bluuebunny/crossref_metadata_2025 huggingface dataset:
An Update on Anemia in Less Developed Countries
Authors: Tolentino Karine , Friedman Jennifer F.
Published: September 2018

The highest prevalence of anemia exists in the developing world where its causes are multi-factorial. Anemia is responsible for significant morbidity and mortality, particularly in less developed countries (LDCs). Understanding causes of anemia and potential mechanisms are crucial to our ability to intervene to reduce this burden. In the past decade, our understanding of the etiology and mechanisms of anemia in LDCs has advanced significantly. This review will focus on recent advances in our understanding of the burden of anemia in specific sub-groups, the causes and mechanisms of anemia, and consequences of anemia for the human host.
A Major Epidemic of Chikungunya Virus Infection on Réunion Island, France, 2005–2006
Authors: Renault Philippe , Solet Jean-Louis , Sissoko Daouda , Balleydier Elsa , Larrieu Sophie , Filleul Laurent , Lassalle Christian , Thiria Julien , Rachou Emmanuelle , de Valk Henriette , Ilef Daniele , Ledrans Martine , Quatresous Isabelle , Quenel Philippe , Pierre Vincent
Published: September 2018

In January 2005, an epidemic of chikungunya fever broke out in the Comoro Islands and lasted until May 2005. In April, cases were also reported in Mayotte and Mauritius. On Réunion Island, the first cases were reported at the end of April. Surveillance of this epidemic required an adaptive system, which at first was based on active and retrospective case detection around the cases reported, then relied on a sentinel network when the incidence increased. Emerging and severe forms of infection were investigated. Death certificates were monitored. By April 2006, the surveillance estimate was 244,000 cases of chikungunya virus infection, including 123 severe cases and 41 of maternoneonatal transmission, with an overall attack rate of 35%. Chikungunya infection was mentioned on 203 death certificates and significant mortality was observed. This epidemic highlighted the need for a mutual strategy of providing information on arboviral diseases and their prevention and control between countries in the southwestern Indian Ocean.
Host Feeding Pattern of Culex quinquefasciatus (Diptera: Culicidae) and Its Role in Transmission of West Nile Virus in Harris County, Texas
Authors: Molaei Goudarz , Andreadis Theodore G. , Armstrong Philip M. , Bueno Rudy , Dennett James A. , Real Susan V. , Sargent Chris , Bala Adilelkhidir , Randle Yvonne , Guzman Hilda , da Rosa Amelia Travassos , Wuithiranyagool Taweesak , Tesh Robert B.
Published: September 2018

The vertebrate hosts of 672 blood-engorged Culex quinquefasciatus Say, collected in Harris County, Texas, during 2005, were identified by nucleotide sequencing PCR products of the cytochrome b gene. Analysis revealed that 39.1% had acquired blood from birds, 52.5% from mammals, and 8.3% were mixed avian and mammalian blood meals. Most frequent vertebrate hosts were dog (41.0%), mourning dove (18.3%), domestic cat (8.8%), white-winged dove (4.3%), house sparrow (3.2%), house finch (3.0%), gray catbird (3.0%), and American robin (2.5%). Results are interpreted in conjunction with concurrent avian and mosquito West Nile virus (WNV) surveillance activities in Harris County. We conclude that Cx. quinquefasciatus is an opportunistic feeder and principal mosquito vector of WNV in this metropolitan area; however, transmission by other mosquito species or by other modes of infection, such as ingestion, must account for the high WNV infection rates among local blue jays and American crows.
Molecular Detection and Characterization of Spotted Fever Group Rickettsiae in Taiwan
Authors: Tsui Pei-Yi , Tsai Kun-Hsien , Weng Ming-Hui , Hung Yao-Wen , Liu Yu-Tien , Hu Kuang-Yu , Lien Jih-Ching , Lin Pey-Ru , Shaio Men-Fang , Wang Hsis-Chieh , Ji Dar-Der
Published: September 2018

Rickettsioses are emerging infectious diseases caused by rickettsiae in association with arthropods. We report the detection of spotted fever group rickettsiae (SFGR) in Taiwan using molecular methods. Phylogenetic analyses of the 17-kd protein and citrate synthase (gltA) genes showed that SFGR TwKM01 detected in Rhipicephalus haemaphysaloides ticks was most similar to Rickettsia rhipicephali. Three TwKM01 isolates were obtained from three individual R. haemaphysaloides ticks. Small, intracellular, coccobacillary bacteria were found in infected L929 cells using immunofluorescence antibody testing and transmission electron microscopy. Two other SFGRs, TwKM02 and TwKM03, identified in Leptotrombidium chigger mites, were closely related to R. australis and R. felis URRWXCal2, respectively. The TwKM03 strain was also detected in Ixodes granulatus ticks and widely distributed in Hualien, Kinmen, and Lienchiang counties in Taiwan. The endonucleases MaeII and HhaI selected for restriction fragment length polymorphism analysis of the gltA and 17-kd polymerase chain reaction products, respectively, were useful for genotyping Rickettsia species TwKM01, TwKM02, TwKM03, and other SFGRs. Although their infectivity and pathogenicity for vertebrates are unknown, the finding of SFGRs raises the possibility that bacteria other than Orientia tsutsugamushi, Coxiella burnetii, and R. typhi may be involved in rickettsial diseases in Taiwan.
Increased Plasmodium falciparum Gametocyte Production in Mixed Infections with P. malariae
Authors: Bousema J. Teun , Drakeley Chris J. , Mens Petra F. , Arens Theo , Houben Rein , Omar Sabah A. , Gouagna Louis C. , Schallig Henk , Sauerwein Robert W.
Published: September 2018

Plasmodium falciparum and P. malariae occur endemically in many parts of Africa. Observations from malariotherapy patients suggest that co-infection with P. malariae may increase P. falciparum gametocyte production. We determined P. falciparum gametocyte prevalence and density by quantitative nucleic acid sequence-based amplification (QT-NASBA) after antimalarial treatment of Kenyan children with either P. falciparum mono-infection or P. falciparum and P. malariae mixed infection. In addition, we analyzed the relationship between mixed species infections and microscopic P. falciparum gametocyte prevalence in three datasets from previously published studies. In Kenyan children, QT-NASBA gametocyte density was increased in mixed species infections (P = 0.03). We also observed higher microscopic prevalences of P. falciparum gametocytes in mixed species infections in studies from Tanzania and Kenya (odds ratio = 2.15, 95% confidence interval = 0.99–4.65 and 2.39, 1.58–3.63) but not in a study from Nigeria. These data suggest that co-infection with P. malariae is correlated with increased P. falciparum gametocytemia.
Eosinophilia Among Returning Travelers: A Practical Approach
Authors: Meltzer Eyal , Percik Ruth , Shatzkes Joshuah , Sidi Yehezkel , Schwartz Eli
Published: September 2018

Eosinophilia is not uncommon among returning travelers; however, the optimal diagnostic and therapeutic approach in travelers, as opposed to immigrants and refugees, is not clearly established. This was a retrospective case series. All returning travelers from developing countries presenting at the post-travel clinic with eosinophilia (≥ 500 cells/mcl) during 1994–2006 were evaluated. Data were compared with other referrals to the post-travel clinic and with a random sample of a pre-travel clinic. Of the 955 returning travelers evaluated during the study period, 82 (8.6%) had eosinophilia, and 44 (4.4%) were diagnosed with schistosomiasis. Another 38 (4.2%) cases presented with non-schistosomal eosinophilia (NSE), among whom a definite parasitologic diagnosis was achieved in only 23.7%. However, an empiric course of albendazole led to a clinical improvement in 90% of NSE cases. Helminthic disease probably accounts for the majority of cases of post-travel eosinophilia. Empiric albendazole therapy should be offered to undiagnosed NSE patients.
Influence of the Dengue Serotype, Previous Dengue Infection, and Plasma Viral Load on Clinical Presentation and Outcome During a Dengue-2 and Dengue-4 Co-Epidemic
Authors: Thomas Laurent , Verlaeten Olivier , Cabié André , Kaidomar Stéphane , Moravie Victor , Martial Jenny , Najioullah Fatiha , Plumelle Yves , Fonteau Christiane , Dussart Philippe , Césaire Raymond
Published: September 2018

Martinique experienced a dengue outbreak with co-circulation of DENV-2 and DENV-4. In an emergency department-based study, we analyzed whether the clinical presentation and outcome of adult patients were related to serotype, immune status, or plasma viral load. Of the 146 adult patients who had confirmed dengue infection, 91 (62.3%) were classified as having classic dengue fever, 11 (7.5%) fulfilled World Health Organization criteria for dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS), 21 other patients (14.4%) presented with at least one typical feature of DHF/DSS [i.e., internal hemorrhage, plasma leakage, marked thrombocytopenia (platelet count ≤ 50,000 platelets/mm3) and/or shock], and 23 further patients (15.8%) had unusual manifestations. Four patients died. Severe illness was more frequent in patients with secondary dengue infection (odds ratio, 7.18; 95% confidence interval, 3.1–16.7; P < 0.001). Multivariate regression analysis showed that gastrointestinal symptoms and other unusual manifestations were independently associated with DENV-2 infection, whereas cough and DHF/DSS features were independently associated with secondary immune response. A high plasma viral load was associated with DENV-2 infection, increased serum liver enzymes, and with DHF/DSS features in patients presenting after the third day of illness. The most severe cases of dengue resulted from the combined effects of DENV-2 and secondary infection.
Passive Immunity to West Nile Virus Provides Limited Protection in a Common Passerine Species
Authors: Nemeth Nicole M. , Oesterle Paul T. , Bowen Richard A.
Published: September 2018

Passerine birds have played an important role in the establishment, maintenance, and spread of West Nile virus (WNV) in North America, and some are susceptible to WNV-associated mortality. Characterization of passive transfer of anti-WNV antibodies in passerines is important to understanding transmission and demographic effects of WNV on wild birds. We showed passively acquired maternal antibodies to WNV in the house sparrow (Passer domesticus). Although all seropositive females (N = 18) produced antibody-positive egg yolks, only 20% of seropositive mothers (3/15) produced seropositive chicks. The estimated average half-life of maternal antibodies in chick sera was 3 days, and no antibodies were detected after 9 days post-hatch (DPH). Maternal antibodies failed to provide protection against viremia in chicks at 21–25 DPH. Although the observed duration of persistence of passively inherited anti-WNV antibodies in house sparrows differs from some non-passerine birds, it remains unknown whether similar patterns occur in other passerines.
Effects of Different Antimalarial Drugs on Gametocyte Carriage in P. Vivax Malaria
Authors: Pukrittayakamee Sasithon , Imwong Mallika , Singhasivanon Pratap , Stepniewska Kasia , Day Nicholas J. , White Nicholas J.
Published: September 2018

The gametocytocidal and asexual stage activities of eight antimalarial and eight antibiotic-containing regimens were evaluated in 349 adult patients with P. vivax malaria. Gametocytemia was found in 63% of patients (22% before and 41% after treatment). The median (range) gametocyte clearance time was 24 hours (range, 2–504 hours) and correlated with asexual parasite clearance time (r = 0.52, P < 0.001). Gametocytemia in vivax malaria was more common in patients with admission parasitemia > 10,000/μL and after treatment with drugs which have weak antimalarial activity, and was also associated with an increased rate of vivax reappearance (29.4% versus 14.1%, P = 0.002). Sexual stage activities corresponded with asexual stage activity for all tested regimens. Treatment with potent antimalarial drugs reduces the transmission potential of P. vivax.
Drinking Water: A Possible Source of Blastocystis spp. Subtype 1 Infection in Schoolchildren of a Rural Community in Central Thailand
Authors: Leelayoova Saovanee , Siripattanapipong Suradej , Thathaisong Umaporn , Naaglor Tawee , Taamasri Paanjit , Piyaraj Phunlerd , Mungthin Mathirut
Published: September 2018

In January 2005, a survey of intestinal parasitic infections was performed in a primary school, central Thailand. Of 675 stool samples, Blastocystis was identified with a prevalence of 18.9%. Genetic characterization of Blastocystis showed subtype 1 (77.9%) and subtype 2 (22.1%). Study of the water supply in this school was performed to find the possible sources of Blastocystis. Blastocystis from one water sample was identified as subtype 1, which had a nucleotide sequence of small subunit (SSU) ribosomal RNA (rRNA) gene that was 100% identical to that of Blastocystis infected in schoolchildren. Our information supports the evidence of water-borne transmission in this population.
Non-septicemic Melioidosis Presenting as Cardiac Tamponade
Authors: Chung Hsing-Chun , Lee Ching-Tai , Lai Chung-Hsu , Huang Chun-Kai , Lin Jiun-Nong , Liang Shiou-Haur , Lin Hsi-Hsun
Published: September 2018

Melioidosis is endemic in Taiwan. It is caused by infection with Burkholderia pseudomallei. A prolonged course of oral eradication therapy to avoid relapse after an intensive intravenous therapy is recommended to treat melioidosis. Melioidosis with cardiac involvement is rare and is often combined with septicemia, for which the mortality rate is 20–60%. The initial clinical presentations of melioidosis mimic Mycobacterium tuberculosis infection, which is the most common etiology of bacterial pericarditis in Taiwan. We present a case of non-septicemic melioidosis that presented as non-suppurative cardiac tamponade and left subcarinal lymphadenopathy. Underlying diseases included hepatitis B–related liver cirrhosis and hepatocellular carcinoma. The patient was successfully treated with 2 weeks of intravenous ceftazidime and 12 weeks of oral doxycycline, trimethoprim-sulfamethoxazole, and amoxicillin/clavulanate. Melioidosis-related pericarditis should be considered in the differential diagnoses of bacterial pericarditis in Taiwan.
Predictors of Lethality in Severe Leptospirosis in Urban Brazil
Authors: Spichler Anne S. , Vilaça Pedro J. , Athanazio Daniel A. , Albuquerque Jose O. M. , Buzzar Marcia , Castro Bronislawa , Seguro Antonio , Vinetz Joseph M.
Published: September 2018

To ascertain prognostic factors associated with fatal outcomes in severe leptospirosis, a retrospective case-control study was done using population-based surveillance data. Centralized death certificate reporting of leptospirosis mortality was combined with details of patients’ hospitalizations, which were obtained from hospitals representing all sectors of São Paulo city. Among identified leptospirosis cases, 89 lethal cases and 281 survivor cases were analyzed. Predictors of death included age > 40 years, development of oliguria, platelet count < 70,000/μL, creatinine > 3 mg/dL, and pulmonary involvement. The latter was the strongest risk factor with an estimated odds ratio of 6.0 (95% confidence interval: 3.0–12.0). Serologic findings with highest titer against Leptospira interrogans serovar Copenhageni did not show significant differences between survivors and non-survivors. Lung involvement was an important predictor of death in leptospirosis in São Paulo, of relevance in leptospirosis-endemic regions where this complication is common.
Epidemiology of Neuroinvasive Arboviral Disease in the United States, 1999–2007
Authors: Reimann Carolyn A. , Hayes Edward B. , DiGuiseppi Carolyn , Hoffman Richard , Lehman Jennifer A. , Lindsey Nicole P. , Campbell Grant L. , Fischer Marc
Published: September 2018

From 1999–2007, the most common causes of neuroinvasive arboviral disease in the United States, after West Nile virus (WNV), were California (CAL) serogroup viruses, St. Louis encephalitis virus (SLEV), and eastern equine encephalitis virus (EEEV). The CAL serogroup virus disease was primarily reported from Appalachia and the upper Midwest, SLEV disease from southern states, and EEEV disease from areas along the Atlantic and Gulf coasts. Children accounted for 88% of CAL serogroup virus disease, whereas 75% of SLEV disease occurred among older adults. The EEEV disease had the highest case-fatality rate (42%). The incidence of CAL serogroup virus and EEEV disease remained stable before and after the detection of WNV in the United States in 1999. The SLEV disease declined 3-fold after 1999; however, SLEV disease has occurred in sporadic epidemics that make trends difficult to interpret. The CAL serogroup virus, SLEV, and EEEV disease are persistent public health concerns in the United States warranting ongoing prevention efforts.
Increasing Fluoroquinolone Resistance in Salmonella typhi in Ontario, 2002–2007
Authors: Morris Shaun K. , Richardson Susan E. , Sauve Laura J. , Ford-Jones E. Lee , Jamieson Frances
Published: September 2018

We reviewed the antibiotic susceptibility patterns of all isolates of Salmonella typhi in Ontario, Canada from January 2002 to December 2007. We identified a total of 381 unique cases over the 5-year period (50–73 cases per year). Of the 381 cases, 171 were female, 164 were male, and no gender was identified for 33 cases. Age of the patients ranged from less than 1 to 102 years of age (median age of 20 years). Although resistance patterns for ampicillin, trimethoprim-sulfamethoxazole, third generation cephalosporins (cefotaxime until May 2005 and ceftriaxone from June 2005 to present), and chloramphenicol remained stable, nalidixic acid resistance rose sharply between 2003 and 2005 and has remained at approximately 80% of isolates since 2005. The significant and sustained increase in nalidixic acid-resistant S. typhi suggests that ciprofloxacin should no longer be used as the drug of choice for the empiric treatment of typhoid fever in Ontario.
Spatial Risk Models for Human Plague in the West Nile Region of Uganda
Authors: Winters Anna M. , Staples J. Erin , Ogen-Odoi Asaph , Mead Paul S. , Griffith Kevin , Owor Nicholas , Babi Nackson , Enscore Russell E. , Eisen Lars , Gage Kenneth L. , Eisen Rebecca J.
Published: September 2018

The West Nile region of Uganda represents an epidemiologic focus for human plague in east Africa. However, limited capacity for diagnostic laboratory testing means few clinically diagnosed cases are confirmed and the true burden of disease is undetermined. The aims of the study were 1) describe the spatial distribution of clinical plague cases in the region, 2) identify ecologic correlates of incidence, and 3) incorporate these variables into predictive models that define areas of plague risk. The model explained 74% of the incidence variation and revealed that cases were more common above 1,300 m than below. Remotely-sensed variables associated with differences in soil or vegetation were also identified as incidence predictors. The study demonstrated that plague incidence can be modeled at parish-level scale based on environmental variables and identified parishes where cases may be under-reported and enhanced surveillance and preventative measures may be implemented to decrease the burden of plague.
High Early Mortality in Patients with Chronic Acquired Immunodeficiency Syndrome Diarrhea Initiating Antiretroviral Therapy in Haiti: A Case-Control Study
Authors: Dillingham Rebecca A. , Pinkerton Relana , Leger Paul , Severe Patrice , Guerrant Richard L. , Pape J. William , Fitzgerald Daniel W.
Published: September 2018

This case-control study examines whether chronic diarrhea at initiation of antiretroviral therapy (ART) affects survival of human immunodefiency virus–infected patients. Cases (288) were treatment-naive, non-pregnant, adults with self report of frequent loose stool for > 3 weeks at the time ART was initiated. One-third of patients had an enteric pathogen identified including Cryptosporidium spp., Giardia spp., Isospora belli, Cyclospora cayetanensis, and Entamoeba histolytica. Control patients (400) did not have diarrhea when initiating ART. At six weeks, mortality was 10% in the patients with diarrhea and 5% in the patients without diarrhea (P = 0.009). Chronic diarrhea in patients requesting ART in Haiti is associated with increased early mortality.
Does Artesunate Prolong the Electrocardiograph QT Interval in Patients with Severe Malaria?
Authors: Maude Richard J. , Plewes Katherine , Faiz M. Abul , Hanson Josh , Charunwatthana Prakaykaew , Lee Sue J. , Tärning Joel , Yunus Emran Bin , Hoque M. Gofranul , Hasan Mahatab Uddin , Hossain Amir , Lindegardh Niklas , Day Nicholas P. J. , White Nicholas J. , Dondorp Arjen M.
Published: September 2018

Several antimalarials can cause significant prolongation of the electrocardiograph QT interval, which can be associated with an increased risk of potentially lethal ventricular arrhythmias. High doses of artemether and artemotil have been associated with QT prolongation in dogs, raising the possibility of a class effect with the artemisinin derivatives. Serial electrocardiograms were recorded, and QTc interval was calculated before and after administration of artesunate by intravenous injection in patients with severe falciparum malaria in Bangladesh. Of 21 adult patients with severe malaria enrolled, 8 (38%) died. The mean QTc interval was unaffected by bolus intravenous artesunate (2.4 mg/kg). In two patients, the QTc interval exceeded 0.5 seconds, but in both cases, an alternative explanation was plausible. No effect was observed on the JTc or PR interval, QRS width, blood pressure, or heart rate. Intravenous artesunate does not have significant cardiovascular effects in patients with severe falciparum malaria.
Comparative Hematologic Analysis of Uncomplicated Malaria in Uniquely Different Regions of Unstable Transmission in Brazil and Colombia
Authors: Caicedo Olga , Ramirez Oscar , Mourão Maria P. G. , Ziadec Jose , Perez Pilar , Santos João B. , Quiñones Francisco , Alecrim Maria G. C. , Arévalo-Herrera Myriam , Lacerda Marcus V. G. , Herrera Sócrates
Published: September 2018

Information on malaria-associated anemia in adult patients is scarce in South American populations. From 2004 to 2006, malaria patients 18 to 45 years of age were recruited in a descriptive cross-sectional study from two different towns: Manaus, in the Brazilian Amazon (120 patients) where Plasmodium falciparum incidence is lower (≈20%), and in Tumaco on the Colombian Pacific Coast (126 patients) where P. falciparum incidence is higher (≈90%). Relationships between hematologic parameters and independent variables were explored using cross-tabulations and multiple linear regression analyses. We found an inverse relationship of hemoglobin (Hb) levels with days of illness in both sites. In Manaus but not in Tumaco, red cell distribution width (RDW) was related to asexual parasitemia. Reticulocytes were higher in Plasmodium vivax infection in Tumaco. Only in Tumaco, two patients with P. falciparum infection presented with severe anemia (Hb < 7 g/dL). Etiologic factors associated with hematologic changes in malaria seem to be multifactorial. More studies are needed to clarify the anemia determinants in uncomplicated malaria in South America, where malaria transmission is mostly unstable.
Efficacy of Cryotherapy versus Intralesional Meglumine Antimoniate (Glucantime) for Treatment of Cutaneous Leishmaniasis in Children
Authors: Layegh Pouran , Pezeshkpoor Fakhrozaman , Soruri Amir Hossein , Naviafar Parisa , Moghiman Toktam
Published: September 2018

We compared intralesional glucantine and cryotherapy for treatment of children with cutaneous leishmaniasis in Iran. We observed that cryotherapy is an effective treatment for cutaneous leishmaniasis in children. No serious posttreament side effects were observed in either group. At six months of follow-up, no recurrence of disease was observed in cured patients in either group. Because of its simplicity, lower cost, low rate of serious complications, and greater tolerability, cryotherapy should be recommended as an appropriate alternative treatment for leishmaniasis in children.
Studies on the Salvador I Strain of Plasmodium vivax in Non-human Primates and Anopheline Mosquitoes
Authors: Collins William E. , Sullivan Joann S. , Strobert Elizabeth , Galland G. Gale , Williams Allison , Nace Douglas , Williams Tyrone , Barnwell John W.
Published: September 2018

A review is presented on studies conducted in New World monkeys and chimpanzees with the Salvador I strain of Plasmodium vivax. This isolate has been adapted to Aotus and Saimiri (squirrel) monkeys and developed as a model for the testing of antimalarial vaccines. After the injection of 10,000 sporozoites, the median prepatent period in S. boliviensis monkeys was 21.5 days. In 103 sporozoite-induced infections in splenectomized monkeys, the median maximum parasite count ranged from 2,139 to 202,368/μL, with a median maximum parasite count of 48,174/μL. Median maximum parasite counts in Aotus lemurinus griseimembra, A. nancymaae, A. azarae boliviensis, and A. vociferans monkeys were 19,902, 18,390, 21,420, and 18,210/μL, respectively and ranged from 124 to 156,000/μL. Mosquito infections were readily obtained in different species of Anopheles mosquitoes. The S. boliviensis monkey and Salvador I strain seems suitable for the testing of sporozoite and liver stage vaccines but not for blood-stage vaccines against P. vivax unless adapted further in spleen-intact Saimiri boliviensis monkeys.
Concurrent Detection of Trypanosoma cruzi Lineages I and II in Domestic Triatoma dimidiata from Guatemala
Authors: Pennington Pamela M. , Paiz Claudia , Grajeda Laura M. , Cordón-Rosales Celia
Published: September 2018

The agent of Chagas disease, Trypanosoma cruzi, is phylogenetically divided into two lineages, T. cruzi I (TCI) and II (TCII). TCI is found in sylvatic and domestic habitats across South America. Despite a high prevalence of TCII in domestic habitats in South America, it has been rarely found in domestic habitats in Central America and Mexico. This may be caused by limitations in detection tests previously used. A modified hemi-nested polymerase chain reaction assay was developed to improve detection of TCI and TCII mini-exon genes. This method detected TCI and II concurrently in 84% of 44 cultured isolates from Triatoma dimidiata specimens collected inside homes across the disease-endemic area in Guatemala.
Genetic Diversity of Trichomonas vaginalis Clinical Isolates Determined by EcoRI Restriction Fragment Length Polymorphism of Heat-Shock Protein 70 Genes
Authors: Meade John C. , de Mestral Jacqueline , Stiles Jonathan K. , Secor W. Evan , Finley Richard W. , Cleary John D. , Lushbaugh William B.
Published: September 2018

Restriction fragment length polymorphism (RFLP) analysis using a multilocus heat-inducible cytoplasmic heat-shock protein 70 (Hsp70) hybridization probe with EcoRI-digested genomic DNA was used in molecular typing of 129 Trichomonas vaginalis isolates. Results indicate that Trichomonas organisms exhibit considerable polymorphism in their Hsp70 RFLP patterns. Analysis of seven American Type Culture Collection reference strains and 122 clinical isolates, including 84 isolates from Jackson, Mississippi, 18 isolates from Atlanta, Georgia, and 20 isolates from throughout the United States, showed 105 distinct Hsp70 RFLP pattern subtypes for Trichomonas. Phylogenetic analysis of the Hsp70 RFLP data showed that the T. vaginalis isolates were organized into two clonal lineages. These results illustrate the substantial genomic diversity present in T. vaginalis and indicate that a large number of genetically distinct Trichomonas isolates may be responsible for human trichomoniasis in the United States.
Potential Renal Sequelae in Survivors of Hantavirus Cardiopulmonary Syndrome
Authors: Pergam Steven A. , Schmidt Darren W. , Nofchissey Robert A. , Hunt William C. , Harford Antonia H. , Goade Diane E.
Published: September 2018

Although other hantaviruses are associated with renal manifestations, hantavirus cardiopulmonary syndrome (HCPS) has not been associated with such sequelae. The HCPS survivors were prospectively evaluated for renal complications. Subjects underwent yearly evaluation, laboratory studies, and 24-hour urine collection. Thirty subjects were evaluated after recovery from HCPS with the first follow-up at a median of 7.4 months after discharge. Subjects were a wide age range (18–51) but had an equal gender composition. Eighteen of 30 (60%) returned for > 1 evaluation. Half (15/30) had a 24-hour urine collection with > 150 mg of total protein and 6 had > 300 mg. Seven had a Cockcroft-Gault creatinine clearance (CrClCG) < 90 mL/min/1.73 m2 and 2 were < 60. Fifty-three percent met the definition of chronic kidney disease. Those treated with extracorporeal membrane oxygenation had less renal sequelae (P = 0.035). Our data suggest that renal sequelae may occur in HCPS. Further study of renal complications of New World hantavirus infections are needed.
Esophageal Histoplasmosis Associated with Disseminated Tuberculosis in Acquired Immunodeficiency Syndrome
Authors: Rezende Rosamar Eulira Fontes , Brunaldi Mariângela Ottoboni , Girão Milena Santana , Zucoloto Sérgio , Garcia Sérgio Britto , Machado Alcyone Artioli , Módena José Luiz Pimenta
Published: September 2018

Bacterial and fungal infections are common in acquired immunodeficiency syndrome (AIDS). Histoplasmosis is a common fungal disease in severely immunocompromised patients infected with human immunodeficiency virus (HIV) in endemic areas. In this population the most frequent form of presentation of histoplasmosis is disseminated, with the clinical manifestations being similar to those of disseminated tuberculosis. Esophageal histoplasmosis and the association of histoplasmosis with tuberculosis are infrequent. We report here a rare case of esophageal histoplasmosis associated with disseminated tuberculosis in AIDS.
Geophagy (Soil-eating) in Relation to Anemia and Helminth Infection among HIV–Infected Pregnant Women in Tanzania
Authors: Kawai Kosuke , Saathoff Elmar , Antelman Gretchen , Msamanga Gernard , Fawzi Wafaie W.
Published: September 2018

Geophagy, the regular and deliberate consumption of soil, is prevalent among pregnant women in sub-Saharan Africa. We examined the associations of geophagy with anemia and helminth infection among 971 human immunodeficiency virus (HIV)-positive pregnant women in Tanzania. About 29% of pregnant women regularly consumed soil. Occupation, marital status, and gestational age were associated with geophagy. Ascaris lumbricoides infection was associated with the prevalence of geophagy (adjusted-prevalence ratio 1.81; 95% confidence interval [CI] = 1.37–2.40); however, hookworm, Trichuris trichiura, and Strongyloides stercoralis showed no association. Anemia and red blood cell characteristics suggestive of iron deficiency were strongly correlated with geophagy at baseline. In longitudinal analyses, we found evidence suggesting that soil consumption may be associated with an increased risk of anemia (adjusted-relative risk 1.16; 95% CI = 0.98–1.36) and a lower hemoglobin concentration (adjusted-mean difference −3.8 g/L; 95% CI [−7.3, −0.4]). Pregnant women should be informed about the potential risks associated with soil consumption.
Evaluation of Nitazoxanide and Oxfendazole Efficacy against Cystic Echinococcosis in Naturally Infected Sheep
Authors: Gavidia Cesar M. , Gonzalez Armando E. , Lopera Luis , Jayashi Cesar , Angelats Roxana , Barron Eduardo A. , Ninaquispe Berenice , Villarreal Lucia , Garcia Hector H. , Verastegui Manuela R. , Gilman Robert H.
Published: September 2018

Cystic echinococosis (CE) is a public health problem caused by Echinococcus granulosus. We aimed to determine the efficacy of nitazoxanide (NTZ) and oxfendazole (OXF) against CE in naturally infected sheep. A total of 151 ewes were assigned to the following groups: 15 mg/kg of NTZ weekly for five weeks (NTZ5); two rounds of 15 mg/ kg of NTZ a day for five days (NTZ5×2) two weeks apart; 30 mg/kg of OXF a week for 11 weeks (OXF11); 30 mg/kg of OXF plus 15 mg/kg of NTZ a week for 11 weeks (OXF/NTZ); and the control group. OXF11 and OXF/NTZ decreased the number of fertile cysts, increased the number of degenerated cysts, and were more efficacious (49.6–61.2%) against lung cysts and liver cysts (91.8–100%) than any other treatment group. OXF might be an additional strategy for control programs and an optional treatment of human CE after it is licensed.
Urine Antigen Detection for the Diagnosis of Human Neurocysticercosis
Authors: Castillo Yesenia , Rodriguez Silvia , García Hector H. , Brandt Jef , Van Hul Anke , Silva Maria , Rodriguez-Hidalgo Richar , Portocarrero Mylagritos , Melendez D. Paolo , Gonzalez Armando E. , Gilman Robert H. , Dorny Pierre , _ _
Published: September 2018

Neurocysticercosis (NCC) is a major cause of seizures and epilepsy. Diagnosis is based on brain imaging, supported by immunodiagnosis in serum or cerebrospinal fluid (CSF). Lumbar puncture is invasive and painful. Blood sampling is slightly painful and poorly accepted. Urine antigen detection has been used for other parasites and tried in NCC with suboptimal performance. We used a monoclonal antibody-based ELISA to detect Taenia solium antigens in urine from 87 Peruvian neurocysticercosis patients (viable cysts, N = 34; subarachnoid cysticercosis, N = 10; degenerating parasites, N = 7; calcified lesions, N = 36) and 32 volunteers from a non-endemic area of Peru. Overall sensitivity of urine antigen detection for viable parasites was 92%, which decreased to 62.5% in patients with a single cyst. Most patients (30/36, 83%) with only calcified cysticercosis were urine antigen negative. Antigen levels in paired serum/urine samples (evaluated in 19 patients) were strongly correlated. Non-invasive urine testing for T. solium antigens provides a useful alternative for NCC diagnosis.
First Detection and Molecular Identification of Borrelia burgdorferi-like Spirochetes in Ixodes granulatus Ticks Collected on Kinmen Island of Taiwan
Authors: Chao Li-Lian , Wu Wen-Jer , Shih Chien-Ming
Published: September 2018

Borrelia burgdorferi-like spirochetes were detected for the first time in Ixodes granulatus ticks collected in Taiwan. The genetic identities of these detected spirochetes were determined by analyzing the gene sequences amplified by a genospecies-specific polymerase chain reaction assay based on the outer surface protein A (OspA) gene of B. burgdorferi sensu lato. Phylogenetic analysis reveals that the sequence similarity of these spirochetes, ranging from 90.5% to 98.7% is highly homogeneous within the B. burgdorferi sensu stricto genospecies and clearly distinguishable from other Borrelia genospecies. These results provide the first evidence of B. burgdorferi spirochetes detected in I. granulatus ticks and confirm their genetic relationship to B. burgdorferi sensu stricto.
Aedes aegypti Immature Forms Distribution According to Type of Breeding Site
Authors: Medronho Roberto A. , Macrini Leonardo , Novellino Daniele M. , Lagrotta Marcos T. F. , Câmara Volney M. , Pedreira Carlos E.
Published: September 2018

More than 2.5 billion people, in more than 100 countries, are estimated to live in risk areas for the transmission of dengue. We investigated the production of Aedes aegypti immature forms in different types of containers. Larvae and pupae presence were inspected in 747 containers in 300 dwellings in Rio de Janeiro state, Brazil. The statistical significance of the differences of immature forms was calculated for different groups of recipients and classified according to the type of use, volume, and material. Containers used to store water and those classified as garbage enclosed 90.2% of the larvae and 88.9% of the pupae. We concluded that a wider covering of more regular water supply, as well as regular garbage collection, are decisive factors for an effective control of dengue vector.
A Community-based Case-control Study of Behavioral Factors Associated with Scrub Typhus during the Autumn Epidemic Season in South Korea
Authors: Kweon Sun-Seog , Choi Jin-Su , Lim Hyun-Sul , Kim Jang-Rak , Kim Keon-Yeop , Ryu So-Yeon , Lee So-Dam , Im Heung-Ku , Kwon Jun-Wook
Published: September 2018

A community-based, case-control study was carried out to investigate risk factors for scrub typhus in South Korea. Cases (n = 299) were defined as persons who were diagnosed serologically within the past two weeks. Two neighborhood control subjects were selected by matching for sex, age, and occupation. Taking a rest directly on the grass, working in short sleeves, working with bare hands, and squatting to defecate or urinate posed the highest risks, with adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of 1.7 (1.2–2.3), 1.6 (1.1–2.4), 1.7 (1.2–2.4), and 2.0 (1.4–2.9), respectively. Wearing a long-sleeved shirt while working, keeping work clothes off the grass, and always using a mat to rest outdoors showed protective associations, with aORs and 95% CIs of 0.5 (0.3–0.9), 0.6 (0.4–0.9), and 0.7 (0.5–0.9), respectively. These results might be useful in the establishment of a detailed control strategy for scrub typhus.
Genetic Diversity of the Malaria Vaccine Candidate Plasmodium falciparum Merozoite Surface Protein-3 in a Hypoendemic Transmission Environment
Authors: Jordan Stephen J. , Branch OraLee H. , Castro Jean Carlos , Oster Robert A. , Rayner Julian C.
Published: September 2018

The N-terminal domain of Plasmodium falciparum merozoite surface protein-3 (PfMSP3) has been excluded from malaria vaccine development largely because of genetic diversity concerns. However, no study to date has followed N-terminal diversity over time. This study describes PfMSP3 variation in a hypoendemic longitudinal cohort in the Peruvian Amazon over the 2003–2006 transmission seasons. Polymerase chain reaction was used to amplify the N-terminal domain in 630 distinct P. falciparum infections, which were allele-typed by size and also screened for sequence variation using a new high-throughput technique, denaturing high performance liquid chromatography. PfMSP3 allele frequencies fluctuated significantly over the 4-year period, but sequence variation was very limited, with only 10 mutations being identified of 630 infections screened. The sequence of the PfMSP3 N-terminal domain is relatively stable over time in this setting, and further studies of its status as a vaccine candidate are therefore warranted.
Phase I/II Evaluation of the Prophylactic Antimalarial Activity of Pafuramidine in Healthy Volunteers Challenged with Plasmodium falciparum Sporozoites
Authors: Nyunt Myaing M. , Hendrix Craig W. , Bakshi Rahul P. , Kumar Nirbhay , Shapiro Theresa A.
Published: September 2018

We evaluated the causal prophylactic antimalarial activity of a single oral dose of pafuramidine (DB289), an experimental prodrug of active metabolite DB75, in a randomized, double-blind, placebo-controlled, outpatient study. Sixteen healthy volunteers were dosed and challenged in a single cohort. Subjects were randomly assigned to one of three treatment arms: 100 mg pafuramidine eight days before challenge, 100 mg pafuramidine the day before challenge, or placebo. Challenge was by the bites of Plasmodium falciparum-infected Anopheles gambiae. Malaria developed in 15 persons but did not develop in one person in the day −8 pafuramidine treatment arm. Plasma levels of DB75 were lower than expected, and as intended were too low to provide suppressive prophylaxis at the earliest appearance of erythrocytic parasites. We conclude that a single dose of 100 mg pafuramidine does not adequately protect non-immune individuals against P. falciparum and shows no clinically or statistically significant evidence of causal prophylactic activity.
Resistance-mediating Polymorphisms in Plasmodium falciparum Infections in Kinshasa, Democratic Republic of the Congo
Authors: Mobula Linda , Lilley Bruce , Tshefu Antoinette K. , Rosenthal Philip J.
Published: September 2018

Genetic polymorphisms in Plasmodium falciparum are associated with resistance to a number of drugs, but data on their prevalence are limited from many areas. We explored the prevalence of key polymorphisms in patients presenting with malaria in Kinshasa. Prevalences of pfcrt K76T; pfmdr1 N86Y; pfdhfr N51I, C59R, and S108N; and pfdhps A437G were well above 50% and of pfmdr1 Y184F, N1042D, and D1246Y; pfdhfr I164L; and pfdhps K540E were low. These results suggest an intermediate level of resistance to aminoquinoline and antifolate antimalarials in Kinshasa compared with other areas of Africa.
Evaluation of Leishmanin Skin Test in Indian Visceral Leishmaniasis
Authors: Gidwani Kamlesh , Rai Madhukar , Chakravarty Jaya , Boelaert Marleen , Sundar Shyam
Published: September 2018

We evaluated the performance of the leishmanin skin test (LST) in 50 patients with visceral leishmaniasis (VL), 124 cured VL patients at different time intervals, 125 healthy controls from an endemic region (HEC), and 14 healthy controls from a non-endemic region (NEHC). The leishmanin antigen used was based on Leishmania major and was obtained from the Pasteur Institute (Iran). A positive LST was found in 14.0% of patients with active VL, 40.3% of cured patients, 21.6% of HECs, and 0% in NEHCs. The 14% positivity in patients with active VL conflicts with the widely held opinion that such patients should be negative because of anergy. Also, a lack of sensitivity of the LST was observed in cured VL patients. An LST antigen produced from L. donovani strains from India should be explored.
Subtype Analysis of Blastocystis Isolates from Blastocystis Cyst Excreting Patients
Authors: Rene Betangbeh A. , Stensvold Christen R. , Badsberg Jens H. , Nielsen Henrik V.
Published: September 2018

To determine the distribution of Blastocystis sp. subtypes from Blastocystis cyst excreters, 1,000 fecal samples from patients suspected of enteroparasitic disease were scored for stool consistency, submitted to xenic in vitro culture (XIVC), formol ethyl acetate concentration (FECT) with subsequent isopycnic centrifugation, and polymerase chain reaction (PCR) with subtype (ST) analysis. Blastocystis was significantly more prevalent in specimens from patients with travel-associated diarrhea (15.6%) than those with persistent diarrhea (8.3%) (P = 0.005). Overall, 115 (11.5%) and 35 (3.5%) specimens were positive by XIVC and FECT, respectively. Blastocystis cysts were detected in 33 (28.7%) of the XIVC-positive specimens. A positive FECT result was associated with ST3 (P = 0.05). The presence of Blastocystis in general or Blastocystis cysts was independent of stool consistency, and no particular ST was significantly associated with cyst identification. In view of these data, the present study indicates that Blastocystis cyst formation is independent of Blastocystis sp. subtype and gastrointestinal transit time.
Epidemiology and Risk Factors for Serogroup X Meningococcal Meningitis during an Outbreak in Western Kenya, 2005–2006
Authors: Mutonga David M. , Pimentel Guillermo , Muindi Judith , Nzioka Charles , Mutiso Julius , Klena John D. , Morcos Myriam , Ogaro Thomas , Materu Sadiki , Tetteh Christopher , Messonnier Nancy E. , Breiman Robert F. , Feikin Daniel R.
Published: September 2018

The epidemiology of serogroup X meningococcal meningitis in Africa is unknown. During a serogroup X meningococcus outbreak in Kenya, case finding involved record review at health facilities and interviews with health workers and community leaders in West Pokot district. An age- and location-matched case-control study for risk factors was done. From December 2005 to April 2006, 82 suspect cases of meningitis were reported; the epidemic threshold was surpassed within two administrative divisions. Most (58%) cases were 5–24 years old; the case-fatality ratio was 21%. Serogroup X meningococcus was the most common serogroup – 5 (63%) of eight isolates serogrouped. Living in the same compound as another case, preceding upper respiratory tract infection and cooking outside the house were significant risk factors for disease. Serogroup X meningococcus caused an outbreak with similar epidemiology and risk factors as other serogroups. Serogroup-specific laboratory-based surveillance for meningococcus in Africa to detect serogroup X disease should be enhanced.
Serial Testing of Refugees for Latent Tuberculosis Using the QuantiFERON-Gold In-Tube: Effects of an Antecedent Tuberculin Skin Test
Authors: Baker Cristina A. , Thomas William , Stauffer William M. , Peterson Phillip K. , Tsukayama Dean T.
Published: September 2018

Screening for latent tuberculosis infection (LTBI) in refugee populations immigrating to low-incidence countries remains a challenge. We assessed the characteristics of the QuantiFERON-Gold In-Tube (QFT-GIT) compared with the tuberculin skin test (TST) in 198 refugees of all ages from tuberculosis-endemic countries. Diagnostic agreement between the first QFT-GIT and simultaneous TST was 78% (κ = 0.56) and between serial QFT-GITs was 89% (κ = 0.76). In serial QFT-GIT testing, 70% of subjects had an increased QFT-GIT value, perhaps the result of an antecedent TST in the setting of previous TB exposure. This boosting seemed to become less prevalent with time from TST and occurred less frequently in those with negative first QFT-GIT readings. Despite small changes in the quantitative results caused by nonspecific variation and boosting, the diagnostic result of the QFT-GIT was reliable. The QFT-GIT shows the potential to replace the TST for LTBI screening in refugees from tuberculosis-endemic areas.
Distribution and Abundance of Host-seeking Culex Species at Three Proximate Locations with Different Levels of West Nile Virus Activity
Authors: Rochlin Ilia , Ginsberg Howard S. , Campbell Scott R.
Published: September 2018

Culex species were monitored at three proximate sites with historically different West Nile virus (WNV) activities. The site with human WNV transmission (epidemic) had the lowest abundance of the putative bridge vectors, Culex pipiens and Cx. salinarius. The site with horse cases but not human cases (epizootic) had the highest percent composition of Cx. salinarius, whereas the site with WNV-positive birds only (enzootic) had the highest Cx. pipiens abundance and percent composition. A total of 29 WNV-positive Culex pools were collected at the enzootic site, 17 at the epidemic site, and 14 at the epizootic site. Published models of human risk using Cx. pipiens and Cx. salinarius as the primary bridge vectors did not explain WNV activity at our sites. Other variables, such as additional vector species, environmental components, and socioeconomic factors, need to be examined to explain the observed patterns of WNV epidemic activity.
Impact of HAART Therapy on Co-Infection of Tuberculosis and HIV Cases for 9 Years in Taiwan
Authors: Tseng Shu-Hui , Jiang Donald Dah-Shyong , Hoi Hao-Seong , Yang Shiang-Lin , Hwang Kao-Pin
Published: September 2018

Free highly active antiretroviral therapy (HAART) was made available by The Department of Health since April 1997. As a result, the incidence rate of tuberculosis (TB)/human immunodeficiency virus (HIV) co-infection among HIV cases rose from 1.90% to 3.82% during 1993 to 1998 and decreased from 3.82% to 0.94% during 1998 to 2006. The incidence rate of TB/HIV co-infection among HIV cases reached its peak in 1998 and then started to reverse, although the next year the TB disease burden (incidence rate: 62.7 cases per 100,000 persons) remained consistently high, and this continued in the following years. The survival rate of TB/HIV co-infection cases was 62.16% during the period 1993–1996 (pre-free HAART era) and increased to 86.60% during the period 1998–2006 (P < 0.0001) (post-free HAART era). Highly active antiretroviral therapy decreased the incidence rate of new TB/HIV co-infection cases among HIV cases and increased the survival rate of TB/HIV co-infection cases.