
Rickettsia conorii in Humans and Dogs: A Seroepidemiologic Survey of Two Rural Villages in Israel
Authors: Harrus Shimon , Lior Yael , Ephros Moshe , Grisaru-Soen Galia , Keysary Avi , Strenger Carmella , Jongejan Frans , Waner Trevor , Baneth Gad
Published: September 2018

The prevalence of IgG-antibodies reactive with an Israeli strain of Rickettsia conorii (Israeli strain 487), the agent of Israeli spotted fever, was examined in humans and dogs from two rural villages in Israel where the disease has been reported in humans. Sixty-nine of 85 (81%) canine sera and 14 of 136 (10%) of human sera had anti-R. conorii antibodies. No direct association could be made between seropositivity of people and ownership of a seropositive dog. This study indicates that exposure to spotted fever group rickettsiae was highly prevalent among dogs compared with humans in the two villages examined, probably reflecting a greater exposure rate of canines to the tick vector. These results support a previous suggestion that canine serology could be a sensitive indicator for the presence and magnitude of human exposure to R. conorii.
How Many Years of Life Could Be Saved If Malaria Were Eliminated from a Hyperendemic Area of Northern Ghana?
Authors: Bawah Ayaga A. , Binka Fred N.
Published: September 2018

Malaria is endemic in about 90 countries of the world, half of which are in Africa. Little is known about the demographic impact of the disease, however. This article uses demographic methods to examine the impact of mortality from malaria on overall mortality in a hyperendemic rural African setting. Using longitudinal demographic surveillance data from northern Ghana and applying multiple decrement and associated single-decrement life-table methods, we estimate the total number of person-years that would have been saved had malaria been eliminated from the population in 1995, given the age- and cause-specific mortality conditions of the period and gains in life expectancy that are implied. Results suggest that as many as one third of deaths in this population are attributable to malaria, depending on the age group under consideration, and that life expectancy at birth would likely increase by more than six years if malaria were eliminated as a cause of death.
Poor Housing Quality Increases Risk of Rodent Infestation and Lassa Fever in Refugee Camps of Sierra Leone
Authors: Bonner Phillip Cullison , Schmidt Wolf-Peter , Belmain Steven R. , Oshin Babafemi , Baglole Debbie , Borchert Matthias
Published: September 2018

Lassa fever, a viral hemorrhagic fever endemic in parts of West Africa, is a severe febrile illness transmitted to humans by the rodent Mastomys natalensis. To determine risk of Lassa fever in households in Sierra Leonean refugee camps, we analyzed the spatial relationships between households with a Lassa case and focal locations of potential rodent habitats. Quality and hygiene factors of households were assessed to determine possible risk factors for household rodent infestation and occurrence of Lassa fever. The odds to have a rat burrow were higher in case houses than in control houses (OR 24, 95% CI 6.0–93). Case houses scored significantly worse in the quality of housing and external hygiene. These findings suggest that risk of Lassa fever in refugee camps depends on individual housing quality and the hygiene of the immediate surrounding environment.
A Major Transition in Malaria Treatment: The Adoption and Deployment of Artemisinin-Based Combination Therapies
Authors: Bosman Andrea , Mendis Kamini N.
Published: September 2018

Parasite resistance to conventional antimalarial medicines has led, in recent years, to a dramatic shift in malaria treatment. Sixty-seven countries with endemic Plasmodium falciparum malaria, 41 of them in Africa, have recently adopted the highly effective artemisinin-based combination therapies (ACTs). In 2005, 31.3 million ACT treatment courses were procured globally for public sector use, 25.5 million of them in Africa. However, in the 39 countries, and in particular the 21 African countries in which ACTs are being deployed, access to these medicines is still unacceptably low. After a period of market instability, the global manufacturing capacity for ACTs is now sufficient to meet the demand. However, increased and sustained financing will be necessary to extend the current levels of ACT coverage. Artemisinins as monotherapies are widely available in the private sector of 47 endemic countries, and their consumption will, if unabated, promote resistance to artemisinins and compromise the effectiveness of ACTs.
A Global Subsidy for Antimalarial Drugs
Authors: Gelband Hellen , Seiter Andreas
Published: September 2018

In 2004, the Institute of Medicine concluded that a global high-level subsidy was the best way to make effective antimalarial drugs—currently, artemisinin-combination therapies (ACTs)—widely available at affordable prices and at the same time substantially delay the emergence and spread of artemisinin-resistant strains of falciparum malaria. The subsidy would be available to manufacturers of all ACTs meeting pre-specified efficacy, safety, and quality criteria. Buyers would pay very low prices, allowing drugs to flow through existing channels, with the aim of reaching consumers at a similar price to chloroquine, the most frequently used (although no longer effective) malaria drug. Unsubsidized artemisinin monotherapies would be more expensive than subsidized ACTs (co-formulations), thereby largely eliminating their use through market forces. Conditions favoring the emergence of artemisinin-resistant malaria would be greatly reduced. The global high-level subsidy is a powerful idea that is moving from economic concept to pragmatic reality.
Chest Radiographic Presentation in Patients with Dengue Hemorrhagic Fever
Authors: Wang Chin-Chou , Wu Chao-Chien , Liu Jien-Wei , Lin An-Shen , Liu Shih-Feng , Chung Yu-Hsiu , Su Mao-Chang , Lee Ing-Kit , Lin Meng-Chih
Published: September 2018

There has been no previously reported case series study regarding chest radiographic (CXR) presentations in dengue hemorrhagic fever (DHF) patients. We retrospectively studied 363 DHF patients from June to December 2002 in southern Taiwan, and a total of 468 CXRs were obtained and reviewed. More than 50% of these showed abnormalities after the 3rd day, with infiltration only and small pleural effusion as the major findings. Progressive changes during the first week and improvements during the second week were observed in these abnormal CXRs. The CXR presentation was also significantly correlated with laboratory findings (white blood cell count, platelet levels, activated partial thromboplastin time, and alanine aminotransferase and albumin levels), as well as the clinical course (renal insufficiency, liver function impairment, upper gastrointestinal bleeding, combination bacterial infection, and duration of admission) and outcome (mortality). The CXR may therefore be a modality for evaluating the clinical course of DHF and should be made during first week after the onset of illness.
Low Gene Flow of Aedes aegypti between Dengue-Endemic and Dengue-Free Areas in Southeastern and Southern Brazil
Authors: da Costa-Ribeiro Magda Clara Vieira , Lourenço-de-Oliveira Ricardo , Failloux Anna-Bella
Published: September 2018

We present a population genetic study of Aedes aegypti in Brazil using isoenzyme markers. Four polymorphic loci were used to examine 11 mosquito collections at four periods in 2003. Samples from a dengue-endemic area (southeastern region) and a dengue-free area (southern region) connected by an important network of roads and railways were analyzed. The degree of genetic differentiation observed between populations is consistent with limited gene flow between them. There was no evidence of passive dispersion of Ae. aegypti by vehicles among the different routes linking metropolitan areas.
Elimination of Onchocercia volvulus Transmission in the Santa Rosa Focus of Guatemala
Authors: Lindblade Kim A. , Arana Byron , Zea-Flores Guillermo , Rizzo Nidia , Porter Charles H. , Dominguez Alfredo , Cruz-Ortiz Nancy , Unnasch Thomas R. , Punkosdy George A. , Richards Jane , Sauerbrey Mauricio , Castro Julio , Catú Eduard , Oliva Orlando , Richards Frank O.
Published: September 2018

To eliminate transmission of Onchocerca volvulus, semiannual mass treatment with ivermectin (Mectizan; donated by Merck & Co) has been underway in Guatemala since 2000. We applied the 2001 World Health Organization (WHO) elimination criteria in the Santa Rosa focus of onchocerciasis transmission in Guatemala (10,923 persons at risk). No evidence of parasite DNA was found in 2,221 Simulium ochraceum vectors (one-sided 95% confidence interval [CI], 0–0.086%), and no IgG4 antibody positives to recombinant antigen OV16 were found in a sample of 3,232 school children (95% CI, 0–0.009%). We also found no evidence of microfilariae in the anterior segment of the eye in 363 area residents (95% CI, 0–0.08%). Our interpretation of these data, together with historical information, suggest that transmission of O. volvulus is permanently interrupted in Santa Rosa and that ivermectin treatments there can be halted.
A Probable Case of Human Neurotrichinellosis in the United States
Authors: Madariaga Miguel G. , Cachay Edward R. , Zarlenga Dante S.
Published: September 2018

Human neurotrichinellosis is seldom reported. This is likely the result of the low incidence of parasites from the genus Trichinella in the United States domestic food supply, as well as difficulties in diagnosing the disease, especially when neither the organism nor the source of the infection are readily available. Although trichinellosis from domestic food supplies has been decreasing for many years, a resurgence has occurred in cases derived from the consumption of wild game. We report a rare case of neurotrichinellosis in the United States and implicate wild game as the source of the infection. These results suggest that clinicians should consider the potential for Trichinella infection in cases where wild game is common in the diets of the patients.
Voriconazole as Therapy for Systemic Penicillium marneffei Infections in AIDS Patients
Authors: Supparatpinyo Khuanchai , Schlamm Haran T.
Published: September 2018

The objective of this study was to evaluate the triazole anti-fungal agent, voriconazole, as therapy for systemic Penicillium marneffei infections in patients with advanced HIV infection. Patients with systemic P. marneffei infection were enrolled into a study of voriconazole for the treatment of less common, emerging, or refractory fungal infections. Patients were eligible for inclusion in the study on the basis that no anti-fungal agents have received regulatory approval specifically for P. marneffei infections. Patients were treated in the hospital setting with intravenous voriconazole (6 mg/kg every 12 hours on Day 1 and then 4 mg/kg every 12 hours for at least 3 days, after which patients could switch to oral therapy at 200 mg twice a day) or as outpatients with oral voriconazole (400 mg twice a day on Day 1 and then 200 mg twice a day) for a maximum of 12 weeks. Eleven patients received treatment with voriconazole. Two received short courses of intravenous therapy followed by the oral formulation; nine were treated with oral voriconazole only. At the end of therapy, eight of the nine evaluable patients had favorable response to therapy, based on mycological and clinical findings. There were no relapses of P. marneffei infection in the six patients who were seen at follow-up within 4 weeks of the end of therapy. Treatment with voriconazole was well tolerated, with no discontinuations caused by drug-related adverse events. The results of this study suggest that voriconazole is an effective, well-tolerated, and convenient option for the treatment of systemic infections with P. marneffei.
Financial Implications of Refugee Malaria: The Impact of Pre-Departure Presumptive Treatment with Anti-Malarial Drugs
Authors: Collinet-Adler Stefan , Stauffer William M. , Boulware David R. , Larsen Kevin L. , Rogers Tyson B. , Williams David N.
Published: September 2018

This study is a cost-benefits analysis of the recommendations of the Centers for Disease Control and Prevention for presumptive anti-malarial treatment among departing West African refugees. We conducted a retrospective chart review of symptomatic, blood smear–positive cases of malaria seen in Minneapolis, Minnesota, from 1996 through 2005. Billing charges of U.S. care were compared with estimates of implementation costs for overseas treatment. Fifty-eight symptomatic malaria infections occurred among West African refugees. After overseas pre-departure presumptive treatment, symptomatic malaria in arriving refugees decreased from 8.2% to 0%. The pre-departure number needed to treat to prevent one case of symptomatic malaria is 13.9 (95% confidence interval = 9.8–24). The average U.S. billing charge for each malaria case is $1,730. Overseas implementation costs for presumptive treatment are estimated to be between $141 and $346 to prevent one U.S. malaria case. Overseas presumptive pre-departure anti-malarial therapy prevents clinical malaria in refugees and results in cost-benefits when the malaria prevalence is > 1%. Overseas presumptive therapy has greater cost-benefits than U.S. based screening and treatment strategies.
Insecticide Resistance Mechanisms of Brazilian Aedes aegypti Populations from 2001 to 2004
Authors: Montella Isabela Reis , Martins Ademir Jesus , Viana-Medeiros Priscila Fernandes , Lima José Bento Pereira , Braga Ima Aparecida , Valle Denise
Published: September 2018

In Brazil, Aedes aegypti resistance to temephos, used since 1967, was detected in several municipalities in 2000. Organophosphates were substituted by pyrethroids against adults and, in some localities, by Bti against larvae. However, high temephos resistance ratios were still detected between 2001 and 2004. Field-simulated assays confirmed a low temephos residual effect. Acethylcholinesterase and Mixed Function Oxidase profiles were not altered. In contrast, higher Esterase activity, studied with three substrates, was found in all examined populations collected in 2001. From 2001 to 2004, a slight reduction in α-Esterase (EST) and β-EST activity together with a gradual increase of p-nitrophenyl acetate (PNPA)-EST was noted. Gluthathione-S-transferase alteration was encountered only in the northeast region in 2001, spreading the entire country thereafter. In general, except for α-EST and β-EST, only one enzyme class was altered in each mosquito specimen. Data are discussed in the context of historic application of insecticides in Brazil.
A New Robust Diagnostic Polymerase Chain Reaction for Determining the Mating Status of Female Anopheles gambiae Mosquitoes
Authors: Ng’habi Kija R. , Horton Ashley , Knols Bart G. J. , Lanzaro Gregory C.
Published: September 2018

The principal malaria vector in Africa, Anopheles gambiae, contains two pairs of autosomes and one pair of sex chromosomes. The Y chromosome is only associated with males and other Y chromosome–specific DNA sequences, which are transferred to women during mating. A reliable tool to determine the mating status of dried wild An. gambiae females is currently lacking. DNA was extracted from dried virgin and mated females and used to test whether Y chromosome–specific polymerase chain reaction (PCR) markers can be successfully amplified and used as a predictor of mating. Here we report a new PCR-based method to determine the mating status among successfully inseminated and virgin wild An. gambiae females, using three male-specific primers. This dissection-free method has the potential to facilitate studies of both population demographics and gene flow from dried mosquito samples routinely collected in epidemiologic monitoring and aid existing and new malaria-vector control approaches.
Effect of Diethylcarbamazine on HIV Load, CD4%, and CD4/CD8 Ratio in HIV-Infected Adult Tanzanians with or without Lymphatic Filariasis: Randomized Double-Blind and Placebo-Controlled Cross-Over Trial
Authors: Nielsen Nina O. , Simonsen Paul E. , Dalgaard Peter , Krarup Henrik , Magnussen Pascal , Magesa Stephen , Friis Henrik
Published: September 2018

We assessed the effect of anti-filarial treatment (diethylcarbamazine, DEC) on HIV load, CD4%, and CD4/CD8 ratio in HIV-positive individuals with and without infection with the filarial parasite Wuchereria bancrofti in a randomized, double-blind, placebo-controlled cross-over trial. The study was conducted in Tanga Region, Tanzania, in 2002 and involved 27 adults. A significant decrease in HIV load (54%) and an insignificant increase in CD4% were observed in the HIV-positive individuals with filarial co-infection at 12 weeks after treatment. HIV load and CD4% both increased, although not statistically significantly, in the HIV-positive individuals without filarial infection. The findings suggest that DEC affected HIV load through its effect on the filarial infection rather than through a direct (pharmacodynamic) effect on HIV. Global efforts to control lymphatic filariasis by annual mass treatment with DEC may have a beneficial effect on the HIV/AIDS epidemic in areas where HIV and lymphatic filariasis co-exist.
N, N-diethyl-m-toluamide–Containing Microcapsules for Bio-Cloth Finishing
Authors: Fei Bin , Xin John H.
Published: September 2018

To obtain long-duration protection from mosquitoes using insect repellent N, N-diethyl-m-toluamide (DEET), this compound was incapsulated in situ during the graft copolymerization of butyl acrylate onto chitosan in an aqueous solution. Morphology of microcapsules was characterized by scanning electron microscopy, scanning probe microscopy, and transmission electron microscopy. This morphology supported successful encapsulation of DEET into polymer capsules. The encapsulation ratio of DEET was greater than 33%, as estimated from thermo-gravimetric results. The aqueous emulsions were applied to cotton textiles by spraying. Treated cloth showed high bactericidal activity against Staphylococcus aureus. Mosquito repellency of the bio-cloth was evaluated with Aedes albopictus. The 90% effective dose of emulsions on textiles was compared with that of DEET in ethanol. A time profile showed that the repellency of an optimized emulsion was 100% after eight hours, and partially preserved even after exposure to air for 48 hours.
Rapid Detection and Quantification of Chikungunya Virus by a One-Step Reverse Transcription–Polymerase Chain Reaction Real-Time Assay
Authors: Carletti Fabrizio , Bordi Licia , Chiappini Roberta , Ippolito Giuseppe , Sciarrone Maria R. , Capobianchi Maria R. , Di Caro Antonino , Castilletti Concetta
Published: September 2018

Chikungunya virus (CHIKV) is a mosquito-transmitted alphavirus. A large outbreak of CHIKV disease occurred in 2005 in the Indian Ocean Islands. Many cases have been imported in European countries. Laboratory confirmation of suspected cases is mandatory for control measures during an outbreak. We report a novel, real-time, reverse transcription–polymerase chain reaction (RT-PCR) for the nonstructural protein 1 region that can quantify a wide range of viral RNA concentrations. This assay was validated by in vitro experiments in which interferon-α, a well-known virus inhibitor, showed a dose-dependent inhibition of virus replication on Vero cells that was assessed by viral infectivity and viral RNA production. This new real-time RT-PCR was used to measure viral load in serum samples from cases recently imported to Italy, and may be a useful tool in rapid detection of CHIKV and monitoring the extent of viral replication in patients.
Over-Diagnosis and Co-Morbidity of Severe Malaria in African Children: A Guide for Clinicians
Authors: Gwer Samson , Newton Charles R.J.C. , Berkley James A.
Published: September 2018

Severe malaria is clinically similar to other severe febrile illnesses. However, in endemic areas, parasitological confirmation of parasitemia is often unavailable or unreliable. False-positive malaria microscopy is common. The most important consequence of treating only for malaria when no parasitemia exists is failure to address other life-threatening conditions. Invasive bacterial infections are detected in up to one third of children with clinical features of severe malaria but a slide with results negative for malaria. Even among genuinely parasitized children, severe illness is not always due to malaria in endemic areas. We believe that routine use of parenteral antibiotics among children with a slide that indicates malaria and life-threatening disease is warranted because invasive bacterial infections are likely to be under-ascertained and are associated with increased mortality. Published data on co-morbidity with HIV infection and malnutrition are reviewed. A structured approach to assessment and care is essential, and is largely independent of underlying etiology.
Coexistence of Trypanosoma cruzi Genotypes in Wild and Periodomestic Mammals in Chile
Authors: Rozas Marlene , Botto-Mahan Carezza , Coronado Ximena , Ortiz Sylvia , Cattan Pedro E. , Solari Aldo
Published: September 2018

Epidemiologic evidence suggests a preferential association of Trypanosoma cruzi genotypes TCI and TCII with marsupials and placental mammals, respectively. We identify T. cruzi genotypes from 117 infected mammals. Minicircle DNA amplified by polymerase chain reaction and hybridization with a panel of four specific probes showed frequencies for the T. cruzi genotypes TCI, TCIIb, TCIId, and TCIIe of 38%, 41%, 26%, and 9%, respectively, in wild mammals. In peridomestic mammals, frequencies for the same clones were 29%, 33%, 43%, and 14%, respectively. As a whole, mixed infections are found in more than 31% of the cases, which indicates the coexistence of multiclonal strains circulating in nature, and the absence of specific associations between T. cruzi genotypes and reservoir hosts, including marsupials. The direct characterization of parasite genotypes emphasizes the importance of obtaining unbiased epidemiologic information from parasite-endemic areas. Results are discussed in the context of competition or facilitation of T. cruzi genotypes within hosts.
Simultaneous Detection and Quantification of Ancylostoma duodenale, Necator americanus, and Oesophagostomum bifurcum in Fecal Samples Using Multiplex Real-Time PCR
Authors: Verweij Jaco J. , Brienen Eric A. T. , Ziem Juventus , Yelifari Lawrence , Polderman Anton M. , Van Lieshout Lisette
Published: September 2018

A multiplex real-time PCR was developed and evaluated for the simultaneous detection of Ancylostoma duodenale, Necator americanus, and Oesophagostomum bifurcum in fecal samples. Using well-defined control samples (N = 150), known positive fecal samples (N = 50), and fecal samples from an area in Ghana where human infections with all 3 nematode species are endemic (N = 339), the method proved to be highly specific and sensitive. Cycle threshold (Ct) values, reflecting parasite-specific DNA load, showed significant correlation with the intensity of infection as measured by microscopy using Kato–Katz fecal smears or by species specific third-stage larval count after coproculture. The multiplex real-time PCR described combined with the simple fecal sample collection procedure and the potential for high throughput makes this approach a powerful diagnostic tool to study species-specific transmission patterns of human hookworm-like infections. Moreover, this procedure facilitates monitoring of intervention programs and allows species-specific detection of treatment failure following rounds of mass treatment.
Scrotal Tuberculosis in Adult Patients: A 10-Year Clinical Experience
Authors: Lee Ing-Kit , Yang Wen-Chou , Liu Jien-Wei
Published: September 2018

Twenty-nine adults (mean age, 59.9 ± 13.5 years) with scrotal tuberculosis (TB) were retrospectively analyzed. The mean interval from emergence of symptoms suggestive of scrotal TB to diagnosis established was 142.44 ± 227.66 days. Scrotal TB was initially suspected in only five (17.2%) patients, and infection caused by bacteria other than Mycobacterium tuberculosis (55.2%) was the leading presumptive diagnosis. Of 28 patients with chest radiographs available, 7 (25%) disclosed active pulmonary TB, and 9 (32.1%) showed a TB scar. All patients received anti-TB chemotherapy; 20 (69%) additionally underwent surgery. Pathologic examination of resected tissue at therapeutic surgery, biopsy, or polymerase chain reaction assay of urine led to rapid diagnosis of scrotal TB. Although evidence of scrotal TB was easily obtainable, the lack of alertness made clinicians avert from the appropriate diagnostic approaches and rendered a delayed diagnosis. Our report underscores the urgent need for improving clinicians’ awareness of scrotal TB.
Incidence and Types of Illness When Traveling to the Tropics: A Prospective Controlled Study of Children and Their Parents
Authors: Newman-Klee Catherine , D’Acremont Valérie , Newman Christopher J. , Gehri Mario , Genton Blaise
Published: September 2018

Increasingly, families travel to tropical destinations exposing them to infectious agents and tropical diseases not encountered at home. We studied 157 children (0–16 years) and their adult relatives traveling to the tropics, who attended a pretravel clinic and were generally adherent to prescribed advice. Incidence rates of common illness in children and adults were respectively 16.9 (14.3–19.7) and 15.1 (12.7–17.8) episodes/100 person-weeks. Diarrhea, abdominal pain, and fever were the most frequent complaints. There was no significant difference in the incidence of morbid episodes between children and adults, except for fever (more frequent in children). Most episodes occurred in the first 10 days of travel. The similar incidence of morbidity in children and adults and the episodes’ mildness challenge the view that it is unwise to travel with small children.
Epidemiology of Clostridium difficile–Associated Diarrhea in a Peruvian Tertiary Care Hospital
Authors: Garcia Coralith , Samalvides Frine , Vidal Margot , Gotuzzo Eduardo , Dupont Herbert L.
Published: September 2018

The prevalence, incidence, and epidemiologic factors of Clostridium difficile–associated diarrhea (CDAD) in a Peruvian hospital were studied. We conducted a cross-sectional study in patients > 14 years of age from medical/surgical wards of the Cayetano Heredia National Hospital (Lima, Peru) from September 2005 to May 2006. CDAD was defined in a case of nosocomial diarrhea when C. difficile toxin A and/or toxin B was detected by enzyme immune assay (EIA) in stools. A total of 4,264 patients were admitted, with 156 (3.7%) developing nosocomial diarrhea. Fifty-five of 156 (35.2%) cases of nosocomial diarrhea were diagnosed as CDAD. The overall incidence per 1,000 admissions was 12.9. Multivariate analysis showed that use of diapers (OR, 3.54; 95% CI, 1.71–7.34; P = 0.001) and presence of another patient with CDAD housed in the same room (OR, 2.97; 95% CI, 1.14–7.76; P = 0.026) were significantly associated with CDAD. Hospital transmission of C. difficile commonly occurred, supporting infection-appropriate measures directed toward the reduction of CDAD in low-resource settings.
Quantitation of B. Pseudomallei in Clinical Samples
Authors: Wuthiekanun Vanaporn , Limmathurotsakul Direk , Wongsuvan Gumphol , Chierakul Wirongrong , Teerawattanasook Nittaya , Teparrukkul Prapit , Day Nicholas P. , Peacock Sharon J.
Published: September 2018

We undertook a prospective study to quantitate Burkholderia pseudomallei in blood, pus, respiratory secretions, and urine obtained from 414 patients with melioidosis. The median was count 1.1, 1.5 × 104, 1.1 × 105, and 1.1 × 107 CFU/mL in these sample types, respectively. This provides important insights into the likely feasibility of future studies such as expression microarray analysis using clinical material.