bluuebunny/crossref_metadata_2025 huggingface dataset:
Cysticercosis of the Breast, a Rare Imaging Finding
Authors: Lucarelli Adrienne Pratti , Martins Maria Marta , de Oliveira Vilmar Marques , Rinaldi José Francisco , Roveda Décio , Galvão Maria Antonieta Longo , Aoki Tsutomo , Piato Sebastião
Published: September 2018

Parasitic infection of the breast is rare, especially in cases of cysticercosis. This disease is acquired by ingestion of tapeworm eggs in contaminated food and water supplies or from hands improperly washed after a bowel movement. Diagnosis is usually made incidentally. We report a patient with cysticercosis of the breast. The patient was a 63-year-old woman who had no clinical manifestations, but cysticercus was observed to cause calcifications detected by mammography. Computed tomography demonstrated brain lesions. A definitive diagnosis of cysticercosis was made by demonstration of characteristic calcified larvae. The definitive diagnosis was confirmed by excisional surgery.
Dengue Virus–Infected Aedes aegypti in the Home Environment
Authors: Garcia-Rejon Julian , Loroño-Pino Maria Alba , Farfan-Ale Jose Arturo , Flores-Flores Luis , Rosado-Paredes Elsy Del Pilar , Rivero-Cardenas Nubia , Najera-Vazquez Rosario , Gomez-Carro Salvador , Lira-Zumbardo Victor , Gonzalez-Martinez Pedro , Lozano-Fuentes Saul , Elizondo-Quiroga Darwin , Beaty Barry J. , Eisen Lars
Published: September 2018

We determined abundance of Aedes aegypti mosquitoes and presence of dengue virus (DENV) in females collected from premises of laboratory-confirmed dengue patients over a 12-month period (March 2007 to February 2008) in Merida, Mexico. Backpack aspiration from 880 premises produced 1,836 females and 1,292 males indoors (predominantly from bedrooms) and 102 females and 108 males from patios/backyards. The mean weekly indoor catch rate per home peaked at 7.8 females in late August. Outdoor abundances of larvae or pupae were not predictive of female abundance inside the home. DENV-infected Ae. aegypti females were recovered from 34 premises. Collection of DENV-infected females from homes of dengue patients up to 27 days after the onset of symptoms (median, 14 days) shows the usefulness of indoor insecticide application in homes of suspected dengue patients to prevent their homes from becoming sources for dispersal of DENV by persons visiting and being bitten by infected mosquitoes.
Comparison of Oral Infectious Dose of West Nile Virus Isolates Representing Three Distinct Genotypes in Culex quinquefasciatus
Authors: Vanlandingham Dana L. , McGee Charles E. , Klingler Kimberly A. , Galbraith Sareen E. , Barrett Alan D. T. , Higgs Stephen
Published: September 2018

Phylogenetic analysis of West Nile virus in North America has identified replacement of the originally introduced clade, Eastern United States (NY99), by the North American clade. In addition, the transient emergence of other clades and genetic variants has also been observed. In this study, we investigated the potential role of the mosquito in the selection of these clades and genetic variants. We determined the relative susceptibility of Culex quinquefasciatus to infection with isolates from the Eastern U.S. clade, the North American clade, and the Southeast coastal Texas clade. Although significant differences were observed in 50% oral infectious dose values between the Eastern U.S. and two attenuated North American genetic variants compared with the North American and Southeast coastal Texas clade viruses, these differences did not correlate with persistence of the genotype in nature. These results indicate that selection of these viral genotypes was independent of viral oral infectivity in the mosquito.
Comparison of Four Selective Media for the Isolation of Burkholderia mallei and Burkholderia pseudomallei
Authors: Glass Mindy B. , Beesley Cari A. , Wilkins Patricia P. , Hoffmaster Alex R.
Published: September 2018

Currently there are no commercially available selective media indicated for the isolation of Burkholderia mallei and Burkholderia pseudomallei. Ashdown’s agar, a custom selective medium for isolation of B. pseudomallei, is well described in the literature but unavailable commercially. Three commercially available media, Burkholderia cepacia selective agar (BCSA), oxidative-fermentative-polymyxin B-bacitracin-lactose (OFPBL) agar, and Pseudomonas cepacia (PC) agar are recommended for isolation of B. cepacia from respiratory secretions of cystic fibrosis patients. We evaluated the sensitivity and selectivity of these four media using 20 B. mallei, 20 B. pseudomallei, 20 Burkholderia spp., and 15 diagnostically challenging organisms. Ashdown’s agar was the most sensitive medium for the isolation of B. pseudomallei, but it was unable to support growth of B. mallei. Pseudomonas cepacia agar was highly sensitive and selective for both organisms. In non-endemic areas, we suggest the use of the commercially available PC agar for the isolation of B. mallei and B. pseudomallei.
Human Immunodeficiency Virus Co-Infection Increases Placental Parasite Density and Transplacental Malaria Transmission in Western Kenya
Authors: Perrault Steven D. , Hajek Jan , Zhong Kathleen , Owino Simon O. , Sichangi Moses , Smith Geoffrey , Shi Ya Ping , Moore Julie M. , Kain Kevin C.
Published: September 2018

Plasmodium falciparum malaria and human immunodeficiency virus (HIV)-1 adversely interact in the context of pregnancy, however little is known regarding the influence of co-infection on the risk of congenital malaria. We aimed to determine the prevalence of placental and congenital malaria and impact of HIV co-infection on trans-placental malaria transmission in 157 parturient women and their infants by microscopy and by quantitative real-time polymerase chain reaction (PCR) in western Kenya. The prevalence of placental and cord blood infections were 17.2% and 0% by microscopy, and 33.1% and 10.8% by PCR. HIV co-infection was associated with a significant increase in placental parasite density (P < 0.05). Cord blood malaria prevalence was increased in co-infected women (odds ratio [OR] = 5.42; 95% confidence interval [CI] = 1.90–15.47) and correlated with placental parasite density (OR = 2.57; 95% CI = 1.80–3.67). A 1-log increase in placental monocyte count was associated with increased risk of congenital infection (P = 0.001) (OR = 48.15; 95% CI = 4.59–505.50). The HIV co-infected women have a significantly increased burden of placental malaria that increases the risk of congenital infection.
Hyponatremia in Severe Malaria: Evidence for an Appropriate Anti-diuretic Hormone Response to Hypovolemia
Authors: Hanson Josh , Hossain Amir , Charunwatthana Prakaykaew , Hassan Mahtab Uddin , Davis Timothy M. E. , Lam Sophia W. K. , Chubb S. A. Paul , Maude Richard J. , Yunus Emran Bin , Haque Gofranul , White Nicholas J. , Day Nicholas P. J. , Dondorp Arjen M.
Published: September 2018

Although hyponatremia occurs in most patients with severe malaria, its pathogenesis, prognostic significance, and optimal management have not been established. Clinical and biochemical data were prospectively collected from 171 consecutive Bangladeshi adults with severe malaria. On admission, 57% of patients were hyponatremic. Plasma sodium and Glasgow Coma Score were inversely related (rs = −0.36, P < 0.0001). Plasma antidiuretic hormone concentrations were similar in hyponatremic and normonatremic patients (median, range: 6.1, 2.3–85.3 versus 32.7, 3.0–56.4 pmol/L; P = 0.19). Mortality was lower in hyponatremic than normonatremic patients (31.6% versus 51.4%; odds ratio [95% confidence interval]: 0.44 [0.23–0.82]; P = 0.01 by univariate analysis). Plasma sodium normalized with crystalloid rehydration from (median, range) 127 (123–140) mmol/L on admission to 136 (128–149) mmol/L at 24 hours (P = 0.01). Hyponatremia in adults with severe malaria is common and associated with preserved consciousness and decreased mortality. It likely reflects continued oral hypotonic fluid intake in the setting of hypovolemia and requires no therapy beyond rehydration.
Giardia duodenalis Assemblages Associated with Diarrhea in Children in South India Identified by PCR-RFLP
Authors: Ajjampur Sitara S. R. , Sankaran Premi , Kannan Arun , Sathyakumar Kirthi , Sarkar Rajiv , Gladstone Beryl P. , Kang Gagandeep
Published: September 2018

Giardial diarrhea in a birth cohort of 452 children in an urban slum in South India was characterized. Of the 155 episodes that occurred in 99 children, 73% were acute diarrhea. Children with better educated mothers and a toilet at home had lower odds of acquiring giardial diarrhea, whereas low socioeconomic status and drinking municipal water were associated with greater risk. Children with co-infections tended to have a slightly longer duration of diarrhea (P = 0.061) and showed significantly more wasting after an episode than children with diarrhea resulting from Giardia alone (P = 0.032). Among the 99 cases, 50 diarrheal and 51 asymptomatic Giardia positive samples were genotyped by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) at the triose phosphate isomerase gene. Assemblage B was predominant both in giardial diarrhea (80%) and asymptomatic giardiasis (94%). Children with Assemblage A subgroup-II alone or dual infections with both assemblage A and B had diarrhea more frequently (P = 0.07).
Genetic Variation among Plasmodium vivax Isolates Adapted to Non-Human Primates and the Implication for Vaccine Development
Authors: Ntumngia Francis B. , McHenry Amy M. , Barnwell John W. , Cole-Tobian Jennifer , King Christopher L. , Adams John H.
Published: September 2018

Plasmodium vivax Duffy binding protein (DBP) is vital for parasite development, thereby making this molecule a good vaccine candidate. Preclinical development of a P. vivax vaccine often involves use of primate models prior to testing efficacy in humans, but primate isolates are poorly characterized. We analyzed the complete gene coding for the DBP in several P. vivax isolates that are used for experimental primate infections and compared these sequences with the Salvador I DBP isolate, which is being used for vaccine development. Our results affirm that primate-adapted isolates are genetically similar to P. vivax circulating in humans, but variability is greatest in the putative target of protective antibodies. In addition, some P. vivax isolates contain multiple genetically different clones. Testing a DBP vaccine may therefore be complicated by heterogeneity and diversity of the P. vivax isolates available for in vivo challenge.
Development of a Framework for Evaluating the Sustainability of Community-based Dengue Control Projects
Authors: Hanh Tran T. Tuyet , Hill Peter S. , Kay Brian H. , Quy Tran Minh
Published: September 2018

There are currently no frameworks developed specifically for assessing community-based dengue control project sustainability. We first review the literature for frameworks for assessing project sustainability and second validate the framework criteria against the oldest community-based intervention using Mesocyclops in Xuan Phong commune, Nam Dinh province, north Vietnam, the subject of an intervention in 1998–2000. The framework used 13 criteria, clustered into three categories: 1) maintenance of health benefits from the original project, 2) continued delivery of community activities, and 3) human resource development. To provide consistency between criteria and to allow comparison both over time and with non-intervention communes, a five-point scale for each criterion was used, with the overall sustainability score calculated as the mean of all criteria. The framework offers a practical tool for assessing sustainability, and is amenable to adaptation for specific interventions without compromising the framework as a whole.
Seroepidemiologic Survey of Cysticercosis-Taeniasis in Four Central Highland Districts of Papua, Indonesia
Authors: Salim Lidwina , Ang Agnes , Handali Sukwan , _ _ , Tsang Victor C. W.
Published: September 2018

Cysticercosis and taeniasis are known to be present in Papua, Indonesia. Several small studies have found a high prevalence of cysticercosis (23.5–56.9%) in the central highlands of Papua. A seroepidemiologic survey was carried out in four districts (Jayawijaya, Paniai, Pegunungan Bintang, and Puncak Jaya) of Papua. Anti-cysticercosis and anti-taeniasis antibodies were measured in 2,931 people using recombinant T24 and recombinant ES33 as a measure of cysticercosis and taeniasis exposures, respectively. Prevalence of cysticercosis-taeniasis is high in the Jayawijaya and Paniai districts (20.8% and 29.2% for cysticercosis and 7% and 9.6% for taeniasis, respectively) and lowest in the other two districts (Pegunungan Bintang and Puncak Jaya) (2% and 2% for cysticercosis and 1.7% and 10.7% for taeniasis, respectively). Our data show that the prevalence of cysticercosis and taeniasis are unchanged from that reported nearly 35 years ago at the beginning of cysticercosis-taeniasis epidemics in Papua, Indonesia.
Factors Associated with Male Mating Success of the Dengue Vector Mosquito, Aedes aegypti
Authors: Ponlawat Alongkot , Harrington Laura C.
Published: September 2018

We studied the effects of male Aedes aegypti age, body size, and density on mating success under laboratory and field conditions. Older males under field conditions transferred the greatest number of sperm to females (1,152 by 1-day-old males to 1,892 sperm by 10-day-old males). Larger males inseminated females with more sperm than smaller ones. Male age, female body size, and density also influenced male mating success. Larger females successfully mated with males more often than smaller females, especially with older males (> 25 days old). Female insemination rates in small high-density laboratory cages (0.009 m3) were artificially high (81.6–98.7%) compared with rates (65.4–84.6%) in large low-density field cages (9 m3). This is the first study to systematically evaluate the effect of Ae. aegypti male body size and age on sperm transfer to females and the first one to evaluate the mating performance of males in a field setting.
Geographic Variation in the Sensitivity of Recombinant Antigen-based Rapid Tests for Chronic Trypanosoma cruzi Infection
Authors: Verani Jennifer R. , Seitz Amy , Gilman Robert H. , LaFuente Carlos , Galdos-Cardenas Gerson , Kawai Vivian , de LaFuente Elizabeth , Ferrufino Lisbeth , Bowman Natalie M. , Pinedo-Cancino Viviana , Levy Michael Z. , Steurer Francis , Todd Charles W. , Kirchhoff Louis V. , Cabrera Lilia , Verastegui Manuela , Bern Caryn
Published: September 2018

Chagas disease affects 8–11 million people throughout the Americas. Early detection is crucial for timely treatment and to prevent non-vectorial transmission. Recombinant antigen-based rapid tests had high sensitivity and specificity in laboratory evaluations, but no Peruvian specimens were included in previous studies. We evaluated Stat-Pak and Trypanosoma Detect rapid tests in specimens from Bolivia and Peru. Specimens positive by three conventional assays were confirmed positives; specimens negative by two or more assays were confirmed negatives. In Bolivian specimens, Stat-Pak and Trypanosoma Detect tests were 87.5% and 90.7% sensitive, respectively; both showed 100% specificity. Sensitivity in Peruvian specimens was much lower: 26.6–33.0% (Stat-Pak) and 54.3–55.2% (Trypanosoma Detect); both had specificities > 98%. Even in Bolivian specimens, these sensitivities are inadequate for stand-alone screening. The low sensitivity in Peru may be related to parasite strain differences. Chagas disease rapid tests should be field tested in each geographic site before widespread implementation for screening.
Community Based Parasitic Screening and Treatment of Sudanese Refugees: Application and Assessment of Centers for Disease Control Guidelines
Authors: Brodine Stephanie K. , Thomas Anne , Huang Robert , Harbertson Judith , Mehta Sanjay , Leake John , Nutman Thomas , Moser Kathleen , Wolf Jamie , Ramanathan Roshan , Burbelo Peter , Nou John , Wilkins Patricia , Reed Sharon L.
Published: September 2018

Centers for Disease Control guidelines for schistosomiasis and strongyloidiasis in Sudanese and Somali refugees are not widely implemented. Given limited prevalence data, we conducted a seroprevalence study of schistosomiasis, strongyloidiasis, and loiasis in Sudanese refugees across diverse ages. Sudanese refugees, ages 4–78, were recruited via community organizations. Half of the patients (86/172), were seropositive for schistosomiasis (46/171; 26.9%), strongyloidiasis (56/172; 33%), or both (16/171; 9.4%). No Loa loa infections were detected. Infection rates were similar in adults and children except that no schistosomiasis was detected in children < 4 years of age at the time of immigration to the United States. The high prevalence of schistosomiasis and strongyloidiasis in a community-based sample of Sudanese confirms the urgency for compliance with CDC refugee health guidelines. We detected no co-infection with Loa loa using the most sensitive serologic techniques, allowing use of ivermectin, the most effective treatment of strongyloidiasis.
Community-Based Promotional Campaign to Improve Uptake of Intermittent Preventive Antimalarial Treatment in Pregnancy in Burkina Faso
Authors: Gies Sabine , Coulibaly Sheick O. , Ky Clotilde , Ouattara Florence T. , Brabin Bernard J. , D’Alessandro Umberto
Published: September 2018

Malaria preventive strategies in pregnancy were assessed in a health center randomized trial comparing intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) with and without community based promotional activities in rural Burkina Faso. The study involved 2,240 secundigravidae and secundigravidae and evaluated factors associated with antenatal clinic (ANC) attendance and uptake of IPTp-SP. With promotion, 64.2% completed ≥ 3 ANC visits compared with 44.7% without (P = 0.05). Complete uptake of IPTp-SP was 71.8% with and 49.1% without promotion (P = 0.008). The IPTp-SP uptake was lowest in adolescents delivering during high malaria transmission with (29%) or without promotion (30%). Uptake of SP was higher during the low transmission season than in the high transmission season (adjusted odds ratio = 2.17, 95% confidence interval = 1.59–3.03). Community sensitization increased ANC attendance and IPTp-SP uptake. Adolescents were the most difficult to reach, particularly during the high malaria transmission period. The impact of IPTp-SP will be limited unless this high risk group is protected.
Performance of Malaria Rapid Diagnostic Tests as Part of Routine Malaria Case Management in Kenya
Authors: de Oliveira Alexandre Macedo , Skarbinski Jacek , Ouma Peter O. , Kariuki Simon , Barnwell John W. , Otieno Kephas , Onyona Phillip , Causer Louise M. , Laserson Kayla F. , Akhwale Willis S. , Slutsker Laurence , Hamel Mary
Published: September 2018

Data on malaria rapid diagnostic test (RDT) performance under routine program conditions are limited. We assessed the attributes of RDTs performed by study and health facility (HF) staffs as part of routine malaria case management of patients ≥ 5 years of age in Kenya. Expert microscopy was used as our gold standard. A total of 1,827 patients were enrolled; 191 (11.6%) were parasitemic by expert microscopy. Sensitivity and specificity of RDTs performed by study staff were 86.6% (95% confidence interval [CI]: 79.8–93.5%) and 95.4% (95% CI: 93.9–96.9%), respectively. Among tests performed by HF staff, RDTs were 91.7% (95% CI: 80.8–100.0%) sensitive and 96.7% (95% CI: 92.8–100.0%) specific, whereas microscopy was 52.5% (95% CI: 33.2–71.9%) sensitive and 77.0% (95% CI: 67.9–86.2%) specific. Our findings suggest that RDTs perform better than microscopy under routine conditions. Further efforts are needed to maintain this high RDT performance over time.
Descriptive Epidemiology of Mortality and Morbidity of Health-Indicator Diseases in Hospitalized Children from Western Jamaica
Authors: McCarthy James E. , Evans-Gilbert Tracy
Published: September 2018

The objectives of our study were to describe the epidemiology of child-health indicator diseases in western Jamaica, examine differences in indicator diseases between sex and age, and generate hypotheses about causes of disease burden. International Classification of Disease, 10th Revision, coded discharge diagnoses were collected from consecutive admissions for 2003–2005 from a public tertiary care hospital. Mortality data were not coded. Perinatal disease was the most common cause of mortality, with hyaline membrane disease the primary cause. Younger children, particularly males, are disproportionately affected by all indicator diseases (P < 0.001) and more likely to die from acute respiratory tract infections and infectious diseases (P < 0.05). Sickle cell disease was the fourth most common diagnosis. Children in western Jamaica are most affected by diseases of prematurity. These children experience disease burden similar to that of children in other developing countries, but fewer neonatal sepsis and insect-borne infections, and more hematologic illness.
Leishmaniases in Bolivia: Comprehensive Review and Current Status
Authors: García Ana L. , Parrado Rudy , Rojas Ernesto , Delgado Raúl , Dujardin Jean-Claude , Reithinger Richard
Published: September 2018

The leishmaniases are protozoan, zoonotic diseases transmitted to human and other mammal hosts by the bite of phlebotomine sandflies. Bolivia has the highest incidence of cutaneous leishmaniasis (CL) in Latin America (LA), with 33 cases per 100,000 population reported in 2006. CL is endemic in seven of the country’s nine administrative departments. Visceral leishmaniasis (VL) is comparatively rare and is restricted to one single focus. Most CL cases are caused by Leishmania (Viannia) braziliensis (85% cases); VL is caused by L. (L.) infantum. Seven sandfly species are incriminated as vectors and Leishmania infections have been detected in several non-human mammal hosts. Transmission is associated with forest-related activities, but recently, cases of autochthonous, urban transmission were reported. Because most cases are caused by L. (V.) braziliensis, Bolivia reports the greatest ratio (i.e., up to 20% of all cases) of mucosal leishmaniasis to localized CL cases in LA. Per national guidelines, both CL and VL cases are microscopically diagnosed and treated with pentavalent antimony.
Analysis of Genetic Variability of Plasmodium vivax Isolates from Different Brazilian Amazon Areas Using Tandem Repeats
Authors: Rezende Antônio M. , Tarazona-Santos Eduardo , Couto Álvaro D’ Almeida , Fontes Cór Jésus F. , De Souza José Maria , Carvalho Luzia H. , Brito Cristiana F. A.
Published: September 2018

Few genetic markers have been described to analyze populations of Plasmodium vivax. The genetic variability of P. vivax has been analyzed mainly among isolates taken from areas ranging from hyper- to holoendemic areas. These studies of genetic variability have neglected many areas with different epidemiologic profiles. The purpose of this study was to analyze the genetic variability of P. vivax isolates from four different Brazilian Amazon areas. We chose to study the five most polymorphic tandem repeats (TRs) identified so far. All TRs studied were polymorphic in at least one studied population, with a modal allele at nearly all loci. Expected heterozygosity ranged from 0.462 to 0.666 and did not correlate with the repeat array length. The genetic distances among the populations varied from 0.027 to 0.241, and did not correlate with their geographic separation. Tandem repeats identified in P. vivax isolates failed to allow geographic clustering.
Plasmodium fieldi: Observations on the Hackeri and ABI Strains in Macaca mulatta Monkeys and Mosquitoes
Authors: Collins William E. , Sullivan Joann S. , Warren McWilson , Galland G. Gale , Williams Allison , Barnwell John W.
Published: September 2018

Macaca mulatta monkeys infected with the Hackeri strain of Plasmodium fieldi had maximum parasite counts ranging from 1,300 to 301,320/μL. In 43 intact animals infected with the ABI strain, the maximum parasite counts ranged from 672 to 57,189/μL (median = 15,100/μL); in 46 splenectomized monkeys, the maximum parasite count ranged from 660 to 350,000/μL (median = 52,245/μL). Transmission through Anopheles dirus mosquitoes was obtained on 11 occasions with pre-patent periods of 9–14 days. Relapses occurred between two and eight times during a 1-year period. P. fieldi has potential for testing prophylactic and radical curative drugs.
Efficacy of Aquatain™, a Monomolecular Surface Film, against the Malaria Vectors Anopheles stephensi and An. gambiae s.s. in the Laboratory
Authors: Bukhari Tullu , Knols Bart G. J.
Published: September 2018

Monomolecular films are used for mosquito control because of their asphyxiating effect on larvae and pupae. Compared with other films, Aquatain mosquito formulation (AMF™) has an improved spreading ability and flexibility on a water surface. In the laboratory, AMF™ showed larvicidal, pupicidal, and oviposition deterrent effects against the malaria vectors Anopheles stephensi and An. gambiae. At a dose of 1 mL/m2, the median lethal time to death for late larval instars was 3.02 (95% confidence interval [CI] = 2.76–3.25) and 0.98 (95% CI = 0.75–1.20) days for An. stephensi and An. gambiae, respectively. None of the treated larvae pupated. Pupal mortality reached 100% within two hours for both species. AMF™ repelled gravid females from ovipositing in treated oviposition cups. Without the choice of an untreated cup, the lowered water surface tension caused most females to drown while attempting to oviposit. This physical control method has the potential to become a safe, cost-effective, and resistance-proof malaria vector control tool.
Melioidosis Risk in a Tropical Industrial Environment
Authors: Inglis Timothy J. J. , Levy Avram , Merritt Adam J. , Hodge Meredith , McDonald Robert , Woods Donald E.
Published: September 2018

An investigation into the risk of occupationally acquired melioidosis at a mine site in northern Australia found that 45 (13%) of 345 staff had serologic evidence of exposure and 14 (4%) had recent exposure to Burkholderia pseudomallei or closely related bacteria. There was only one culture-confirmed case of melioidosis in mine staff during the study period. The lack of overt infection directly attributable to work activities despite detectable B. pseudomallei on site, the absence of an association between positive serology and occupational activity on site, or duration of employment in the mining industry stand against a significant occupationally acquired infection risk on this industrial site. Workplace exposure to a dust-generating tropical environment in the melioidosis-endemic north of Australia did not appear to pose a measurable increase in infection risk. The effect of long-term climatic trends on this potential biologic threat requires further study.
Attribution of Malnutrition to Cause-Specific Diarrheal Illness: Evidence from a Prospective Study of Preschool Children in Mirpur, Dhaka, Bangladesh
Authors: Mondal Dinesh , Haque Rashidul , Sack R. Bradley , Kirkpatrick Beth D. , Petri William A.
Published: September 2018

We examined whether malnutrition (underweight [WAZ] < −2) increased the risk of diarrhea equally for all enteropathogens. The study was conducted prospectively between January 1999 and July 2002 in Mirpur, an urban slum in Dhaka. Two hundred eighty-nine Bangladeshi children (147 male and 142 female) 2–5 years of age were included in the study. Malnutrition was present in 39% of the children at the time of enrollment. The parents and children were visited and interviewed every other day by health care workers for details about any diarrheal episodes. Stool samples were successfully collected from 62% of episodes of diarrhea. Of the identified enteropathogens, only enterotoxigenic Escherichia coli (ETEC), Cryptosporidium sp., and Entamoeba histolytica were significantly more prevalent in malnourished children. We concluded that the malnutrition attributed risk is not equal for enteric pathogens associated with diarrheal illness.
Pulmonary Disease in Hamsters Infected with Leptospira interrogans: Histopathologic Findings and Cytokine mRNA Expressions
Authors: Marinho Márcia , Oliveira-Júnior Itamar Souza , Monteiro Cristina Maria Rodrigues , Perri Silvia Helena , Salomão Reinaldo
Published: September 2018

Our aim was to evaluate the pulmonary changes induced by Leptospira interrogans infection in hamsters, and the gene expression of endogenous mediators in lung fragments during 28 days of observation. The animals were euthanized on days 4, 7, 14, 21, and 28 post-inoculation. Histopathologic lung analysis showed hemorrhage, pneumonia, alveolar congestion, and infiltrated cellular areas, with increasing severity until day 21 post-inoculation. Tumor necrosis factor (TNF)-α mRNA expression enhanced in first days with peak on day 4 and slightly decreased in the final phase. The interleukin (IL)-10 remained relatively constant throughout the period, with the exceptions of days 4 and 14. The endothelial nitric-oxide synthesis (eNOS) showed an increased expression on day 4, followed by an augment on days 7 and 14, and remaining constant up to day 28 post-infection. Our results demonstrate that inoculation of L. interrogans sorovar Icterohaemorrhagiae induced pulmonary lesions, including pulmonary hemorrhage, supporting that the lung is a target organ.
Impact of Maternal Human Immunodeficiency Virus Infection on Birth Outcomes and Infant Survival in Rural Mozambique
Authors: Naniche Denise , Bardají Azucena , Lahuerta María , Berenguera Anna , Mandomando Inacio , Sanz Sergi , Aponte John J. , Sigauque Betuel , Alonso Pedro L. , Menéndez Clara
Published: September 2018

We assessed the effect of maternal human immunodeficiency virus (HIV) infection on birth outcomes and infant survival in rural Mozambique. Pregnant women attending the antenatal clinic were recruited. These women and their infants were followed-up for one year. Birth outcomes were assessed at delivery and infant HIV status was determined at 1 and 12 months of age. Women positive for HIV were more likely to have anemia at delivery than women negative for HIV (51.3% versus 35.4%; P < 0.001). Infants born to HIV-positive mothers had a significantly higher post-neonatal mortality rate than infants born to HIV-negative mothers (7.8% versus 1.9%; P < 0.001). The rate of transmission of HIV by breastfeeding during the first year of life was 15.1% (95% confidence interval = CI 7.6–22.4). Assessment of the impact of HIV infection on birth outcomes in rural Africa is essential for tailoring public health measures to reduce mother-to-child transmission of HIV and excess infant mortality.
Antimalarial Drug Susceptibility of Plasmodium vivax in the Republic of Korea
Authors: Chotivanich Kesinee , Sattabongkot Jetsumon , Choi Yien Kyong , Park Jae Sun , Sritabal Juntima , Lim Chae Seung , Udomsangpetch Rachanee , White Nicholas J. , Lee Won Ja
Published: September 2018

The antimalarial susceptibility of ring stage (> 80%) Plasmodium vivax from the Republic of Korea, where long incubation–period strains are prevalent, was evaluated using the schizont maturation inhibition technique. During 2005–2007, susceptibility to seven antimalarial drugs was evaluated with 24 fresh isolates. The geometric mean (95% confidence interval) 50% inhibition concentration (IC50) were quinine 60 (54–75) ng/mL, chloroquine 39 (22–282) ng/mL, piperaquine 27 (17–58) ng/mL, mefloquine 39 (35–67) ng/mL, pyrimethamine 138 (89–280) ng/mL, artesunate 0.6 (0.5–0.8) ng/mL, and primaquine 122 (98–232) ng/mL. Positive correlations were found between quinine and mefloquine (r = 0.6, P = 0.004), piperaquine and chloroquine (r = 0.6, P = 0.008), and piperaquine and primaquine IC50 values (r = 0.5, P = 0.01). Compared with P. vivax in Thailand, P. vivax in the Republic of Korea was more sensitive to quinine and mefloquine, but equally sensitive to chloroquine and artesunate.
Field Evaluation of rK39 Test and Direct Agglutination Test for Diagnosis of Visceral Leishmaniasis in a Population with High Prevalence of Human Immunodeficiency Virus in Ethiopia
Authors: ter Horst Rachel , Tefera Tewodros , Assefa Gessesse , Ebrahim Abdurazik Z. , Davidson Robert N. , Ritmeijer Koert
Published: September 2018

Accuracy of an rK39 rapid diagnostic test (DiaMed-IT-Leish ®) for visceral leishmaniasis (VL) was compared with splenic aspiration and the direct agglutination test (DAT) in a population with a high prevalence of infection with human immunodeficiency virus (HIV) in Ethiopia. There were 699 patients clinically suspected of having VL (153 parasitologically confirmed, 482 DAT confirmed, and 130 DAT negative), and 97 DAT-negative controls. A total of 84% were tested for HIV and 34% were HIV positive. Sensitivity of the rK39 test in parasitologically confirmed VL patients was 84% (77% in HIV positive and 87% in HIV negative; P = 0.25). Sensitivity of the DAT was higher (94%; P = 0.01), 89% in HIV-positive patients and 95% in HIV-negative patients; P = 0.27). Specificity of the rK39 test was 99% in DAT-negative controls and 92% in DAT-negative patients clinically suspected of having VL. A diagnostic algorithm combining DAT and the rK39 test had a sensitivity of 98% in HIV-positive VL patients and 99% in HIV-negative VL patients. Despite the lower sensitivity in a population with a high prevalence of HIV, the DiaMed-IT-Leish ® rK39 test enables decentralization of diagnosis. Patients clinically suspected of having VL who show negative results on the rK39 antigen test should undergo follow-up DAT testing, especially if they are HIV positive.
Protein Kinase A Regulatory Subunit Interacts with P-Type ATPases in Trypanosoma cruzi
Authors: Bao Yi , Weiss Louis M. , Hashimoto Muneaki , Nara Takeshi , Huang Huan
Published: September 2018

Cyclic AMP–protein kinase A (PKA) signaling is important for the growth and differentiation of Trypanosoma cruzi. Immunofluorescence suggests that PKA can associate with the plasma membrane of trypomastigotes. We found that the PKA regulatory subunit interacts with several P-type ATPases. These P-type ATPases may play a role in anchoring PKA to the plasma membrane in T. cruzi.
European Rabbits (Oryctolagus cuniculus) are Naturally Infected with Different Trypanosoma cruzi Genotypes
Authors: Botto-Mahan Carezza , Acuña-Retamar Mariana , Campos Ricardo , Cattan Pedro E. , Solari Aldo
Published: September 2018

Trypanosoma cruzi, the etiologic agent of Chagas disease, presents a complex life cycle, cycling between reduviid vectors and wild and domestic mammals. The European rabbit is an introduced species in America, but its role as reservoir in the wild transmission cycle of Chagas disease remains unknown. We used polymerase chain reaction, Southern blot, and hybridization tests to detect infection and characterize genotypes in rabbits from a hyperendemic area of Chagas disease in Chile. Results show 38% of infection with different genotypes. We provide evidence that rabbits are naturally infected with T. cruzi, which may have important epidemiologic consequences for the wild transmission cycle.
Spore Persistence and Likelihood of Aeroallergenicity of Entomopathogenic Fungi Used for Mosquito Control
Authors: Darbro Jonathan M. , Thomas Matthew B.
Published: September 2018

Entomopathogenic fungi, such as Metarhizium anisopliae and Beauveria bassiana, are being researched as alternatives to chemical adulticides to control mosquito vectors of malaria and dengue. Two cited concerns of fungal control include conidial viability and risks fungal entomopathogens pose to human health. We measured spore viability of 10 fungal isolates over 26 weeks and found a range of persistence. Three B. bassiana isolates maintained ≥ 50% viability 14 weeks after application. No M. anisopliae isolate persisted longer than 1 week. To help assess risk of conidia as potential human allergens, we measured airborne conidia in enclosed environments after simulated biopesticide treatment of M. anisopliae. Conidia were detectable immediately after treatment, with concentrations of ~7000/m3, decreasing over 48 hours to 500 conidia/m3. At most, Metarhizium conidia comprised 2% of total visible particulate matter, falling to 0.1% by 2 days. The implications for viability of biological control of adult mosquitoes are discussed.
Etiology of Acute Undifferentiated Febrile Illness in the Amazon Basin of Ecuador
Authors: Manock Stephen R. , Jacobsen Kathryn H. , de Bravo Narcisa Brito , Russell Kevin L. , Negrete Monica , Olson James G. , Sanchez José L. , Blair Patrick J. , Smalligan Roger D. , Quist Brad K. , Espín Juan Freire , Espinoza Willan R. , MacCormick Fiona , Fleming Lila C. , Kochel Tadeusz
Published: September 2018

We conducted a longitudinal observational study of 533 patients presenting to two hospitals in the Ecuadorean Amazon basin with acute undifferentiated febrile illness (AUFI) from 2001 through 2004. Viral isolation, reverse transcription-polymerase chain reaction (RT-PCR), IgM seroconversion, and malaria smears identified pathogens responsible for fever in 122 (40.1%) of 304 patients who provided both acute and convalescent blood samples. Leptospirosis was found in 40 (13.2%), malaria in 38 (12.5%), rickettsioses in 18 (5.9%), dengue fever in 16 (5.3%), Q fever in 15 (4.9%), brucellosis in 4 (1.3%), Ilhéus infection in 3 (1.0%), and Venezuelan equine encephalitis (VEE), Oropouche, and St. Louis encephalitis virus infections in less than 1% of these patients. Viral isolation and RT-PCR on another 229 participants who provided only acute samples identified 3 cases of dengue fever, 2 of VEE, and 1 of Ilhéus. None of these pathogens, except for malaria, had previously been detected in the study area.
MM3-ELISA Detection of Fasciola hepatica Coproantigens in Preserved Human Stool Samples
Authors: Ubeira Florencio M. , Muiño Laura , Valero M. Adela , Periago M. Victoria , Pérez-Crespo Ignacio , Mezo Mercedes , González-Warleta Marta , Romarís Fernanda , Paniagua Esperanza , Cortizo Sandra , Llovo José , Más-Coma Santiago
Published: September 2018

In this study, we evaluate the MM3-COPRO method for detection of Fasciola coproantigens in human fecal samples, and the usefulness of a new preservative/diluent, CoproGuard, developed for preservation of Fasciola coproantigens. The MM3-COPRO assay was evaluated with 213 samples from healthy patients, 30 Fasciola positive fecal samples (according to the Kato-Katz method), and 83 samples from patients with other parasitic infections. All Fasciola positive specimens were detected with the MM3-COPRO assay (100% sensitivity) and there was no cross-reactivity with other common parasites present in the clinical specimens analyzed (100% specificity). The use of CoproGuard enhanced coproantigen extraction without affecting the detection limit of the assay, and the antigenicity of Fasciola coproantigens in fecal samples stored at 37°C was retained throughout the entire observation period (120 days). We concluded that the MM3-COPRO ELISA combined with the use of CoproGuard may be a very useful tool for the diagnosis of human fascioliasis.
Seasonality of Influenza in the Tropics: A Distinct Pattern in Northeastern Brazil
Authors: Moura Fernanda E. A. , Perdigão Anne C. B. , Siqueira Marilda M.
Published: September 2018

Influenza epidemics occur worldwide annually. The incidence of influenza shows a seasonal pattern in temperate areas, but little is known about influenza seasonality in tropical regions. The objective of this study was to determine the prevalence and the seasonal pattern of influenza infections in children living in the city of Fortaleza in northeastern Brazil. An indirect immunofluorescence assay was performed on nasopharyngeal aspirates collected from children attending in ambulatories, emergency rooms, and wards of the Hospital Infantil Albert Sabin with suspicion of acute respiratory infection during 7 consecutive years (2001–2007). Influenza viruses were detected in 6.3% (234/3,708) of specimens. Laboratory-based surveillance data showed a clear annual epidemic cycle of influenza, with a peak usually occurring in the rainy periods. In Fortaleza, flu infections occurred at a low level throughout the year but exhibit a marked seasonal increase during the rainy season.
High Frequency of Antimicrobial Drug Resistance of Diarrheagenic Escherichia coli in Infants in Peru
Authors: Ochoa Theresa J. , Ruiz Joaquím , Molina Margarita , Del Valle Luis J. , Vargas Martha , Gil Ana I. , Ecker Lucie , Barletta Francesca , Hall Eric , Cleary Thomas G. , Lanata Claudio F.
Published: September 2018

In a prospective passive diarrhea surveillance cohort study of 1,034 infants of low socioeconomic communities in Lima, Peru, we determined the prevalence and antimicrobial drug susceptibility of the diarrheagenic
Escherichia coli
. The prevalence of diarrheagenic
E. coli
was 29% (161 of 557) in children with gastroenteritis and 30% (58 of 195) in the control group without diarrhea. The most common
E. coli
pathogens in diarrhea were enteroaggregative
E. coli
(EAEC) (14%), enteropathogenic
E. coli
(EPEC) (7%), diffusely adherent
E. coli
(DAEC) (4%), and enterotoxigenic
E. coli
(ETEC) (4%). Diarrheagenic
E. coli
as a group exhibited high levels of antimicrobial drug resistance in diarrheal cases to ampicillin (85%), cotrimoxazole (79%), tetracycline (65%), and nalidixic acid (28%). Among individual
E. coli
groups in patients with diarrhea, DAEC and EAEC exhibited significant higher frequencies of resistance to ampicillin, cotrimoxazole, tetracycline and nalidixic acid than EPEC and ETEC. Antimicrobial drug resistance to ampicillin and cotrimoxazole were more frequent in
E. coli
isolated from diarrheal samples than controls, which reflected greater antibiotic exposure in patients with gastroenteritis.
Guinea Worm Disease Outcomes in Ghana: Determinants of Broken Worms
Authors: Glenshaw Mary T. , Roy Sharon , Ruiz-Tiben Ernesto , Downs Philip , Williamson John , Eberhard Mark
Published: September 2018

In 2006, Ghana ranked second in Guinea worm disease (GWD) incidence and reported a previously undocumented 20% prevalence of worm breakage. A prospective study was conducted in 2007 to validate and describe worm breakage and determinants. Among 221 patients with known outcomes, the worm breakage rate observed was 46%. After controlling for demographics, worm and wound presentation, and treatment course and provision, worm breakage was associated with narrow-diameter worms (< 2 mm) (adjusted odds ratio [AOR] 2.79; 95% confidence interval [CI] = 1.03–7.53). Protective factors against worm breakage included antibiotic ointment use (AOR 0.31; 95% CI = 0.14–0.70), bandage protocol compliance (AOR: 0.38; 95% CI = 0.16–0.89), intact bandages (AOR 0.27; 95% CI = 0.09–0.82), and bloody compared with dry wounds (AOR 0.09; 95% CI = 0.01–0.7). The high worm breakage rate observed warrants improvement in case management and patient care. Adherence to established treatment protocols should be facilitated through improved provider training and supervision to reduce the disabling consequences of broken worms.
Intrascrotal Nodules in Adult Men as a Marker for Filarial Granuloma in a Bancroftian Filariasis-Endemic Area
Authors: Norões Joaquim , Figueredo-Silva José , Dreyer Gerusa
Published: September 2018

A retrospective study was undertaken in Recife, Brazil to evaluate the specificity of intrascrotal nodules detected by physical examination as a marker of dead or degenerating adult Wuchereria bancrofti worms (filarial granuloma). A total of 372 nodules from 340 adult male patients (mean age 23.1 years) were studied. Of those, 253 (68%) nodules were from 226 patients treated with antifilarial drugs (Group 1) and 119 (32%) nodules were considered non-drug related and were obtained from 114 patients (Group 2). On histologic examination, all nodules from Group 1 and all but one (99.1%) from Group 2 contained degenerated or dead adult worms. In the one case without filarial granuloma, ectopic cortical adrenal tissue was found in the spermatic cord. These findings emphasize the high specificity of intrascrotal nodules for bancroftian granuloma and draw attention to the importance of examining the scrotal contents of young men in studies of antifilarial drug efficacy. These findings also have potential implications for bancroftian filariasis control programs.
Serum Concentrations of Rifampin, Isoniazid, and Intestinal Absorption, Permeability in Patients with Multidrug Resistant Tuberculosis
Authors: Barroso Elizabeth C. , Pinheiro Valéria G. F. , Façanha Mônica C. , Carvalho Maria R. D. , Moura Maria E. , Campelo Creusa L. , Peloquin Charles A. , Guerrant Richard L. , Lima Aldo A. M.
Published: September 2018

This study evaluates the serum concentrations of rifampin (RMP), isoniazid (INH), and intestinal barrier function in patients with multidrug-resistant tuberculosis (MDR-TB), drug susceptible tuberculosis (DS-TB), and health volunteers (HC; controls). Peak serum concentrations of RMP were significantly lower in MDR-TB and DS-TB as compared with HC (odds ratio [OR] = 3.125, confidence interval [CI] [1.037–9.418] and OR = 4.025, CI [1.207–13.418], respectively). The INH peak serum concentration was not significantly different between MDR-TB versus DS-TB or DS-TB versus HC. The percent of mannitol excretion was significantly lower in the MDR-TB group compared with DS-TB (13.18 versus 16.03, analysis of covariance [ANCOVA],
P
= 0.0369) and compared with HC (13.18 versus 16.61, ANCOVA,
P
= 0.0291) the other study groups. These data suggested a lower peak serum concentration of RMP for both MDR-TB and DS-TB as compared with the HC group. The data also showed a lower intestinal area of absorption in patients with tuberculosis and even worse in MDR-TB.
Increase of NK Cells and Proinflammatory Monocytes Are Associated with the Clinical Improvement of Diffuse Cutaneous Leishmaniasis after Immunochemotherapy with BCG/Leishmania Antigens
Authors: Pereira Ledice I. A. , Dorta Miriam L. , Pereira Ana Joaquina C. S. , Bastos Rosidete P. , Oliveira Milton A. P. , Pinto Sebastião A. , Galdino Hélio , Mayrink Wilson , Barcelos Warly , Toledo Vicente P. C. P. , Lima Gloria Maria C. A. , Ribeiro-Dias Fátima
Published: September 2018

Diffuse cutaneous leishmaniasis (DCL) is characterized by disseminated lesions and the absence of a specific cellular immune response. Here, the immunochemotherapy outcome of a patient with DCL from Amazonian Brazil infected with Leishmania (Leishmania) amazonensis is presented. After several unsuccessful chemotherapy treatment regimens and many relapses, a monthly immunotherapy scheme of L. amazonensis PH8 plus L. (Viannia) braziliensis M2903 monovalent vaccines associated with Bacillus Calmette-Guerin (BCG) was established, one round of which also included an M2903 vaccine associated with intermittent antimonial treatment. Temporary healing of all lesions was achieved, although Leishmania skin tests were negative and interferon γ was not detected in mononuclear cell cultures stimulated with Leishmania antigens. The frequencies of CD16 +CD56+ NK cells (~2×) and CD14 +CD16+ proinflammatory monocytes (~8×) increased in peripheral blood, and CD56 + lymphocytes were found infiltrating the lesions. An association between the increase of the frequency of innate immune system cells and the healing of lesions is shown, suggesting that this protocol of immunotherapy reduced the parasite load and activated NK cells and monocytes.