bluuebunny/crossref_metadata_2025 huggingface dataset:
Heart Rate–corrected QT Interval Duration in Rheumatoid Arthritis and Its Reduction with Treatment with the Interleukin 6 Inhibitor Tocilizumab
Authors: Kobayashi Hitomi , Kobayashi Yasuyuki , Yokoe Isamu , Kitamura Noboru , Nishiwaki Atsuma , Takei Masami , Giles Jon T.
Published: September 2018

Objective.

Individuals with rheumatoid arthritis (RA) are at a heightened risk of sudden cardiac death, an outcome increased in those with prolongation of the corrected electrocardiographic QT interval (QTc). We compared QTc between patients with RA and demographically matched controls and studied the change in QTc after treatment with the interleukin 6 inhibitor tocilizumab (TCZ).

Methods.

Standard 12-lead electrocardiograms were obtained and QTc was measured in patients with RA at baseline and after 24 weeks of TCZ treatment, then compared with non-RA controls who were frequency-matched on age and sex. Indicators of the baseline QTc and predictors of change in QTc were studied using multivariable linear regression.

Results.

A total of 94 RA and 42 non-RA controls were studied. The average baseline QTc was 10 ms longer in the RA group vs controls (422 vs 412 ms, respectively; p < 0.001) and decreased to an average of 406 ms with treatment (p < 0.001). Baseline QTc was significantly and independently higher among those with anticyclic citrullinated peptide antibodies seropositivity, higher swollen joint counts, and higher levels of C-reactive protein (CRP) and matrix metalloproteinase 3. Each log unit decrease in CRP with treatment was associated with an average reduction in QTc of 2.9 ms (p = 0.002) after adjusting for age and baseline QTc. Clinical response measures were not associated with the change in QTc.

Conclusion.

The marked normalization of QTc observed with TCZ treatment, and its close parallel with CRP reduction, support the premise that systemic inflammation contributes to cardiac repolarization abnormalities in RA that may be amenable to treatment.
INSEMINAÇÃO ARTIFICIAL A FRESCO EM UMA FÊMEA BULLDOG INGLÊS: RELATO DE CASO
Authors: Olsson Débora Cristina
Published: September 2018

Este relato de caso teve como objetivo descrever uma técnica de inseminação artificial modificada, em uma fêmea Bulldog Inglês, utilizando e método de inseminação artificial vaginal a fresco. Após detecção do cio, por citologia vaginal, com células superficiais acima de 80%, utilizou-se cerca de 5ml de sêmen a fresco, colhido por método de estimulação manual, com uma seringa estéril de 10ml. Os membros pélvicos da fêmea foram elevados dorsalmente e através de uma pipeta comercial, o sêmen foi introduzido na região do vestíbulo vaginal. A técnica foi repetida três vezes e decorrido 27 dias do início do protocolo, detectou-se por exame ultrassonográfico a imagem sugestiva de cinco fetos viáveis. Concluiu-se que a técnica descrita utilizando sêmen a fresco é de fácil aplicabilidade e alta viabilidade
HIPERINSULINISMO ASSOCIADO A NEOPLASIA DE CÉLULAS BETA DO PÂNCREAS
Authors: Oliveira silva Caio vitor , Dos Santos Renato Lobo , Soares Francisco Wander , Almeida Jorge Walker Augusto , Peixoto Tainara Micaele Bezerra , Correia costa Paula Priscila
Published: September 2018

O hiperinsulinismo é uma patologia associada a presença de neoplasias nas células Beta do pancreas.Sendo essas celulas as reponsaveis pela secreção da insulina, hormônio cujo mecanismo de ação está relacionado com o aumento da atividade da enzima hexoquinase, facilitando a utilização da glicose pelos tecidos.A neoplasia das celulas beta é conhecida por insulinoma,sendo raros tomores secretores de insulina.Existe poucos relatos de caso em gatos,sendo mais prevalente em cães com idade ente 6 e 14 anos.Os pricipais sinais clinicos estão relacionados ao baixo aporte de glicose para o sistema nervoso central.Os perfis bioquímicos, hematológicos e análise de urina não fecham diagnóstico de Insulinoma,sendo a ecografia abdominal o exame confirmatório para diagnostico.O tratamento deve ser efetivo no controle dos sinais clínicos do paciente, estabilizando o cão para se realizar a cirurgia posteriormente.
INCIDÊNCIA DE MEDICAÇÃO SEM PRESCRIÇÃO EM UM HOSPITAL VETERINÁRIO NA CIDADE DE UMUARAMA, PARANÁ, NO PERÍODO ENTRE 2011 E 2015
Authors: Benedito Geovanna Santana , Albuquerque Ana Paula Lourenção , Taffarel Marilda Onghero , Bastos-Pereira Amanda Leite
Published: September 2018

A automedicação é um termo que provêm do uso de medicamentos sem prescrição médica, em humanos. Em Medicina Veterinária, utiliza-se o mesmo termo, por analogia, quando o proprietário ou cuidador administra fármacos no animal sem a prévia consulta e prescrição médico-veterinária. Tendo como objetivo fornecer informações a respeito do uso indiscriminado de fármacos na Medicina Veterinária, especialmente a medicação sem prescrição, elaborou-se esse estudo retrospectivo. Nele, foram avaliadas fichas clínicas do setor de atendimento de pequenos e grandes animais entre 2011 e 2015, no Hospital Veterinário da Universidade Estadual de Maringá – UEM, campus Umuarama. No setor de grandes animais, havia informação a respeito de medicações prévias em 65 de 323 prontuários avaliados. Em 54(83%) deles, houve administração de medicamento previamente à consulta. A espécie em que mais ocorreu essa ação foi na equina. As principais classes de medicamentos utilizados em grandes animais foram anti-inflamatórios não-esteroidais (AINEs) e antibióticos, fármacos que exigem supervisão profissional durante o seu uso. No setor de cães e gatos foram avaliadas 2908 fichas clínicas, onde havia menção sobre medicações em 1391 dos prontuários analisados. Desses, 823 (59% das 1391 fichas) houve administração de algum medicamento previamente à consulta. As classes de fármacos mais citadas também foram AINEs e antibióticos, seguidas por fármacos que atuam no trato gastrointestinal, antiparasitários, anti-inflamatórios esteroidais, outros hormônios, vitaminas e suplementos. Dessa forma, a administração de drogas sem prescrição profissional é uma realidade comprovada na Medicina Veterinária, sendo ponto importante a ser considerado no atendimento, já que pode ser determinante para o sucesso do tratamento.
AFECÇÕES DA PRÓSTATA CANINA E SEUS PRINCIPAIS DIAGNÓSTICOS
Authors: Vasques Gabriela Maria Benedetti , Romani Isaac , Mattosinho Rodrigo De Oliveira , Fiorato Camila André , De Almeida Letícia Maria , Machado Marco Antonio
Published: September 2018

A próstata é a única glândula sexual em cães, tendo fundamental importância para a manutenção do fluido seminal, além de anatomicamente, estar intimamente ligada a uretra prostática, onde os ductos ejaculatórios desembocam. As prostatopatias representam uma incidência baixa na rotina clínica, mas quando presentes possuem sintomas inespecíficos e necessitam de exames complementares para seu diagnóstico. A principal afecção prostática é a hiperplasia prostática benigna, estando presente na maioria de cães adultos inteiros, sintomáticos ou não. A prostatite e os cistos prostáticos referem menor prevalência dentre as prostatopatias, mas possuem grande importância clínica, principalmente pelos seus sinais clínicos sistêmicos. As neoplasias referem-se à forma mais severa de afecção, sendo que a mais comum é o adenocarcinoma, que possui alto índice de metástase. Os biomarcadores de próstata são semelhantes aos dos homens, porém sua identificação em cães ainda é restrita, principalmente pela falta de conhecimento de suas reais funções. O CPSE é um marcador promissor, pois há estudos recentes que o relacionam a detecção precoce de neoplasia prostática. O exame ultrassonográfico é uma técnica diagnóstica pouco invasiva e que fornece informações importantes sobre a anatomia, tamanho e comprometimento prostático. O trabalho objetiva descrever as prostatopatias e principais métodos diagnósticos para estas afecções. Pela análise da literatura conclui-se que a hiperplasia prostática é a afecção prostática mais comum, a CPSE é a principal glicoproteína para diagnóstico de hiperplasia e neoplasia, e o exame ultrassonográfico o método diagnóstico menos invasivo para determinar o tamanho e comprometimento prostático.
OSTEOTOMIA DE NIVELAMENTO DO PLATÔ TIBIAL PARA O TRATAMENTO DA RUPTURA BILATERAL DO LIGAMENTO CRUZADO CRANIAL EM CÃO: RELATO DE CASO
Authors: Salme Deryck Picioneri , CURTI CARLOS EVERTON , CURTI MURILO CEZAR , FUCK EGON JOSÉ , FUCK ELIANE THOMACELLI , SALAMÃO ANA PAULA , NASCIMENTO GABRIELA , GARCIA FILHO SÉRGIO PINTER
Published: September 2018

A Ruptura do ligamento cruzado cranial (RLCCr) é uma das enfermidades articulares mais comuns no cão e diversas são as técnicas cirúrgicas utilizadas para correção de sua instabilidade, porém nenhuma delas impede o desenvolvimento da doença articular degenerativa (DAD). Entretanto deve-se promover a estabilidade articular, garantindo qualidade de vida ao animal. A osteotomia de nivelamento do platô tibial (TPLO) é umas das técnicas mais utilizadas na atualidade e tem demonstrado melhores resultados quanto ao retorno funcional nos animais submetidos a este procedimento. O objetivo deste trabalho é avaliar o resultado da técnica de osteotomia de nivelamento do platô da tíbia (TPLO) em um cão com RLCCr bilateral.
NANISMO EM GATO ASSOCIADO À ADENOMATOSE FOLICULAR TIREOIDIANA
Authors: Silva Alisson Paulo , Gomes Lorenna Alves , Souza Bianca Moreira , Teixeira Myrian Kátia Iser , Silva Cristiano Rodrigo Nicomedes , Reis Amanda Maria Sena , Oliveira Karina Pessoa , Serakides Rogéria , Ocarino Natalia De Melo
Published: September 2018

O trabalho descreve os achados anatomo-histopatológicos e radiológicos do esqueleto de um gato com nanismo associado à adenomatose folicular tireoidiana. Uma gata de 40 dias com pequena estatura e pesando 100g foi encaminhada para a necropsia com histórico de crescimento ósseo severamente reduzido e suspeita de nanismo. Na necropsia, os ossos de todo o esqueleto eram curtos e frágeis. No RX, os ossos longos apresentaram epífises radioluscentes. Microscopicamente, foram observadas características de osteoporose e interrupção do crescimento endocondral, intramembranoso e aposicional, caracterizando o nanismo proporcional. A tireoide apresentava folículos predominantemente pequenos revestidos por células cuboidais e com uma pequena quantidade de colóide. Entre os folículos, havia grande quantidade de células foliculares sem formação de lúmen como característica da adenomatose interfolicular. Com base nos achados macro e microscópicos, o diagnóstico de nanismo proporcional associado à adenomatose folicular tireoidiana foi confirmado.
CARACTERÍSTICAS EPIDEMIOLÓGICAS DE ACIDENTES POR MORDEDURAS DE ANIMAIS NO MUNICÍPIO DE INDAIAL – SC.
Authors: Cardoso Edgar , Andriani Camila , Hachmann Leticia , Catafesta Barbara , Venzon Julye Camila
Published: September 2018

Objetivo: Levantar as características epidemiológicas de pacientes que sofreram agravos por animais no município de Indaial – SC, entre janeiro de 1994 a dezembro de 2016. Métodos: Pesquisa documental retrospectiva com dados fornecidos pela Vigilância Epidemiológica de Indaial com base nas fichas epidemiológicas do SINAN. Resultados: foram avaliadas 2.130 fichas, onde 51.17% das vítimas dos agravos eram do sexo masculino e 86.29% foram causadas por cães. O agravo teve como característica ser único e superficial. Os membros inferiores foram acometidos com maior frequência. A faixa etária com maior incidência foi de 0 a 9 anos, seguida da população acima de 80 anos. A medida adotada para 55.12% dos casos foi a observação do animal. Conclusão: Indaial comporta-se como as demais cidades do país, destaca-se a importância da determinação da taxa de incidência onde pode-se verificar a alta taxa de agravos em idosos acima de 80 anos.
THE EFFICACY OF PERMETHRIN-TREATED BED NETS ON CHILD MORTALITY AND MORBIDITY IN WESTERN KENYA II. STUDY DESIGN AND METHODS
Authors: PHILLIPS-HOWARD PENELOPE A. , TER KUILE FEIKO O. , NAHLEN BERNARD L. , ALAII JANE A. , GIMNIG JOHN E. , KOLCZAK MARGARETTE S. , TERLOUW DIANNE J. , KARIUKI SIMON K. , SHI YA PING , KACHUR S. PATRICK , HIGHTOWER ALLEN W. , VULULE JOHN M. , HAWLEY WILLIAM A.
Published: September 2018

This paper describes the study design and methods used in a large community-based, group-randomized, controlled trial of permethrin-treated bed nets (ITNs) in an area with intense, perennial malaria transmission in western Kenya conducted between 1996 and 1999. A multi-disciplinary framework was used to explore the efficacy of ITNs in the reduction of all-cause mortality in children less than five years old, the clinical, entomologic, immunologic, and economic impact of ITNs, the social and behavioral determinants of ITN use, and the use of a geographic information system to allow for spatial analyses of these outcomes. Methodologic difficulties encountered in such large-scale field trials are discussed.
COMMUNITY REACTIONS TO THE INTRODUCTION OF PERMETHRIN-TREATED BED NETS FOR MALARIA CONTROL DURING A RANDOMIZED CONTROLLED TRIAL IN WESTERN KENYA
Authors: ALAII JANE A. , VAN DEN BORNE H. W. , KACHUR S. PATRICK , SHELLEY KAREN , MWENESI HALIMA , VULULE JOHN M. , HAWLEY WILLIAM A. , NAHLEN BERNARD L. , PHILLIPS-HOWARD PENELOPE A.
Published: September 2018

Prior to implementation of a randomized controlled trial of insecticide (permethrin)-treated bed nets (ITNs) in western Kenya, ethnographic studies were conducted to understand local perceptions of disease, sleeping patterns, and other factors that might affect use of ITNs. Educational activities took place prior to distribution, but immediately after distribution in Asembo only approximately half of the ITNs were in use. A qualitative study was then conducted to identify the community’s perceptions about ITNs and the ITN project. While participants ranked malaria as important and recognized that malaria prevention could be beneficial, they believed ITNs would be only partly effective due to the perception that malaria has multiple causes. Concerns expressed included fear of the insecticide, thought by some to be a toxic family planning aid, the taking of blood during clinical studies, and the mixing up of family ITNs during net re-treatment, which would violate cultural taboos. Attempts were made to allay fears by improved communication on these subjects and modification of the study design.
FACTORS AFFECTING USE OF PERMETHRIN-TREATED BED NETS DURING A RANDOMIZED CONTROLLED TRIAL IN WESTERN KENYA
Authors: ALAII JANE A. , HAWLEY WILLIAM A. , KOLCZAK MARGARETTE S. , TER KUILE FEIKO O. , GIMNIG JOHN E. , VULULE JOHN M. , ODHACHA AMOS , OLOO AGGREY J. , NAHLEN BERNARD L. , PHILLIPS-HOWARD PENELOPE A.
Published: September 2018

Adherence with permethrin-treated bed net (ITN) use and their proper deployment was directly observed in 2,178 individuals (784 households) participating in a large-scale trial of ITNs on child mortality in western Kenya. The ITNs were distributed free of charge to ensure high coverage, resulting in a ratio of 1.46 persons per ITN. Approximately 30% of ITNs present were unused. The overall percentage adherence was 72.3%. The probability of adherence by individuals depended strongly on age (relative risk [RR] = 0.86, 95% confidence limit [CL] − 0.78–0.94), in which children less than five years of age were less likely to use ITNs than older individuals, and temperature, in which ITNs were more likely to be used in periods of cooler weather. A marginally significant diminution in adherence during the second year of the project was also observed (RR = 0.83, 95% CL = 0.68–1.01). Mosquito numbers, relative wealth, number of house occupants, and the educational level of the head of the household had no effect on adherence. In unstructured questioning of house residents, excessive heat was often cited as a reason for not deploying the child’s ITN. The most important reason for non-adherence was disruption of sleeping arrangements, indicating that ITNs were not readily redeployed in the face of shifting sleeping patterns due to visitors, funerals, house construction, and other events. Challenges faced by health education programs to maximize adherence with ITN use are discussed.
DRUG-RESISTANT MALARIA IN BANGLADESH: AN IN VITRO ASSESSMENT
Authors: NOEDL H. , FAIZ M. A. , YUNUS E. B. , RAHMAN M. R. , HOSSAIN M. A. , SAMAD R. , MILLER R. S. , PANG L. W. , WONGSRICHANALAI C.
Published: September 2018

Forty-four Plasmodium falciparum isolates from Bangladesh and 22 from western Thailand were successfully tested for their drug susceptibility. High degrees of resistance were observed against chloroquine with geometric mean IC50s of 114.25 120.5 nM, respectively, for Bangladesh and western Thailand. Most isolates from both sites were sensitive to quinine, and all were sensitive to artesunate. Many isolates were considered in vitro resistant to mefloquine, but the geometric mean IC50 for the Thai isolates (98.79 nM) was 1.6 times (P = 0.002) higher than that of isolates from Bangladesh (60.3 nM). The high prevalence of in vitro mefloquine resistance in Bangladesh suggests that close surveillance is necessary to delay widespread multidrug resistant problems in the area.
CASE REPORT: AN UNUSUAL LATE RELAPSE OF PLASMODIUM VIVAX MALARIA
Authors: MANGONI EMANUELE DURANTE , SEVERINI CARLO , MENEGON MICHELA , ROMI ROBERTO , RUGGIERO GIUSEPPE , MAJORI GIANCARLO
Published: September 2018

We observed an unusual case of Plasmodium vivax malaria who presented with an initial relapse four years after the primary infection. This occurred in Cameroon, where the patient, a 56-year-old priest, acquired a mild form of malaria and was treated with only chloroquine. Since he returned to Italy, he had not experienced any malaria-like symptoms, had not visited any other areas endemic for malaria, and had not received a blood transfusion. Blood smear microscopy confirmed the presence of Plasmodium spp. parasites, but unclear morphologic characteristics did not allow discrimination between P. vivax and P. ovale. A nested polymerase chain reaction-based molecular analysis identified P. vivax as the plasmodial species responsible. This case emphasizes the importance of taking into account the possibility of a very late initial relapse of P. vivax malaria and the relevant issues in terms of infection control.
IMPACT OF PERMETHRIN-TREATED BED NETS ON ENTOMOLOGIC INDICES IN AN AREA OF INTENSE YEAR-ROUND MALARIA TRANSMISSION
Authors: GIMNIG JOHN E. , VULULE JOHN M. , LO TERRENCE Q. , KAMAU LUNA , KOLCZAK MARGARETTE S. , PHILLIPS-HOWARD PENELOPE A. , MATHENGE EVAN M. , TER KUILE FEIKO O. , NAHLEN BERNARD L. , HIGHTOWER ALLEN W. , HAWLEY WILLIAM A.
Published: September 2018

The effect of permethrin-treated bed nets (ITNs) on malaria vectors was studied as part of a large-scale, randomized, controlled trial in western Kenya. Indoor resting densities of fed Anopheles gambiae s.l. and An. funestus in intervention houses were 58.5% (P = 0.010) and 94.5% (P = 0.001) lower, respectively, compared with control houses. The sporozoite infection rate in An. gambiae s.l. was 0.8% in intervention areas compared with 3.4% (P = 0.026) in control areas, while the sporozoite infection rates in An. funestus were not significantly different between the two areas. We estimated the overall transmission of Plasmodium falciparum in intervention areas to be 90% lower than in control areas. Permethrin resistance was not detected during the study period. As measured by densities of An. gambiae s.l., the efficacy of bed nets decreased if one or more residents did not sleep under a net or if bed nets had not been re-treated within six months. These results indicate that ITNs are optimally effective if used every night and if permethrin is reapplied at least biannually.
HUMAN GENETIC POLYMORPHISMS AND ASYMPTOMATIC PLASMODIUM FALCIPARUM MALARIA IN GABONESE SCHOOLCHILDREN
Authors: MOMBO LANDRY-ERIK , NTOUMI FRANCINE , BISSEYE CYRILLE , OSSARI SIMON , LU CHANG YONG , NAGEL RONALD L. , KRISHNAMOORTHY RAJAGOPAL
Published: September 2018

Several studies have focused their attention on the relationship between host genetic factors and susceptibility/resistance to severe malaria. However, there is a paucity of information concerning the role of host genetic factors in asymptomatic malaria, a form of low-grade Plasmodium falciparum infection without clinical symptoms. We investigated in this study the potential relationship between the host (human) genetic polymorphisms (glucose-6-phosphate dehydrogenase [G6PD], mannose binding lectin [MBL], tumor necrosis factor α [TNF α]−308 and −238, and nitric oxide synthase 2 [NOS2]−954) and the prevalence and profile of asymptomatic P. falciparum infection in 158 Gabonese schoolchildren. We found that G6PD A− heterozygous females (18 of 74) have a low prevalence of asymptomatic malaria (38.9% versus 67.3%; P = 0.03, by chi-square test). Children heterozygous for TNFα −238 (25 of 156) carry high number of diverse infecting parasite genotypes (2.5 versus 1.99; variance F = 3.05). No statistically significant association was found between MBL, TNF α −308, or NOS2 polymorphisms and asymptomatic malaria. Upon combining our data on asymptomatic forms with those from the literature for others forms, we conclude that G6PD A− heterozygous females are protected against all forms of P. falciparum malaria, and that the TNF α −238A allele confers protection against clinical malaria.
HYPERENDEMIC HUMAN AND PORCINE TAENIA SOLIUM INFECTION IN PERÚ
Authors: GARCÍA HÉCTOR H. , GILMAN ROBERT H. , GONZALEZ ARMANDO E. , VERASTEGUI MANUELA , RODRIGUEZ SILVIA , GAVIDIA CESAR , TSANG VICTOR C. W. , FALCON NESTOR , LESCANO ANDRES G. , MOULTON LAWRENCE H. , BERNAL TERESA , TOVAR MARCO , _ _
Published: September 2018

The prevalence and characteristics of human taeniasis/cysticercosis and porcine cysticercosis were assessed in an endemic area of the Peruvian highlands. Individuals from 10 communities had stool examinations (N = 2,951) and serologic testing for Taenia solium antibodies (N = 2,583). The total porcine population present (N = 703) was also examined by serology. Cysticercosis is hyperendemic in this area and is associated with an important number of seizure cases. Human seroprevalence by village ranged from 7.1–26.9% (mean, 13.9%). Seroprevalence was higher among individuals with a history of seizures but not in those reporting a history of headache or intestinal taeniasis. Prevalence of taeniasis ranged from 0–6.7% (median, 2.5%). Coproantigen detection found 2.4 times more taeniasis cases than did microscopy (direct and after concentration). Age distribution for taeniasis showed a peak at younger ages than for seroprevalence. Porcine seroprevalence ranged from 42–75%. Random effects logistic regression models for human seropositivity demonstrated both in-house clustering of cases and a large increase in risk associated with a tapeworm carrier in the house. Besides confirming the close relationship between taeniasis and cysticercosis cases, this large-scale field study demonstrated early age of tapeworm and cysticercosis infections in humans, and short duration of taeniasis infections.
SIMILAR DIAGNOSTIC PERFORMANCE FOR NEUROCYSTICERCOSIS OF THREE GLYCOPROTEIN PREPARATIONS FROM TAENIA SOLIUM METACESTODES
Authors: VILLOTA GUIDO E. , GOMEZ DIANA I. , VOLCY MICHEL , FRANCO ANDRÉS F. , CARDONA EDGAR A. , ISAZA RODRIGO , SANZÓN FERNANDO , TEALE JUDY M. , RESTREPO BLANCA I.
Published: September 2018

The detection of antibodies to Taenia solium metacestodes is very important in the differential diagnosis of neurocysticercosis (NCC). In this study, an electroimmunotransfer blot (EITB) assay that uses an elaborate protocol with metacestode glycoproteins as antigens was compared with two other Western blots that use glycoproteins obtained using simpler methods, including an eluate from a lectin column, or the vesicular fluid (VF) of the parasite. The concordance between the three assays was 91% in patients with active NCC and 100% in patients with suspected NCC and previous documentation of negative serology. The specificities for the Western blots and the EITB assay were 98% and 100%, respectively (98% concordance). These data suggest that the simplest of these immunoassays, the one that uses the VF of T. solium metacestodes in a Western blot format, can be reliably used for the serologic diagnosis of NCC in developing countries where access to the EITB assay is difficult.
THE EFFICACY OF PERMETHRIN-TREATED BED NETS ON CHILD MORTALITY AND MORBIDITY IN WESTERN KENYA I. DEVELOPMENT OF INFRASTRUCTURE AND DESCRIPTION OF STUDY SITE
Authors: PHILLIPS-HOWARD PENELOPE A. , NAHLEN BERNARD L. , ALAII JANE A. , TER KUILE FEIKO O. , GIMNIG JOHN E. , TERLOUW DIANNE J. , KACHUR S. PATRICK , HIGHTOWER ALLEN W. , LAL ALTAF A. , SCHOUTE ERIK , OLOO AGGREY J. , HAWLEY WILLIAM A.
Published: September 2018

Randomized controlled trials in sub-Saharan Africa have shown that permethrin-treated bed nets and curtains reduce all-cause child mortality by 15–33% in areas with low or high but seasonal malaria transmission. This report describes the study site for a community-based, group-randomized, controlled trial in an area of high and year-round malaria transmission in western Kenya. We outline the development of the human and physical infrastructure required to conduct this trial and discuss some of the difficulties encountered and lessons learned in conducting it.
PREVALENCE AND PATHOGENIC ROLE OF CYCLOSPORA CAYETANENSIS IN A VENEZUELAN COMMUNITY
Authors: CHACIN-BONILLA LEONOR , DE YOUNG MARGOT MEJIA , ESTEVEZ JESUS
Published: September 2018

The prevalence and pathogenic role of Cyclospora cayetanensis among 212 subjects (age range = two months to 70 years) in an impoverished community in Venezuela were assessed retrospectively. For identification of the coccidium, modified Ziehl-Neelsen carbolfuchsin staining of formalin-ether concentrates was used. For other pathogenic parasites, iron-hematoxylin-stained smears and formalin-ether concentrates were examined. Cyclospora infections were identified in 13 (6.1%) subjects with a high percentage of asymptomatic carriers (11 of 13, 84.6%). Only two (15.4%) infants had diarrhea and the coccidium as the single detectable pathogenic parasite. The findings suggest that Cyclospora infections are relatively common and often asymptomatic in this region.
NEW HAPLOTYPES OF THE PLASMODIUM FALCIPARUM CHLOROQUINE RESISTANCE TRANSPORTER (PFCRT) GENE AMONG CHLOROQUINE-RESISTANT PARASITE ISOLATES
Authors: NAGESHA HADYA S. , CASEY GERARD J. , RIECKMANN KARL H. , FRYAUFF DAVID J. , LAKSANA BUDI S. , REEDER JOHN C. , MAGUIRE JASON D. , BAIRD J. KEVIN
Published: September 2018

Mutations in the Plasmodium falciparum chloroquine resistance transporter (pfcrt) gene were examined to assess their associations with chloroquine resistance in clinical samples from Armopa (Papua) and Papua New Guinea. In Papua, two of the five pfcrt haplotypes found were new: SVIET from Armopa and CVIKT from an isolate in Timika. There was also a strong association (P < 0.0001) between the pfcrt 76T allele and chloroquine resistance in 50 samples. In Papua New Guinea, mutations in the pfcrt gene were observed in 15 isolates with chloroquine minimum inhibitory concentrations (MICs) of 16–64 pmol, while the remaining six isolates, which had a wild-type pfcrt gene at codon 76, had MICs of 2–8 pmol. These observations confirm that mutations at codon 76 in the pfcrt gene are present in both in vivo and in vitro cases of chloroquine resistance, and that detection of the pfcrt 76T allele could predict potential chloroquine treatment failures.
SHORT REPORT: HUMAN INFECTION WITH TRICHINELLA BRITOVI IN GRANADA, SPAIN
Authors: GOMEZ-GARCIA V. , HERNANDEZ-QUERO J. , RODRIGUEZ-OSORIO M.
Published: September 2018

An outbreak of trichinellosis caused by ingestion of pork infected with Trichinella britovi occurred in the province of Granada in southern Spain in April–May 2000. Thirty-eight people were affected and 15 of them were hospitalized at the University Hospital of San Cecilio (Granada). The probable source of infection was sausage made from uninspected wild boar meat and inspected pork. Ninety-two percent of the patients had myalgias, 47.6% had diarrhea and/or vomited, 78.6% had periorbital edema, and 76.0% had fever. Twenty-two patients (15 hospitalized and 7 nonhospitalized) were serologically studied. Eosinophil levels were less than 5% of the total leukocyte count in 86.7% of the patients. Levels of creatinine phosphokinase (range = 200–2,213 U/L) and lactate dehydrogenase (range = 560–7,558 U/L) were elevated in 85.7% and 78.6% of the patients, respectively. Sixteen (72.7%) and 20 (90.9%) patients were positive for T. britovi by indirect immunofluorescence and Western blot, respectively.
SEROLOGIC EVIDENCE OF INFECTION WITH EHRLICHIAE AND SPOTTED FEVER GROUP RICKETTSIAE AMONG RESIDENTS OF GAG ISLAND, INDONESIA
Authors: RICHARDS ALLEN L. , RATIWAYANTO SUTANTI , RAHARDJO EKO , KELLY DARYL J. , DASCH GREGORY A. , FRYAUFF DAVID J. , BANGS MICHAEL J.
Published: September 2018

The causative agents of scrub and murine typhus are considered endemic to Indonesia. However, the presence of spotted fever group rickettsiae and ehrlichiae have not been previously described in this country. During an investigation of arthropod-borne diseases on Gag Island, located northwest of the island of New Guinea in eastern Indonesia, the prevalence of antibody to the etiologic agents of monocytic ehrlichiosis, spotted fever rickettsiosis, and scrub and murine typhus were determined. Analysis of 55 blood samples from residents of Gag Island showed serore-activity to antigen preparations of Ehrlichia chaffeensis (7 of 48, 14.6%), two spotted fever group rickettsiae: Rickettsia rickettsii (5 of 48, 10.4%) and R. conorii (10 of 49, 20.4%), Orientia tsutsugamushi (5 of 53, 9.4%), and R. typhi (1 of 48, 2.1% [by an indirect immunofluorescence assay] and 1 of 50, 2.0% [by an enzyme-linked immunosorbent assay]). These results show serologic evidence of infection with ehrlichiae and spotted fever group rickettsiae for the first time in Indonesia in a location where the prevalence of antibody to O. tsutsugamushi and R. typhi was lower.
TRANSMISSION OF EASTERN EQUINE ENCEPHALOMYELITIS VIRUS IN CENTRAL ALABAMA
Authors: CUPP EDDIE W. , KLINGLER KIMBERLY , HASSAN HASSAN K. , VIGUERS LESLIE M. , UNNASCH THOMAS R.
Published: September 2018

A site near Tuskegee, Alabama was examined for vector activity of eastern equine encephalomyelitis (EEE) virus in 2001. More than 23,000 mosquitoes representing 8 genera and 34 species were collected during a 21-week period, and five species, Culiseta melanura, Aedes vexans, Coquillettidia perturbans, Culex erraticus, and Uranotaenia sapphirina, were examined for the presence of virus using a nested reverse transcriptase–polymerase chain reaction for EEE virus. Each species was infected at various times of the mosquito season (May–September) with different minimum infection rates (MIRs). Culiseta melanura had the highest MIR (20.2) and positive pools were detected from late May to mid-September. Aedes vexans had an MIR of 2.2 and was infected early in the season (June), while Cq. perturbans exhibited a much higher field infection rate (9.9) with all positive pools collected in August. Culiseta melanura is a likely endemic vector in central Alabama, while Ae. vexans and Cq. perturbans probably function as bridge vectors. Culex erraticus, the most common mosquito in the habitat (54% of total collections), had an MIR of 3.2, and was persistently infected from mid-June to mid-September. This is the first report of high rates of EEE virus infection in this species, a member of the tropical subgenus Melanoconion. Uranotaenia sapphirina, considered to feed on amphibians and possibly reptiles, had an MIR of 5.6, with positive pools spanning a four-month period. This suggests that species other than birds may serve as a reservoir for EEE in hardwood swamps in the Southeastern United States and elsewhere. The lengthy period of mosquito infection with EEE virus, coupled with the diverse habits of the vectors and their proximity to a population center, indicate the importance of monitoring EEE virus activity in the Mid-South.
SEASONAL VARIATION IN DIRECT OBSTETRIC MORTALITY IN RURAL SENEGAL: ROLE OF MALARIA?
Authors: ETARD J. F. , KODIO B. , RONSMANS C.
Published: September 2018

We explore a possible link between malaria and maternal death in a rural area of Senegal by assessing the seasonal pattern of maternal mortality by cause and examining whether this pattern coincides with the malaria season. Overall mortality in women 15–49 years of age did not differ by season, while maternal and direct obstetric deaths were significantly more frequent during the rainy/malaria season than during the rest of the year, even after adjusting for place of delivery.
RAPID ASSESSMENT FOR LYMPHATIC FILARIASIS IN CENTRAL NIGERIA: A COMPARISON OF THE IMMUNOCHROMATOGRAPHIC CARD TEST AND HYDROCELE RATES IN AN AREA OF HIGH ENDEMICITY
Authors: EIGEGE ABEL , RICHARDS FRANK O. , BLANEY DAVID D. , MIRI EMMANUEL S. , GONTOR IBRAHIM , OGAH GLADYS , UMARU JOHN , JINADU M. Y. , MATHAI WANJIRA , AMADIEGWU STANLEY , HOPKINS DONALD R.
Published: September 2018

The rapid immunochromatographic card test (ICT) for Wuchereria bancrofti circulating filarial antigen is being used to map areas endemic for lymphatic filariasis. However, the ICT is expensive; thus, surveys based on this test must be relatively limited. Our study was conducted to determine if village-based hydrocele surveys could be used to supplement the ICT surveys in the mapping activities. We compared in 144 Nigerian villages the two assessment methods, ICT and examination for clinical hydrocele, in random samples of 30 adults selected using a procedure that obtained 15 younger males (reported age = 16–39 years old) and 15 older males (≥ 40 years), based on the assumption that hydrocele rates may be more prevalent in older age groups. The men were asked if they had scrotal swelling, then examined and tested by the ICT. We found a weakly positive correlation between village prevalence determined by the ICT and hydrocele (r = 0.041, P < 0.001). Only villages with hydrocele rates of 20% or greater were also consistently classified as having endemic filariasis by the ICT. There was no correlation between an individual’s ICT positivity and clinical presence of hydrocele, and questioning about scrotal swelling was not predictive for presence of hydrocele. More research is needed to determine if community level hydrocele prevalence surveys can offer an economical and broadly applicable supplement to the ICT for determining the endemicity of filariasis.
IMPACT OF PERMETHRIN-TREATED BED NETS ON MALARIA, ANEMIA, AND GROWTH IN INFANTS IN AN AREA OF INTENSE PERENNIAL MALARIA TRANSMISSION IN WESTERN KENYA
Authors: TER KUILE FEIKO O. , TERLOUW DIANNE J. , KARIUKI SIMON K. , PHILLIPS-HOWARD PENELOPE A. , MIREL LISA B. , HAWLEY WILLIAM A. , FRIEDMAN JENNIFER F. , SHI YA PING , KOLCZAK MARGARETTE S. , LAL ALTAF A. , VULULE JOHN M. , NAHLEN BERNARD L.
Published: September 2018

As part of a community-based, group-randomized, controlled trial of insecticide-treated bed nets (ITNs) in an area with intense malaria transmission in western Kenya, a birth cohort (n = 833) was followed monthly until the age of 24 months to determine the potential beneficial and adverse effects of reduced malaria exposure during pregnancy and infancy. Malaria transmission and morbidity were comparable pre-intervention. The ITNs reduced malaria attack rates (force of infection) in infancy by 74%, and delayed the median time-to-first parasitemia (4.5 to 10.7 months; P < 0.0001). The incidence of both clinical malaria and moderate-severe anemia (hemoglobin level <7 g/dL) were reduced by 60% (P < 0.001 for both). Protective efficacy was greatest in infants less than three months old and similar in older infants and one-year-old children. Efficacy was lowest in the dry season. Infants from ITN villages experienced better height and weight gain. In areas of intense perennial malaria transmission, ITNs substantially reduce exposure to malaria and subsequent malaria-associated morbidity in children less than 24 months old. Reduced malaria exposure during infancy did not result, with continued ITN use, in increased malaria morbidity in one-year-old children.
ALTERATION OF CLINICAL OUTCOME AND HISTOPATHOLOGY OF YELLOW FEVER VIRUS INFECTION IN A HAMSTER MODEL BY PREVIOUS INFECTION WITH HETEROLOGOUS FLAVIVIRUSES
Authors: XIAO SHU-YUAN , GUZMAN HILDA , DA ROSA AMELIA P. A. TRAVASSOS , ZHU HONG-BING , TESH ROBERT B.
Published: September 2018

Using a recently described hamster model of severe yellow fever (YF), we examined the hypothesis that prior infection with heterologous flaviviruses protects against severe or fatal YF. Hamsters were singly or sequentially infected with Japanese encephalitis, St. Louis encephalitis, West Nile, and/or dengue-1 viruses, and then challenged with a virulent strain of yellow fever virus (YFV). In contrast to control (naive) hamsters, many of which appeared clinically ill or died after YFV infection, the flavivirus-immune animals remained asymptomatic. The flavivirus-immune hamsters also had a reduced viremia and lower serum levels of alanine aminotransferase and total bilirubin, compared with naive hamsters, following YFV infection. Histologically, livers of animals in the flavivirus-immune and control groups showed comparable levels of multifocal necrapoptosis. However, steatosis was not observed in the flavivirus-immune animals, whereas naive hamsters developed extensive microvesicular steatosis in the liver following YFV infection. These findings suggest that hepatocytic steatosis is an adverse microscopic feature associated with severe disease in YFV infection. Our experimental results support earlier anecdotal reports that prior exposure of humans to heterologous flaviviruses reduces subsequent risk of fatal YFV infection.
PREVALENCE AND SEVERITY OF MALNUTRITION IN PRE-SCHOOL CHILDREN IN A RURAL AREA OF WESTERN KENYA
Authors: KWENA ARTHUR M. , TERLOUW DIANNE J. , DE VLAS SAKE J. , PHILLIPS-HOWARD PENELOPE A. , HAWLEY WILLIAM A. , FRIEDMAN JENNIFER F. , VULULE JOHN M. , NAHLEN BERNARD L. , SAUERWEIN ROBERT W. , TER KUILE FEIKO O.
Published: September 2018

We determined the nutritional status of children less than five years of age in an area in rural western Kenya with intense malaria transmission, a high prevalence of severe anemia and human immunodeficiency virus, and high infant and under-five mortality (176/1,000 and 259/1,000). No information is available on the prevalence of malnutrition in this area. Three cross-sectional surveys were conducted between 1996 and 1998 to monitor the effect of insecticide-treated bed nets on child morbidity. Anthropometric indices are presented for 2,103 children collected prior to and during intervention (controls only). The prevalence of stunting (Z-scores for height-for-age [HAZ] <−2), wasting (Z-scores for weight-for-height [WHZ] <−2) and being underweight (Z-scores for weight-for-age [WAZ] <−2) was 30%, 4%, and 20%, respectively. This was severe (Z-score <−3) in 12% (stunting), 1% (wasting), and 5% (underweight) of the children. Few children less than three months of age were malnourished (<2%), but height-for-age and weight-for-age deficits increased rapidly in children 3–18 months of age, and were greatest in children 18–23 months old (44% stunted and 34% underweight). While the mean HAZ and WAZ stabilized from 24 months of age onwards, they still remained substantially below the reference median with no evidence of catch-up growth. Malnutrition is likely to interact with infectious diseases, placing children 3–24 months of age at high risk of premature death in this area.
INFECTIOUS DISEASES IN IMMIGRANTS FROM THE PERSPECTIVE OF A TROPICAL MEDICINE REFERRAL UNIT
Authors: LÓPEZ-VÉLEZ R. , HUERGA H. , TURRIENTES M. C.
Published: September 2018

Immigrants from less developed countries to Europe are growing in number and could contribute to the emergence of some infectious diseases. To address this issue, we conducted a descriptive study of 988 immigrants, of whom 79.9% were sub-Saharan Africans and 72% were of undocumented origin. Fever, pruritus, eosinophilia, visceromegaly, and anemia were more frequent in Africans, while a cough was more common Latin Americans (P < 0.005). The most frequent diagnoses were previous hepatitis B (46.5%), latent tuberculosis (44.2%), filariasis (24.8%), infection with intestinal helminths (15.4%), malaria (15.1%), infection with intestinal protozoa (10%), hepatitis C (8.8%), other non-parasitic infections (7.8%), active hepatitis B (7.6%), sexually transmitted diseases (7.5%), active tuberculosis (5.8%), and infection with human immunodeficiency virus (HIV) (5.2%). Past and active hepatitis B and C, active tuberculosis, infection with HIV, malaria, and filariasis were more frequent in Africans (P < 0.005). Thirty-two other tropical diseases were also diagnosed.
CLINICAL TRIAL OF ORAL ARTESUNATE WITH OR WITHOUT HIGH-DOSE PRIMAQUINE FOR THE TREATMENT OF VIVAX MALARIA IN THAILAND
Authors: SILACHAMROON UDOMSAK , KRUDSOOD SRIVICHA , TREEPRASERTSUK SOMBAT , WILAIRATANA POLRAT , CHALEARMRULT KOBSIRI , MINT HLA YIN , MANEEKAN PANNAMAS , WHITE NICHOLAS J. , GOURDEUK VICTOR R. , BRITTENHAM GARY M. , LOOAREESUWAN SORNCHAI
Published: September 2018

We studied prospectively 801 Thai patients admitted to the Bangkok Hospital for Tropical Diseases with acute, symptomatic Plasmodium vivax malaria to determine the optimum duration of treatment with oral artesunate and the safety, tolerability, and effectiveness of a high dose of primaquine in prevention of relapse. Patients were randomly assigned to one of four treatment groups: 1) a five-day course of artesunate (Group A5); 2) a seven-day course of artesunate (Group A7); 3) a five-day course of artesunate plus a 14-day course of high-dose primaquine (0.6 mg/kg, maximum dose = 30 mg) (Group A5 + P); and 4) a seven-day course of artesunate plus a 14-day course of high-dose primaquine (Group A7 + P). During 28 days of observation, P. vivax reappeared in the blood of 50% of those who received artesunate alone (Groups A5 and A7), compared with none of those who received primaquine (Groups A5 + P and A7 + P; P < 0.0001). Adverse effects were confined to the 13 patients with a deficiency for glucose-6-phosphate dehydrogenase; high-dose primaquine (0.6 mg/kg of base a day) had to be stopped in four (31%) patients because of a significant decrease in the hematocrit. The combination of five days of artesunate and 14 days of primaquine is a highly effective and generally well-tolerated treatment regimen for vivax malaria in Thailand.
CLINICAL CHARACTERISTICS AND ENDOSCOPIC FINDINGS ASSOCIATED WITH BLASTOCYSTIS HOMINIS IN HEALTHY ADULTS
Authors: CHEN TE-LI , CHAN CHE-CHANG , CHEN HSIN-PAI , FUNG CHANG-PHONE , LIN CHIH-PEI , CHAN WAN-LEONG , LIU CHENG-YI
Published: September 2018

Ninety-nine individuals with stools positive for Blastocystis hominis but negative for other parasites were identified from medical records of healthy adults who had received a physical examination at Taipei Veterans General Hospital from November 2000 to October 2002. The medical records of these 99 positive cases and 193 randomly selected controls, matched for age, sex, and date of examination, were retrospectively reviewed. The pathogenicity of B. hominis could not be demonstrated due to a lack of association with the development of gastrointestinal symptoms or pathologic findings on endoscopic examination. Multivariate analyses revealed that chronic hepatitis B infection was a predisposing condition to the acquisition of B. hominis (odd ratio = 2.848, 95% confidence interval = 1.299–6.242, P = 0.009), and concentration of urate was significantly lower in B. hominis-positive individuals (mean ± SD = 361.64 ± 87.44 versus 392.57 ± 93.38 μmol/L; P = 0.009). Among the 64 individuals who underwent gastric biopsy, Helicobacter pylori was found more frequently in the individuals harboring B. hominis (19 of 26 versus 15 of 38; P = 0.017).
ISOSPORIASIS IN VENEZUELAN ADULTS INFECTED WITH HUMAN IMMUNODEFICIENCY VIRUS: CLINICAL CHARACTERIZATION
Authors: CERTAD GABRIELA , ARENAS-PINTO ALEJANDRO , POCATERRA LEONOR , FERRARA GIUSEPPE , CASTRO JULIO , BELLO ANDREINA , NÚÑEZ LUZ
Published: September 2018

A cross-sectional study was undertaken to determine the prevalence of isosporiasis and its clinical and laboratory pattern in Venezuelan patients infected with human immunodeficiency virus (HIV) (n = 397). At enrollment, they underwent a thorough clinical history and physical examination, and provided stool specimens for the identification of Isospora belli and other parasites. Isospora belli was identified in 56 subjects (14%) and diarrhea, either acute or chronic, was present in 98% of these cases (P < 0.001). Eosinophilia was strongly associated with isosporiasis (P = 0.01). It was also found that the presence of eosinophilia was more common in I. belli-infected patients without weight loss (P < 0.001). Twenty-six (81.25%) subjects with I. belli infection had CD4+ cell counts < 200 cells/mm3 (P = 0.03). In addition, the data and its description shows the association to be < 100 cells/mm3. This infection seems to be seasonal because the recovery of oocysts occurred mainly in months with significant rainfall. In fact, isosporiasis should be suspected in HIV-infected patients from tropical countries with diarrhea, weight loss, eosinophilia, and low CD4+ cell counts.
RAPID DIAGNOSTIC DEVICES FOR MALARIA: FIELD EVALUATION OF A NEW PROTOTYPE IMMUNOCHROMATOGRAPHIC ASSAY FOR THE DETECTION OF PLASMODIUM FALCIPARUM AND NON-FALCIPARUM PLASMODIUM
Authors: WONGSRICHANALAI CHANSUDA , AREVALO IRACEMA , LAOBOONCHAI ANINTITA , YINGYUEN KRITSANAI , MILLER R. SCOTT , MAGILL ALAN J. , FORNEY J. RUSS , GASSER ROBERT A.
Published: September 2018

The NOW® ICT Malaria P.f./P.v. for Whole Blood (Binax, Inc., Portland, ME) is a new malaria rapid diagnostic device that represents a technical advance over previous assays, such as ICT™ Malaria P.f./P.v. and ICT™ Malaria P.f. We evaluated this device in March 2001 in symptomatic patients at malaria clinics in Maesod, Thailand. Microscopic examination of Giemsa-stained blood smears was the reference standard. In 246 patients, microscopy showed 32 (13.0%) infected with Plasmodium falciparum, 63 (25.6%) with P. vivax, 6 (2.4%) with mixed infections of P. falciparum and P. vivax, 5 (2.0%) with P. malariae, and 140 (56.9%) negative. Sensitivity for P. falciparum was 100% and specificity was 96.2% (200 of 208; 95% confidence interval [CI] = 92–98). For P. vivax, sensitivity was 87.3% (55 of 63; 95% CI = 77–93) and specificity was 97.7% (173 of 177; 95% CI = 95–99), but all the four false-positive results were microscopically positive for P. malariae; thus, specificity for non-falciparum Plasmodium was 100%. These results suggest improved performance over NOW® ICT predecessors.
INDUCTION OF SEVERE DISEASE IN HAMSTERS BY TWO SANDFLY FEVER GROUP VIRUSES, PUNTA TORO AND GABEK FOREST (PHLEBOVIRUS, BUNYAVIRIDAE), SIMILAR TO THAT CAUSED BY RIFT VALLEY FEVER VIRUS
Authors: FISHER ANN F. , TESH ROBERT B. , TONRY JESSICA , GUZMAN HILDA , LIU DONGYING , XIAO SHU-YUAN
Published: September 2018

Adult golden hamsters inoculated subcutaneously with either of two sandfly fever group viruses, Punta Toro and Gabek Forest (Phlebovirus, Bunyaviridae), developed a fulminating fatal illness characterized by hepatic and splenic necrosis and interstitial pneumonitis. Most animals died within three days after infection; this was accompanied by high levels of viremia. Necropsy and histopathologic examination of the infected animals revealed pathologic changes involving multiple organs that resembled those described in Rift Valley fever. These two hamster-phlebovirus systems may serve as alternative animal models for Rift Valley fever and should be useful in studying the pathogenesis of severe phlebovirus infection and for testing potential therapeutic agents.