bluuebunny/crossref_metadata_2025 huggingface dataset:
Year-to-Year Variation in the Age-Specific Incidence of Clinical Malaria in Two Potential Vaccine Testing Sites in Mali With Different Levels of Malaria Transmission Intensity
Authors: Dicko Alassane , Sagara Issaka , Diemert David , Sogoba Moussa , Niambele Mohamed B. , Dao Adama , Dolo Guimogo , Yalcouye Daniel , Diallo Dapa A. , Saul Allan , Miller Louis H. , Toure Yeya T. , Klion Amy D. , Doumbo Ogobara K.
Published: September 2018

To explore the feasibility of field sites for malaria vaccine trials, we conducted a prospective study of clinical malaria incidence during two consecutive transmission seasons in children and young adults living in two areas of Mali with different entomologic inoculation rates (EIRs). Approximately 200 subjects (3 months to 2 years of age) were enrolled per site and followed weekly. Malaria smears were performed monthly in all participants and when symptoms or signs of malaria were present. In Sotuba (annual EIR < 15 infective bites per person), the incidence of clinical malaria was comparable across all age groups but varied significantly between the 2 years. In contrast, in Donéguébougou (annual EIR > 100 infective bites per person), incidence rates decreased significantly with increasing age but remained stable between years. Our results suggest that, although the age distribution of clinical malaria depends on transmission intensity, the total burden of disease may be similar or higher in settings of low transmission.
Polymorphisms in the pfcrt and pfmdr1 Genes of Plasmodium falciparum and in Vitro Susceptibility to Amodiaquine and Desethylamodiaquine
Authors: Echeverry Diego F. , Holmgren Gabrielle , Murillo Claribel , Higuita Juan C. , Björkman Anders , Gil Jose P. , Osorio Lyda
Published: September 2018

The potential role of polymorphisms in the pfcrt and pfmdr1 genes and in vitro susceptibility to amodiaquine and desethylamodiaquine were explored in 15 chloroquine-resistant Colombian Plasmodium falciparum isolates. Single nucleotide polymorphisms in the pfcrt gene, including a newly reported mutation (S334N), were seen in isolates with decreased susceptibility to amodiaquine and desethylamodiaquine. The lowest susceptibility found to amodiaquine was observed in an isolate carrying a pfcrt and pfmdr1 Dd2-like haplotype, whereas a pfcrt haplotype related to the 7G8 Brazilian strain was found in a Colombian isolate with the lowest susceptibility to desethylamodiaquine. This exploratory study suggests that polymorphisms in the pfcrt and pfmdr1 genes play a role in amodiaquine and desethylamodiaquine resistance and warrants further study.
Protection of Susceptible BALB/c Mice from Challenge with Leishmania major by Nucleoside Hydrolase, a Soluble Exo-antigen of Leishmania
Authors: Al-Wabel Mohammad A. , Tonui Willy K. , Cui Liwang , Martin Samuel K. , Titus Richard G.
Published: September 2018

Leishmania major culture-derived, soluble, exogenous antigens have been shown to be a source of vaccine targets for the parasite. We have previously reported that L. major culture-derived, soluble, exogenous antigens can immunize BALB/c mice against challenge with L. major. However, the molecule(s) involved in this protection was not known. We describe the potential of one component of soluble exogenous antigens (recombinant nucleoside hydrolase) to vaccinate mice against challenge with L. major. We found that recombinant nucleoside hydrolase vaccinated BALB/c mice against a subsequent challenge with L. major. Protection was manifested by a significant decrease in lesion size (as much as a 30-fold reduction) and parasite burden (as much as a 71-fold reduction). Protection was achieved whether recombinant nucleoside hydrolase was administered to mice in the presence or absence of adjuvant (interleukin-12). Finally, protection was accompanied by an increase in interferon-γ production but a decrease in interleukin-10 production by vaccinated animals in response to challenge with L. major.
The Effect of Compliance on the Impact of Mass Drug Administration for Elimination of Lymphatic Filariasis in Egypt
Authors: El-Setouhy Maged , Abd Elaziz Khaled M. , Helmy Hanan , Farid Hoda A. , Kamal Hussein A. , Ramzy Reda M. R. , Shannon William D. , Weil Gary J.
Published: September 2018

We studied effects of compliance on the impact of mass drug administration (MDA) with diethylcarbamazine and albendazole for lymphatic filariasis (LF) in an Egyptian village. Baseline microfilaremia (mf) and filarial antigenemia rates were 11.5% and 19.0%, respectively. The MDA compliance rates were excellent (> 85%). However, individual compliance was highly variable; 7.4% of those surveyed after five rounds of MDA denied having ever taken the medications and 52.4% reported that they had taken all five doses. The mf and antigenemia rates were 0.2% and 2.7% in those who reported five doses of MDA and 8.3% and 13.8% in those who reported zero doses. There was no significant difference in residual infection rates among those who had taken two or more doses. These results underscore the importance of compliance for LF elimination programs based on MDA and suggest that two ingested doses of MDA are as effective as five doses for reducing filariasis infection rates.
Disseminated Balamuthia mandrillaris Amoeba Infection in an AIDS Patient from Brazil
Authors: Silva-Vergara Mario León , Da Cunha Colombo Eduardo Rodrigues , De Figueiredo Vissotto Eduardo , Silva Ana Cristina Araújo Lemos , Chica Javier Emilio Lazo , Etchebehere Renata Margarida , Adad Sheila Jorge
Published: September 2018

This report describes a 32-year-old male AIDS patient. He presented with a clinical picture characterized by severe headache, blurred vision, and fever that had lasted for 10 days. At admission, no remarkable neurologic abnormalities were observed. Cranial tomography showed a ring-enhanced lesion with edema and a mass effect in the right occipital lobe. The initial diagnosis was toxoplasmosis, and treatment of this was administered. However, 5 days later, the patient’s clinical status worsened and he died. The necropsy showed necrotizing and hemorrhagic encephalitis, with trophozoites similar to an amoeba species. Furthermore, the kidneys, adrenal glands, thyroid gland, and liver were also involved. The amoeba Balamuthia mandrillaris was identified by an immunofluorescence test.
Modeling the Geographic Distribution of Bacillus anthracis, the Causative Agent of Anthrax Disease, for the Contiguous United States using Predictive Ecologic Niche Modeling
Authors: Blackburn Jason K. , McNyset Kristina M. , Curtis Andrew , Hugh-Jones Martin E.
Published: September 2018

The ecology and distribution of Bacillus anthracis is poorly understood despite continued anthrax outbreaks in wildlife and livestock throughout the United States. Little work is available to define the potential environments that may lead to prolonged spore survival and subsequent outbreaks. This study used the genetic algorithm for rule-set prediction modeling system to model the ecological niche for B. anthracis in the contiguous United States using wildlife and livestock outbreaks and several environmental variables. The modeled niche is defined by a narrow range of normalized difference vegetation index, precipitation, and elevation, with the geographic distribution heavily concentrated in a narrow corridor from southwest Texas northward into the Dakotas and Minnesota. Because disease control programs rely on vaccination and carcass disposal, and vaccination in wildlife remains untenable, understanding the distribution of B. anthracis plays an important role in efforts to prevent/eradicate the disease. Likewise, these results potentially aid in differentiating endemic/natural outbreaks from industrial-contamination related outbreaks or bioterrorist attacks.
Characterization of a Dengue Patient Cohort in Recife, Brazil
Authors: Cordeiro Marli Tenório , Silva Ana Maria , Brito Carlos A. A. , Nascimento Eduardo J. M. , Magalhães Maria Cecilia F. , Guimarães Georgia F. , Lucena-Silva Norma , de Carvalho Eduardo M. Freese , Marques Ernesto T. A.
Published: September 2018

From 2004 to 2006, 658 patients with suspected dengue virus infections were enrolled in a clinical dengue cohort established in Recife, Pernambuco, located at the northeastern region of Brazil. A total of 2,364 blood samples were collected, and serum, plasma, and cells were cryopreserved. Among the suspected cases, 354 (54%) were confirmed as acute DENV-3 infection based on reverse transcription-polymerase chain reaction, virus isolation, and ELISA-IgM. According to WHO criteria, 29.4% of the positive acute cases were classified as dengue fever (DF) and 8.2% of the cases as dengue hemorrhagic fever (DHF), grade 1 or 2. The DHF cases represent 100% of those confirmed in Recife during the period of the study. The dengue cases that did not fulfill the definition of either DHF or DF were classified as DF complicated and accounted for 44.0% of the cases. All the acute cases were classified as either primary or secondary acute dengue virus infections. Secondary infection was predominant in patients with DF; however, there was no predominance of either primary or secondary infections in patients with DHF.
Lack of Efficacy of High-Dose Intravenous Immunoglobulin Treatment of Severe Thrombocytopenia in Patients with Secondary Dengue Virus Infection
Authors: Dimaano Efren M. , Saito Mariko , Honda Shoko , Miranda Edna A. , Alonzo Maria T. G. , Valerio Myra D. , Mapua Cynthia A. , Inoue Shingo , Kumaori Atsushi , Matias Ronald , Natividad Filipinas F. , Oishi Kazunori
Published: September 2018

Because most cases of secondary dengue virus infection are associated with an increased level of platelet-associated IgG, a high dose of intravenous immunoglobulin (IVIG) may have an effect on the development of severe thrombocytopenia in this disease. A randomized, controlled study was conducted with two treatment groups consisting of a treatment (IVIG) group (n = 15) and a non-treatment (non-IVIG) group (n = 16) to determine whether a high dose of IVIG is effective in hastening the recovery from thrombocytopenia in patients with secondary dengue virus infection. No significant difference was found in the baseline demographic data between the two groups. No adverse effect of IVIG was observed, but no effect in hastening the recovery of platelet counts was found in patients with secondary dengue infections. The lack of efficacy of IVIG suggests that platelet clearance by macrophages through Fc γ receptors is not a primary mechanism in this disease.
Genetic Relationships of Jamestown Canyon Virus Strains Infecting Mosquitoes Collected in Connecticut
Authors: Armstrong Philip M. , Andreadis Theodore G.
Published: September 2018

Jamestown Canyon virus (JCV) (family Bunyaviridae, genus Orthobunyavirus) is maintained in a mosquito-deer cycle and has been implicated in the etiology of meningitis and encephalitis with human cases reported from Ontario, Canada, Michigan, Connecticut, and New York. Despite the recognition of symptomatic cases in the northeastern United States, little is known about the genetic relationships of JCV variants circulating in this region. Accordingly, we compared the phylogenetic relationships of 56 JCV isolates from mosquitoes collected in Connecticut over a 40-year period to evaluate their evolutionary history and characterize patterns of genetic diversity in the state. We distinguished at least two major lineages in Connecticut on the basis of phylogenetic reconstruction of small (S), medium (M), and large (L) segment nucleotide sequences. Viruses representing each lineage infected a diverse group of mosquito species over multiple years of sampling and appeared to be geographically structured along an east-west axis. One of these lineages was detected in Connecticut from 1966 through 2006 with few mutational changes accumulating over time. Phylogenetic trees generated from portions of the M and L segments yielded different topologies from S segment sequences as three clades became consolidated into two. Although direct evidence for genetic exchange by reassortment was lacking among cocirculating strains in Connecticut, molecular trees from S, M, and L segments were incongruent, which suggests a distinct evolutionary history or process for each genomic segment. These results suggest that JCV variants are stably maintained in Connecticut where they infect a wide diversity of mosquito species.
Scaling Up Malaria Control in Africa: An Economic and Epidemiological Assessment
Authors: Teklehaimanot Awash , McCord Gordon C. , Sachs Jeffrey D.
Published: September 2018

This paper estimates the number of people at risk of contracting malaria in Africa using GIS methods and the disease’s epidemiologic characteristics. It then estimates yearly costs of covering the population at risk with the package of interventions (differing by level of malaria endemicity and differing for rural and urban populations) for malaria as recommended by the UN Millennium Project. These projected costs are calculated assuming a ramp-up of coverage to full coverage by 2008, and then projected out through 2015 to give a year-by-year cost of meeting the Millennium Development Goal for reducing the burden of malaria by 75%. We conclude that the cost of comprehensive malaria control for Africa is US$3.0 billion per year on average, or around US$4.02 per African at risk.
Emergency Liver Transplantation in Amodiaquine-Induced Fulminant Hepatitis
Authors: Markham Lydia Novisi , Giostra Emiliano , Hadengue Antoine , Rossier Michel , Rebsamen Michela , Desmeules Jules
Published: September 2018

Amodiaquine is an amino-4-quinoline with the basic spectrum of activity of chloroquine. It has been used widely to treat and prevent malaria. From the mid-1980s, there were reports of fatal adverse drug reactions described in travelers using amodiaquine as antimalarial prophylaxis. In 1990, the World Health Organization (WHO) stopped using this drug in malaria control programs. The WHO Expert Committee on Malaria modified this in 1993 and reported that amodiaquine could be used for treatment if the risk of infection outweighs the potential for adverse drug reactions. Currently, amodiaquine is a potential useful drug, especially if used with artemisinin-based combination therapy and with sulfadoxine-pyrimethamine to improve treatment efficacy for chloroquine-resistant strains of Plasmodium falciparum and P. vivax. We report a case of fulminant hepatitis induced by antimalarial prophylactic use of amodiaquine that necessitated emergency orthotopic liver transplantation.
Infection and Dissemination of Venezuelan Equine Encephalitis Virus in the Epidemic Mosquito Vector, Aedes taeniorhynchus
Authors: Smith Darci R. , Arrigo Nicole C. , Leal Grace , Muehlberger Linda E. , Weaver Scott C.
Published: September 2018

The mosquito Aedes taeniorhynchus is an important epidemic vector of Venezuelan equine encephalitis virus (VEEV), but detailed studies of its infection are lacking. We compared infection by an epidemic VEEV strain to that by an enzootic strain using virus titrations, immunohistochemistry, and a virus expressing the green fluorescent protein. Ae. taeniorhynchus was more susceptible to the epidemic strain, which initially infected the posterior midgut and occasionally the anterior midgut and cardia. Once dissemination beyond the midgut occurred, virus was present in nearly all tissues. Transmission of the epidemic strain to mice was first detected 4 days after infection. In contrast, the enzootic strain did not efficiently infect midgut cells but replicated in muscles and nervous tissue on dissemination. Because VEEV emergence can depend on adaptation to epidemic vectors, these results show that epidemic/enzootic strain comparisons not only comprise a useful model system to study alphavirus transmission by mosquitoes, but also have important public health implications.
Antibody to the Human T-Lymphotropic Virus Type 1 (HTLV-1) Envelope Protein Gp46 in Patients Co-infected with HCV and HTLV-1
Authors: Takeoka Hiroaki , Furusyo Norihiro , Toyoda Kazuhiro , Murata Masayuki , Sagara Yasuko , Kashiwagi Seizaburo , Hayashi Jun
Published: September 2018

Human T-lymphotropic virus type 1 (HTLV-1) infection is known to affect hepatitis C virus (HCV) clearance and to accelerate the development of hepatocellular carcinoma in HCV-infected patients. In this study, we found the prevalence and titer of an antibody recognizing the central region of the HTLV-1 Gp46 protein to be associated with the severity of chronic liver disease. The antibody prevalence was significantly correlated with the stage of chronic liver disease (P < 0.0001): 3 (14.3%) of 21 patients with minimal–mild chronic hepatitis, 12 (24%) of 50 with moderate–severe chronic hepatitis, 7 (87.5%) of 8 with liver cirrhosis, and 13 (100%) of 13 with hepatocellular carcinoma. These results indicate that the antibody may be a useful marker of the deterioration of liver disease in patients co-infected with HCV and HTLV-1. This antibody may be useful for the diagnosis of liver diseases and the development of more effective treatments.
Quick Wins Versus Sustainability: Options for the Upscaling of Insecticide-Treated Nets
Authors: Lengeler Christian , Grabowsky Mark , McGuire David , deSavigny Don
Published: September 2018

A review of the main elements determining strategic choices for the large-scale distribution of insecticide-treated nets (ITNs) clearly shows the need for multiple strategies. Mass distributions of free nets provide a unique opportunity to achieve quickly high coverage rates. However, there is also a need for additional approaches to 1) provide continuous provision of ITNs for newly pregnant women and their babies and 2) provide protection for the rest of the population. Targeted subsidies will continue to be an important tool to achieve the first objective, either through direct distribution of ITNs or through vouchers. To achieve objective 2, a strong and competitive commercial sector for ITNs seems to be a good option. It is clear that “one size doesn’t fit all,” and more experience needs to be gathered and shared. With planning and good promotion campaigns, these strategies can co-exist and re-enforce each other.
Parasite Prevalence: A Static Measure of Dynamic Infections
Authors: O’Meara Wendy Prudhomme , Collins William E. , McKenzie F. Ellis
Published: September 2018

The intensity of malaria transmission is often measured by looking at the fraction of individuals infected at a given point in time. However, malaria infections in individuals are dynamic, leading to uncertainty about whether a cross-sectional survey that represents a single snapshot in time is a useful representation of a temporally complex process. In this analysis, we examine the impact of parasite density fluctuations on the measurement of parasite prevalence. Our results show that parasite prevalence may be underestimated by 20% or more, depending on the sensitivity of parasite detection.
A Polymerase Chain Reaction/Ligase Detection Reaction–Fluorescent Microsphere Assay to Determine Plasmodium falciparum MSP-119 Haplotypes
Authors: Dent Arlene E. , Yohn Christopher T. , Zimmerman Peter A. , Vulule John , Kazura James W. , Moormann Ann M.
Published: September 2018

The merozoite surface protein-1 (MSP-1) is a blood stage antigen currently being tested as a vaccine against Plasmodium falciparum malaria. Determining the MSP-119 haplotype(s) present during infection is essential for assessments of MSP-1 vaccine efficacy and studies of protective immunity in human populations. The C-terminal fragment (MSP-119) has four predominant haplotypes based on point mutations resulting in non-synonymous amino acid changes: E-TSR (PNG-MAD20 type), E-KNG (Uganda-PA type), Q-KNG (Wellcome type), and Q-TSR (Indo type). Current techniques using direct DNA sequencing are laborious and expensive. We present an MSP-119 allele-specific polymerase chain reaction (PCR)/ligase detection reaction–fluorescent microsphere assay (LDR-FMA) that allows simultaneous detection of the four predominant MSP-119 haplotypes with a sensitivity and specificity comparable with other molecular methods and a semi-quantitative determination of haplotype contribution in mixed infections. Application of this method is an inexpensive, accurate, and high-throughput alternative to distinguish the predominant MSP-119 haplotypes in epidemiologic studies.
Implications of Dynamic Changes among Tumor Necrosis Factor-α (TNF-α), Membrane TNF Receptor, and Soluble TNF Receptor Levels in Regard to the Severity of Dengue Infection
Authors: Wang Lin , Chen Rong-Fu , Liu Jien-Wei , Yu Hong-Ren , Kuo Ho-Chang , Yang Kuender D.
Published: September 2018

Tumor necrosis factor-α (TNF-α) and soluble TNF receptors (sTNFR1 and sTNFR2) have been implicated in infectious diseases. We investigated dynamic changes among TNF-α, membrane TNF receptors (mTNFR1 and mTNFR2), and sTNFR1 and sTNFR2 levels for patients with dengue hemorrhagic fever (DHF) and those not infected during a DEN-2 outbreak in southern Taiwan in 2002–2003. Patients with DHF showed the lowest levels of mTNFR1 and mTNFR2 expression. Multivariate analysis showed that a decrease in levels of mTNFR1 expression was the only factor significantly different between patients with DHF and those with dengue fever. Moreover, lower mTNFR1 expression was significantly correlated with higher plasma TNF-α levels, but not with sTNFR1 levels in patients with DHF. This finding suggests that a lower level of mTNFR1 expression in response to a higher plasma TNF-α level may be a pathogenic marker for early detection of DHF.
Taeniasis in Mongolia, 2002–2006
Authors: Myadagsuren Narankhajid , Davaajav Abmed , Wandra Toni , Sandar Tsogtsaikhan , Ichinkhorloo Purevdorj , Yamasaki Hiroshi , Sako Yasuhito , Nakao Minoru , Sato Marcello O. , Nakaya Kazuhiro , Ito Akira
Published: September 2018

Survey on secondary data of taeniasis/cysticercosis was carried out in Mongolia in 2002–2006. A total of 118 taeniid proglottids, a diphyllobothriid segment, and 59 serum samples from 118 taeniasis cases were collected at National Center for Communicable Diseases, Ulaanbaatar, Mongolia. In 2006, 14 serum samples were collected from local people who had histories of epileptic seizures in Selenge Province where pig husbandry was the main business. The 118 proglottids were confirmed to be Taenia saginata by mitochondrial DNA analysis using cytochrome c oxidase subunit 1 and cytochrome b genes. T. saginata taeniasis was widely distributed at least in 10 of 21 provinces. No variation in the nucleotide sequences of the two genes was observed among T. saginata isolates from Mongolia. There was no evidence of Taenia solium taeniasis/cysticercosis or Taenia asiatica taeniasis. A diphyllobothriid segment was confirmed to be Diphyllobothrium latum by mitochondrial DNA analysis.
Seroprevalence of Antibodies to Parvovirus B19 among Children in Papua New Guinea
Authors: Wildig James , Mueller Ivo , Kiniboro Benson , Maraga Seri , Siba Peter , Cossart Yvonne
Published: September 2018

Parvovirus B19 (B19) is a common childhood infection that has recently been found to be associated with severe anemia in Papua New Guinean children. Population surveys were performed in 15 villages in Maprik district, East Sepik Province, Papua New Guinea in 2005. Plasma samples collected from children less than 10 years of age were tested for IgM and IgG antibodies to B19 by enzyme immunoassay. The prevalence of IgG antibody to B19 was 53.8% and ranged from 20% in those less than one year of age to 85.5% in those nine years of age. Considerable variation in IgG prevalence was observed between study areas, indicating complex patterns of transmission. Prevalence of IgM antibody to B19 was 1.5%. This study confirms that B19 infection is common among children in this tropical area. With 19.5% of children one year of age showing evidence of previous infection, any preventive measures should be targeted at the very young.
Combined Molecular and Clinical Assessment of Plasmodium falciparum Antimalarial Drug Resistance in the Lao People’s Democratic Republic (Laos)
Authors: Mayxay Mayfong , Nair Shalini , Sudimack Dan , Imwong Mallika , Tanomsing Naowarat , Pongvongsa Tiengkham , Phompida Samlane , Phetsouvanh Rattanaxay , White Nicholas J. , Anderson Tim J. C. , Newton Paul N.
Published: September 2018

Molecular markers provide a rapid and relatively inexpensive approach for assessing antimalarial drug susceptibility. We collected 884 Plasmodium falciparum–infected blood samples from 17 Lao provinces. Each sample was genotyped for 11 codons in the chloroquine resistance transporter (pfcrt), dihydrofolate reductase (pfdhfr), and dihydropteroate synthase (pfdhps) genes. The samples included 227 collected from patients recruited to clinical trials. The pfcrt K76T mutation was an excellent predictor of treatment failure for both chloroquine and chloroquine plus sulfadoxine-pyrimethamine, and mutations in both pfdhfr and pfdhps were predictive of sulfadoxine-pyrimethamine treatment failure. In multivariate analysis, the presence of the pfdhfr triple mutation (51 + 59 + 108) was strongly and independently correlated with sulfadoxine-pyrimethamine failure (odds ratio = 9.1, 95% confidence interval = 1.4–60.2, P = 0.017). Considerable geographic heterogeneity in allele frequencies occurred at all three loci with lower frequencies of mutant alleles in southern than in northern Laos. These findings suggest that chloroquine and sulfadoxine-pyrimethamine are no longer viable therapy in this country.
Experience with Intravenous Metronidazole to Treat Moderate-to-Severe Amebiasis in Japan
Authors: Kimura Mikio , Nakamura Tetsuya , Nawa Yukifumi , _ _
Published: September 2018

Twenty-eight cases of either intestinal amebiasis, amebic liver abscess, or both, most of which were of moderate-to-severe intensity, were treated with intravenous metronidazole, pioneered by the Research Group on Chemotherapy of Tropical Diseases, Japan. This study was not conducted as a formal clinical trial, and all patients either underwent colectomy for intestinal amebiasis, received oral metronidazole, or both. Despite these limitations, intravenous metronidazole was shown to be well tolerated and seemed to be very effective. This agent should be more widely recommended than previously thought for treating moderate-to-severe amebiasis, especially its intestinal form.
Signs and Symptoms Predictive of Respiratory Failure in Patients with Foodborne Botulism in Thailand
Authors: Wongtanate Manas , Sucharitchan Niwatchai , Tantisiriwit Kanit , Oranrigsupak Petchdee , Chuesuwan Aphinya , Toykeaw Sukumal , Suputtamongkol Yupin
Published: September 2018

We conducted a clinical study of 137 patients with home-canned bamboo shoot botulism at Nan Hospital, northern Thailand. The median age of the patients was 44 years (range = 14–74 years) and 36.2% were male. The median incubation period was 2 days (range = 1–8 days). Forty-three patients (31.4%) developed respiratory failure, but there were no deaths. Patients who did not have either nausea or vomiting and did not have urinary retention that required Foley catherization was less likely to develop respiratory failure. This clinical predictor rule had a sensitivity of 75.5% and a specificity of 90.7%. The clinical syndrome most predictive of respiratory failure was nausea or vomiting and any cranial neuropathy with urinary retention or difficulty swallowing. This clinical syndrome had a sensitivity of 69.8% and a specificity of 93.6%. These clinical characteristics could help triage large numbers of patient in the event of a future outbreak.
Concurrent Infections in Acute Febrile Illness Patients in Egypt
Authors: Parker Tina M. , Murray Clinton K. , Richards Allen L. , Samir Ahmed , Ismail Tharwat , Fadeel Moustafa Abdel , Jiang Ju , Wasfy Momtaz O. , Pimentel Guillermo
Published: September 2018

We report the occurrence of concurrent infections with multiple acute febrile illness (AFI) pathogens during an ongoing prospective laboratory-based surveillance in four infectious disease hospitals in urban and rural areas of Egypt from June 2005 to August 2006. Patients were screened for Leptospira, Rickettsia typhi, Brucella, or Salmonella enterica serogroup Typhi by various methods including serology, culture, and PCR. One hundred eighty-seven of 1,510 patients (12.4%) evaluated had supporting evidence for the presence of coinfections; 20 (1%) of these patients had 2 or more pathogens based upon confirmatory 4-fold rise in antibody titer, culture, and/or PCR. Most coinfected patients lived or worked in rural agricultural areas. The high coinfection rates suggest that defining the etiologies of AFI is imperative in guiding proper disease treatment, prevention, and control strategies in Egypt.
Use of Handheld Computers with Global Positioning Systems for Probability Sampling and Data Entry in Household Surveys
Authors: Vanden Eng Jodi L. , Wolkon Adam , Frolov Anatoly S. , Terlouw Dianne J. , Eliades M. James , Morgah Kodjo , Takpa Vincent , Dare Aboudou , Sodahlon Yao K. , Doumanou Yao , Hawley William A. , Hightower Allen W.
Published: September 2018

We introduce an innovative method that uses personal digital assistants (PDAs) equipped with global positioning system (GPS) units in household surveys to select a probability-based sample and perform PDA-based interviews. Our approach uses PDAs with GPS to rapidly map all households in selected areas, choose a random sample, and navigate back to the sampled households to conduct an interview. We present recent field experience in two large-scale nationally representative household surveys to assess insecticide-treated bed net coverage as part of malaria control efforts in Africa. The successful application of this method resulted in statistically valid samples; quality-controlled data entry; and rapid aggregation, analyses, and availability of preliminary results within days of completing the field work. We propose this method as an alternative to the Expanded Program on Immunization cluster sample method when a fast, statistically valid survey is required in an environment with little census information at the enumeration area level.
Tetanus-Induced Acute Kidney Injury in a Renal Transplant Recipient
Authors: Lima Emerson Q. , Silva Ricardo G. , Fernandes Ida M. M. , Abbud-Filho Mário , Burdmann Emmanuel A.
Published: September 2018

A 48-year-old renal transplant recipient who developed tetanus 6 years after transplantation is described. His immunosuppressive protocol was mofetil mycophenolate, sirolimus, and prednisone. The patient presented symptoms of severe tetanus with autonomic dysfunction, requiring ICU care and mechanical ventilation. His clinical course was marked by development of tetanus-induced acute kidney injury and sepsis. He was discharged after 37 days of hospitalization with recovered renal function. Tetanus is a preventable disease associated with a high fatality rate. Its treatment is difficult and requires specialized and intensive care. This case highlights the crucial importance of following adequate immunization guidelines in transplant recipients.
Toxoplasma gondii Infection in the United States, 1999–2004, Decline from the Prior Decade
Authors: Jones Jeffrey L. , Kruszon-Moran Deanna , Sanders-Lewis Kolby , Wilson Marianna
Published: September 2018

Toxoplasma gondii can cause congenital, neurologic, ocular, and mild or asymptomatic infection. To determine the U.S. prevalence of T. gondii infection, we tested sera collected from the National Health and Nutrition Examination Survey (NHANES) 1999–2004 for T. gondii immunoglobulin G antibodies in persons 6–49 years old and contrasted the results to those comparable in NHANES III (1988–1994) (ages 12–49 years). Of the 17,672 persons examined in NHANES 1999–2004, 15,960 (90%) were tested. The age-adjusted T. gondii seroprevalence among persons 6–49 years old was 10.8% (95% confidence limits [CL] 9.6%, 11.9%), and among women 15–44 years old, 11.0% (95% CL 9.5%, 12.4%). T. gondii seroprevalence declined from 14.1% to 9.0% (P < 0.001) from NHANES III to NHANES 1999–2004 among U.S.-born persons ages 12–49 years. Although T. gondii infects many persons in the U.S., the prevalence has declined in the past decade.
Selection of Antifolate-Resistant Plasmodium falciparum by Sulfadoxine-Pyrimethamine Treatment and Infectivity to Anopheles Mosquitoes
Authors: Méndez Fabián , Herrera Sócrates , Murrain Bermans , Gutiérrez Andrés , Moreno Luz A. , Manzano María , Muñoz Álvaro , Plowe Christopher V.
Published: September 2018

Resistance-conferring mutations in dihydrofolate reductase (DHFR) and dihydropteroate synthase (DHPS) in Plasmodium falciparum are selected by treatment with sulfadoxine pyrimethamine (SP). We assessed the association between these mutations and transmission capacity of parasites to Anopheles mosquitoes on the Pacific coast of Colombia. Patients with uncomplicated P. falciparum malaria received SP treatment and were followed-up to compare the prevalence of DHFR and DHPS mutations before and after SP treatment. Membrane feeding assays were used to measure infectivity to mosquitoes of post-treatment gametocytes with and without these mutations. Per-protocol treatment efficacy was 95.0% (132 of 139). Gametocytes carrying resistance-conferring mutations were selected after SP treatment and were infective to mosquitoes. Seven days after treatment, infections with two DHFR mutations had a 10-fold higher probability of infecting mosquitoes than infections with no DHFR mutations (odds ratio = 10.23, P < 0.05). Low-level drug resistance mutations have the potential to enhance transmission of P. falciparum and spread resistant parasites.
Development of a Molecular Assay to Detect Predation on Anopheles gambiae Complex Larval Stages
Authors: Schielke Erika , Costantini Carlo , Carchini Gianmaria , Sagnon N’Falé , Powell Jeffrey , Caccone Adalgisa
Published: September 2018

We developed a molecular assay to detect predation on Anopheles gambiae sensu lato (s.l.) mosquitoes. This intergenic spacer ribosomal DNA polymerase chain reaction assay and restriction enzyme analysis uses An. gambiae-specific primers to detect mosquito DNA in the DNA extracts from whole invertebrate predators, which enables identification of species (An. gambiae s.s. versus An. arabiensis) and molecular forms (M versus S in An. gambiae s.s.). We show that An. gambiae s.l. DNA can be detected after ingestion by members of the families Lestidae (order Odonata) after four hours, Libellulidae (order Odonata) after six hours, and Notonectidae (order Hemiptera) after 24 hours. This method is an improvement over previously published methods because of ease of execution and increased time of detection after ingestion.
Combined Sewage Overflows (CSO) Are Major Urban Breeding Sites for Culex quinquefasciatus in Atlanta, Georgia
Authors: Calhoun Lisa M. , Avery Melissa , Jones LeeAnn , Gunarto Karina , King Raymond , Roberts Jacquelin , Burkot Thomas R.
Published: September 2018

A longitudinal study of mosquito ecology in Tanyard Creek, an urban stream in Atlanta, GA, that receives combined storm and waste water effluent from the Atlanta combined sewage overflow system, was undertaken in 2006. Culex quinquefasciatus was the dominant species found, but Culex restuans was also abundant during the spring with limited numbers of Culex nigripalpis and Anopheles punctipennis also collected. Significant differences in mosquito densities were found with greater densities associated with side pools of water and stagnant water. Mosquito numbers are regulated largely by flooding of the stream by effluent discharges exceeding 15 kgal/min. These floods are associated with significant immediate reductions, but not complete elimination, of mosquitoes from Tanyard Creek. Mosquito numbers rebound within 5–10 days after such floods and rapidly reach high densities.
Long-Term Disability from Acute Childhood Japanese Encephalitis in Shanghai, China
Authors: Ding Ding , Hong Zhen , Zhao Shou-jun , Clemens John D. , Zhou Bin , Wang Bei , Huang Mao-sheng , Zeng Jun , Guo Qi-hao , Liu Wei , Tao Fang-biao , Xu Zhi-Yi
Published: September 2018

We traced 85 Japanese encephalitis (JE) patients, 6–27 years after hospitalizations. The first control group was made up of 73 non-JE encephalitis patients 6–27 years previously, whereas the second control group was made up 78 neighborhood residents, matched to the 78 surviving JE cases by age, sex, and residence. All subjects were examined with neurologic examinations, intelligence quotient (IQ) measurement, Mini-Mental State Examinations (MMSE), and activities of daily living (ADL) assessments. At follow-up, 22% of JE patients had objective neurologic deficits compared with 3% of non-JE encephalitis patients. Moreover, 28% of JE patients had subnormal IQs, as opposed to 2% non-JE encephalitis patients. Abnormal ADL scores were only noted in 15% JE patients. All neighborhood controls had normal examination results, and one non-JE encephalitis case showed mildly reduced IQ. The study showed that significant neurologic and overall functional disability were evident in a high proportion of JE survivors many years after their index hospitalizations.
Differentiation of Patients with Leprosy from Non-Infected Individuals by the Chemokine Eotaxin/CCL11
Authors: Mendonça Vanessa A. , Malaquias Luiz C. , Brito-Melo Gustavo E. , Castelo-Branco Alexandre , Antunes Carlos M. , Ribeiro Antonio L. , Teixeira Mauro M. , Teixeira Antonio L.
Published: September 2018

Diagnosis of leprosy is usually made clinically and there are no tests available for the routine laboratory diagnosis of the disease. The aim of this study was to investigate the potential role of chemokines as biologic markers of disease activity. We used an enzyme-linked immunosorbent assay to measure chemokines in plasma of patients with leprosy (LE) and non-infected (NI) individuals. There were significantly greater concentrations of the chemokines CCL3 and CCL11 in plasma of LE patients than in NI individuals. When the use of CCL11 to differentiate LE patients versus NI individuals was evaluated, the area under the receiver-operator-characteristic curve was 0.95 ± 0.03 (P < 0.0001). In a group of selected individuals, CCL11 was useful in diagnosis of leprosy, thereby suggesting that measurement of this chemokine may be useful as an aid in diagnosing leprosis.
Cutaneous Extensively Drug-Resistant Tuberculosis
Authors: Olson Douglas P. , Day Cheryl L. , Magula Nombulelo P. , Sahid Faieza , Moosa Mahomed-Yunus S.
Published: September 2018

A 48-year-old immunocompetent man without known exposure to tuberculosis had a > 10-year history of recurrent skin lesions. Cutaneous tuberculosis without any current or past history of pulmonary tuberculosis was diagnosed. Culture of biopsy specimens showed the organism to be resistant to multiple first-line and second-line agents. The patient had a broad, vigorous CD4-specific immune response against multiple tuberculosis antigens. This case is the first report of cutaneous extensively drug-resistant tuberculosis.
Relationship of Hepcidin with Parasitemia and Anemia among Patients with Uncomplicated Plasmodium falciparum Malaria in Ghana
Authors: Howard Caitlin T. , McKakpo Uri S. , Quakyi Isabella A. , Bosompem Kwabena M. , Addison Ebenezer A. , Sun Kai , Sullivan David , Semba Richard D.
Published: September 2018

The pathogenesis of malarial anemia is incompletely understood. Hepcidin, a recently discovered peptide hormone, is a major regulator of iron metabolism and is thought to play a central role in the anemia of chronic inflammation. The specific aim of the study was to characterize the association between urinary hepcidin, hemoglobin, and parasitemia in 199 patients presenting for evaluation of Plasmodium falciparum malaria in Ghana. Urinary hepcidin was semi-quantitatively assessed using surface-enhanced laser desorption/ionization time-of-flight mass spectrometry. Urinary hepcidin (intensity/mmol creatinine) was associated with log parasitemia in 86 children (beta = 0.086, standard error [SE] = 0.035, P < 0.017), 31 pregnant women (beta = 0.218, SE = 0.085, P < 0.016), and 82 adults (beta = 0.184, SE =0.043, P < 0.0001). Urinary hepcidin was not significantly associated with hemoglobin or anemia. Urinary hepcidin is more strongly associated with parasitemia than hemoglobin or anemia among patients with acute P. falciparum malaria in Ghana.
A Randomized Clinical Trial Comparing Oral Azithromycin and Meglumine Antimoniate for the Treatment of American Cutaneous Leishmaniasis Caused by Leishmania (Viannia) braziliensis
Authors: Krolewiecki Alejandro J. , Romero Héctor D. , Cajal Silvana P. , Abraham David , Mimori Tatsuyuki , Matsumoto Tamami , Juarez Marisa , Taranto Nestor J.
Published: September 2018

Azithromycin was compared with meglumine antimoniate for treatment of patients with cutaneous leishmaniasis. Patients were randomized to receive oral azithromycin, 500 mg/day (22 patients) or intramuscular meglumine antimoniate, 10 mg Sb/kg/day (23 patients), both for 28 days, with a second cycle of 15 days if necessary, and followed-up for one year after completion of treatment. Efficacy, defined as complete re-epithelization without relapse for 12 months after completing therapy, was 82.6% (95% confidence interval [CI] = 67–98%) for meglumine antimoniate and 45.5% (95% CI = 25–66%) for azithromycin. All patients who failed treatment with azithromycin were treated with meglumine antimoniate and clinically cured. Azithromycin was well tolerated; meglumine antimoniate caused arthralgias and local symptoms in 78% of the patients. In 17 cases, species identification was obtained; Leishmania (Viannia) braziliensis was identified in all of them. For the treatment of American cutaneous leishmaniasis caused by L. (V.) braziliensis, meglumine antimoniate is significatively more efficacious than azithromycin, which was clinically curative in almost half of the patients and well-tolerated.
Genetic Influences on Mosquito Feeding Behavior and the Emergence of Zoonotic Pathogens
Authors: Kilpatrick A. Marm , Kramer Laura D. , Jones Matthew J. , Marra Peter P. , Daszak Peter , Fonseca Dina M.
Published: September 2018

The feeding behavior of vectors influences the likelihood of pathogen invasion and the exposure of humans to vector-borne zoonotic pathogens. We used multilocus microsatellite genetic typing of an introduced mosquito vector and DNA sequencing of mosquito blood meals to determine the impact of hybrid ancestry on feeding behavior and the emergence of West Nile virus (WNV). The probability of ancestry of Culex pipiens mosquitoes from two bionomically divergent forms, form molestus and form pipiens, influenced the probability that they fed on humans but did not explain a late summer feeding shift from birds to humans. We used a simple model to show that the occurrence of pure form molestus mosquitoes would have decreased the likelihood of WNV invasion (R0 in bird populations) 3- to 8-fold, whereas the occurrence of pure forms pipiens mosquitoes would have halved human exposure compared with the hybrids that are present. Data and modeling suggest that feeding preferences may be influenced by genetic ancestry and contribute to the emergence of vector-borne pathogens transmitted by introduced species, including malaria, and dengue, Chikungunya, yellow fever, and West Nile viruses.
The Relative Influence of Polyparasitism, Environment, and Host Factors on Schistosome Infection
Authors: de Cássia Ribeiro Silva Rita , Barreto Maurício Lima , Assis Ana Marlúcia Oliveira , de Santana Mônica Leila Portela , Parraga Isabel M. , Reis Mitermayer Galvão , Blanton Ronald E.
Published: September 2018

Where prevalence of geohelminths and schistosomes is high, co-infections with multiple parasite species are common. Previous studies have shown that the presence of geohelminths either promotes or is a marker for greater prevalence and intensity of Schistosoma mansoni infections. Some of this apparent synergy may simply represent shared conditions for exposure, such as poor sanitation, and may not suggest a direct biologic interaction. We explored this question in a study of 13,279 school children in Jequié, Bahia, Brazil, with a survey of demographic characteristics and stool examinations. Cross-sectional analysis revealed a statistically significant increase in the prevalence and intensity of S. mansoni infection with increasing numbers of geohelminth species (OR 2.5, 95% CI 1.38–3.64). Less than 20% of the strength of this association was contributed by socioeconomic status or environmental conditions. Thus, polyparasitism itself, as well as intrinsic host factors, appears to produce greater susceptibility to additional helminth infections.
T Regulatory Cell Levels Decrease in People Infected With Schistosoma mansoni on Effective Treatment
Authors: Watanabe Kanji , Mwinzi Pauline N. M. , Black Carla L. , Muok Erick M. O. , Karanja Diana M. S. , Secor W. Evan , Colley Daniel G.
Published: September 2018

Schistosomiasis mansoni is usually a chronic infection that leads to long-term, systemic exposure to schistosome antigens. Experimental Schistosoma mansoni infection is associated with immunoregulatory mechanisms, including T regulatory cells (Treg) that may help control morbidity and dampen resistance to re-infection. We now show that some schistosomiasis mansoni patients have high proportions of CD3+/CD4+/CD25high Treg. On effective treatment with praziquantel, these high Treg percentages decrease, and fewer of the remaining Treg express CD45RO. The proportion of Treg in S. mansoni–infected patients is inversely related to their percentage of activated, putative effector T cells (CD3+/CD4+/CD25medium/HLA-DR+ cells). We conclude some, but not all, schistosomiasis mansoni patients develop high percentages of circulating Treg, and effective treatment both decreases the levels of these cells and changes their phenotypes, possibly because of the removal of constant exposure to antigens from intravascular, egg-producing adult worms.
Increased Detection Rate of Strongyloides stercoralis by Repeated Stool Examinations Using the Agar Plate Culture Method
Authors: Hirata Tetsuo , Nakamura Hiroshi , Kinjo Nagisa , Hokama Akira , Kinjo Fukunori , Yamane Nobuhisa , Fujita Jiro
Published: September 2018

To clarify the efficacy of repeated stool examinations by the agar plate culture method for the detection of Strongyloides stercoralis infection, 4,071 stool samples collected from 2,406 patients > 50 years of age in Ryukyu University Hospital were examined. The cumulative detection rate of S. stercoralis infection was 4.7% (112/2,406). At the first, second, third, and beyond fourth examinations, the detection rates were 3.6% (86/2,406), 1.5% (12/786), 2.6% (10/392), and 2.0% (4/198), respectively. From these results, the cumulative detection rate was estimated to be 7.4% when three stool samples were examined for all patients. Our study showed that repeated stool examinations increase the sensitivity of detection of S. stercoralis infection.