Transactions of The Royal Society of Tropical Medicine and Hygiene最新文献

{"title":"Whose sepsis? Tropical infections and the limits of contemporary sepsis evidence.","authors":"Praveen Kumar Tirlangi, Nitin Gupta","doi":"10.1093/trstmh/trag132","DOIUrl":"https://doi.org/10.1093/trstmh/trag132","url":null,"abstract":"","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Out-of-pocket expenditure in dermatophytosis: a prospective observational study from a tertiary care center in India.","authors":"Manavi Gupta, Sukhdeep Singh, Sheetal Thakur, Kavita Kavita, Shankar Prinja, Sunil Dogra, Tarun Narang","doi":"10.1093/trstmh/trag126","DOIUrl":"https://doi.org/10.1093/trstmh/trag126","url":null,"abstract":"<p><strong>Objectives: </strong>Superficial dermatophytosis (tinea) has emerged as a chronic, relapsing public health problem in India, leading to repeated healthcare visits and increasing out-of-pocket expenditure (OOPE). This study aimed to estimate the magnitude and pattern of OOPE among patients with dermatophytosis attending a tertiary care hospital and identify major contributors to overall expenditure.</p><p><strong>Methods: </strong>This prospective observational study included 102 patients with clinically and mycologically confirmed dermatophytosis. Data were collected using a structured questionnaire capturing demographic, socioeconomic, and disease-related variables. Costs related to medications, diagnostics, travel, food, lodging, and hospital-user fees were recorded at baseline and at first and second month follow-up. Expenditures were calculated in Indian rupees (₹) and converted to US dollars ($).</p><p><strong>Results: </strong>The mean OOPE during the first month was ₹3492 ± 6112 ($38.9 ± 68.0), ranging from ₹100 to ₹9100. Medicines constituted the largest share (₹1899.6 ± 2893.6), followed by travel costs (₹824.8 ± 841.6). Other components contributed minimally. In the second month, mean OOPE declined to ₹2340.8 ± 1013.8 ($26.0 ± 11.3). The average monthly household income was ₹42 720.5, with first-month OOPE accounting for ∼8%-10%.</p><p><strong>Conclusion: </strong>Dermatophytosis imposes a substantial financial burden, mainly due to medication and travel costs. Improving affordable antifungal access and public health programs may reduce OOPE.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seroprevalence and risk factors of hepatitis E virus infection in a rural Argentine community: a cross-sectional study.","authors":"M A Rivero, L P Arce, S E Gutiérrez, A Tisnés, J A Silva, B Alegretti, A Barón Prato, S M Estein, M G Vizoso Pinto","doi":"10.1093/trstmh/trag125","DOIUrl":"https://doi.org/10.1093/trstmh/trag125","url":null,"abstract":"<p><strong>Background: </strong>Hepatitis E virus (HEV) is a leading cause of acute viral hepatitis worldwide. Rural populations and pig production systems in Argentina may be at increased risk of HEV exposure; however, epidemiological data from these settings remain scarce.</p><p><strong>Methods: </strong>A cross-sectional study was conducted among residents of a rural community. Serum samples from 90 residents were tested for anti-HEV immunoglobulin G. Participants completed structured questionnaires and residential addresses were georeferenced to evaluate exposures and spatial distribution.</p><p><strong>Results: </strong>Rural residents reported greater exposure to homemade pork and wild boar sausages, wastewater, untreated well water, agricultural settings, livestock, rodents and flood-prone areas compared with levels previously documented in the urban population of the same region. The overall seroprevalence was 23.3% (95% confidence interval 14.0 to 32.6). Age and history of constipation were related with seropositivity. Rodent presence was more frequent in households of seropositive individuals, while feline contact coincided with reduced rodent occurrence. Spatial analysis identified one high-risk cluster (71.4% [5/7], p>0.05) of seropositivity and one low-risk cluster (0% [0/14], p>0.05), the latter corresponding to areas where contact with felines is greater.</p><p><strong>Conclusions: </strong>HEV exposure may be substantial in this Argentine rural community, supporting the need for integrated One Health surveillance targeting sanitation, reservoirs and food safety. Larger studies are warranted to validate these findings and better define transmission pathways.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Entomological response to control interventions during the first chikungunya and dengue outbreak in White Nile, Sudan.","authors":"Set Alnafer Magdy Aljaily, Ismail Ali Yousif Hamed, Khalid Sarour Mustafa, Ezeirig Awad Ezeirig Musa, Abdel Kreem Ahmed Abdel Kareem, Eiman Mohmmed Adam Ibrahim, Marc S Halfon, Rasha Siddig Azrag","doi":"10.1093/trstmh/trag120","DOIUrl":"https://doi.org/10.1093/trstmh/trag120","url":null,"abstract":"<p><strong>Background: </strong>White Nile State in south-central Sudan experienced its first documented outbreak of dengue and chikungunya in 2022. The present study evaluates the entomological response following an integrated vector management package implemented during the outbreak in Tandalti town.</p><p><strong>Methods: </strong>Longitudinal entomological surveillance across 10 clusters encompassing 600 households and 2500 containers was conducted from July to December 2022. Stegomyia indices together with per-container productivity of larvae and pupae were calculated to quantify container infestation and evaluate entomological changes following the intervention.</p><p><strong>Results: </strong>Widespread Aedes aegypti infestation was documented across all clusters, with clay pots (zeers) and barrels accounting for 97.1% of positive containers. Following the implementation of control interventions, Stegomyia indices decreased substantially from September to December (house index by 78.2%, container index by 35.1%, Breteau index by 92.8% and pupal/demographic index by 94.1%) and total immatures decreased by 89.5% (larvae) and 95.5% (pupae). The few residual containers remaining in December were still producing pupae at per-container rates comparable to baseline, with barrels sustaining higher productivity than zeers.</p><p><strong>Conclusions: </strong>The decrease in vector density is a combined effect of the control interventions and the wet to dry seasonal transition. Combining Stegomyia indices with per-container productivity identifies and quantifies residual containers sustaining the vector population. Sustained post-outbreak surveillance is needed, as these residual containers may contribute to vector population resurgence during subsequent transmission seasons.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Probable Ophiophagus sp. envenomation with cardiopulmonary arrest: sequential antivenom escalation in the Philippines.","authors":"Paolo S Ortillo, Yoshihiro Aoki, Jonathan Paghubasan, Patrick Joseph Tiglao, Kyoko Yamamoto, Kensuke Takahashi, Shuhei Yamano, Koichi Hayakawa, Osamu Tasaki, Maria Rizza D Devora","doi":"10.1093/trstmh/trag127","DOIUrl":"https://doi.org/10.1093/trstmh/trag127","url":null,"abstract":"<p><p>Snakebite envenomation remains a leading cause of preventable mortality in Southeast Asia. We report a 52-year-old woman from Leyte, Philippines, who sustained a bite from a probable king cobra (Ophiophagus sp.) and arrived at a tertiary center in cardiopulmonary arrest. Return of spontaneous circulation was achieved after a single resuscitation cycle. Initial treatment with Purified Cobra Antivenom, a monovalent product directed against Naja philippinensis, produced only minimal improvement. Escalation to Taradoc® (VINS Bioproducts Limited, India), a trivalent antivenom with additional coverage for Ophiophagus sp., was followed by progressive neurologic recovery, extubation on hospital day 3, and discharge without deficits. This case illustrates the potential role of polyvalent antivenom escalation in elapid envenomation refractory to monovalent therapy.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Albendazole ointment: a potentially safe, painless, and effective therapy for cutaneous larva migrans during pregnancy.","authors":"Alfonso Gotor-Rivera, Elena Porres-López, Pablo L Ortiz-Romero, María Asunción Pérez-Jacoiste Asín","doi":"10.1093/trstmh/trag117","DOIUrl":"https://doi.org/10.1093/trstmh/trag117","url":null,"abstract":"<p><strong>Objectives: </strong>We report two cases of cutaneous larva migrans in pregnant women.</p><p><strong>Methods: </strong>Due to pregnancy, systemic therapy was not considered. Limited efficacy of cryotherapy and unavailability of topical thiabendazole led to the in-office preparation of 10% albendazole ointment.</p><p><strong>Results: </strong>Application of this compound thrice daily under occlusion for 10 days led to complete resolution without recurrence. No safety signals were reported during pregnancy follow-up and until birth.</p><p><strong>Conclusion: </strong>Topical albendazole may be an effective, safe, and painless treatment of cutaneous larva migrans. Larger studies are needed to confirm its efficacy and safety, though previous experience supports its use.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ambiguities in WHO rabies immunization recommendations: implications for clinical practice.","authors":"Sher Bahadur Pun, Krishna Prasad Acharya","doi":"10.1093/trstmh/trag123","DOIUrl":"https://doi.org/10.1093/trstmh/trag123","url":null,"abstract":"","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preparedness of primary health centres for snakebite management and challenges faced by healthcare providers: a mixed-methods study from a selected district, southern India.","authors":"Amar Gumataj, Palanivel Chinnakali, Chanaveerappa Bammigatti, Rashmi Basapure, Madhanraj Ayyanar, Vivekanandan Thandapani, Senthil Kumar Samraj, Ganesh Kumar S","doi":"10.1093/trstmh/trag121","DOIUrl":"https://doi.org/10.1093/trstmh/trag121","url":null,"abstract":"<p><strong>Objectives: </strong>Primary health centres (PHCs) are the first point-of-care in rural settings for snakebite management and are expected to provide early management, including anti-snake venom (ASV) administration. However, evidence on their functional readiness and operational challenges remains limited. This study assessed PHC preparedness for snakebite management and explored challenges faced by healthcare providers in a district of Tamil Nadu, India.</p><p><strong>Methods: </strong>A convergent mixed-methods study was conducted across 65 PHCs. Quantitative data on preparedness were collected using a structured checklist. Qualitative data from 12 in-depth interviews with healthcare providers were analysed using descriptive content analysis.</p><p><strong>Results: </strong>Most PHCs demonstrated high structural preparedness, with availability of ASV (96.9%) and trained healthcare providers (93.8%). Although 44 centres (67.7%) reported at least one snakebite case in the preceding 3 months, only two PHCs (4.5%) managed cases at the PHC level. Qualitative findings revealed a consistent pattern of early referral, driven by provider hesitancy to administer ASV because of a fear of adverse reactions and social pressure, limited hands-on training, inadequate capacity for adverse-event monitoring, and workforce constraints. Community care-seeking behaviour further contributed to underutilisation of PHCs.</p><p><strong>Conclusion: </strong>Despite high structural preparedness, functional readiness for snakebite management at PHCs remains limited, highlighting a critical implementation gap. Strengthening emergency preparedness, practical training, and addressing systemic and socio-behavioural barriers are essential to improve early management and reduce preventable mortality.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New-onset refractory status epilepticus with a hyperferritinemic hyperinflammatory phenotype in Kyasanur Forest Disease.","authors":"Praveen Kumar Tirlangi, Anjely Sebastian, Muralidhar Varma, Nitin Gupta","doi":"10.1093/trstmh/trag122","DOIUrl":"https://doi.org/10.1093/trstmh/trag122","url":null,"abstract":"<p><strong>Background: </strong>Kyasanur Forest Disease (KFD) is a tick-borne flaviviral infection endemic to India. While neurological manifestations are recognized, new-onset refractory status epilepticus (NORSE) has not been previously reported. We describe NORSE in the setting of severe KFD-associated hyperinflammation and multiorgan dysfunction.</p><p><strong>Case presentation: </strong>A 53-year-old previously healthy woman with virologically confirmed KFD developed generalized tonic-clonic seizures that progressed to NORSE during a severe systemic illness. She had profound cytopenias, severe hepatitis, coagulopathy, myocarditis, acute kidney injury, and marked hyperferritinemia, with a peak ferritin concentration of 14,466 ng/ml, consistent with a macrophage activation-like hyperinflammatory phenotype. Neurological evaluation demonstrated normal brain magnetic resonance imaging and non-inflammatory cerebrospinal fluid. CSF reverse-transcription polymerase chain reaction for KFD virus was negative, and no alternative evidence of central nervous system infection was identified. The patient required mechanical ventilation, multiple anti-seizure medications, continuous anesthetic therapy, ketamine, and corticosteroids for control of refractory status epilepticus. Seizure burden subsequently declined in parallel with improvement in systemic inflammation and multiorgan dysfunction. Ferritin decreased from 14,466 to 834 ng/ml, accompanied by progressive neurological and organ recovery.</p><p><strong>Conclusions: </strong>NORSE may represent a rare neurological manifestation of severe KFD. In this case, the absence of demonstrable central nervous system infection, together with the temporal association between systemic hyperinflammation and seizure activity, raises the possibility that KFD-associated immune dysregulation contributed to the development of NORSE. Recognition of this potential association may be important when evaluating neurological deterioration in patients with severe KFD and hyperinflammatory multiorgan disease..</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistence of leprosy in northeast Brazil: epidemiological characterization and spatial distribution over a decade.","authors":"Welleson Sousa da Silva, Sabryna Fukahori Barbosa, Luís Gabriel Dos Santos Gomes, Almir Honório Torres, Israel Gomes de Amorim Santos, Leticia Pereira Bezerra, Rosália Elen Santos Ramos","doi":"10.1093/trstmh/trag119","DOIUrl":"https://doi.org/10.1093/trstmh/trag119","url":null,"abstract":"<p><p>Leprosy is an infectious disease caused by Mycobacterium leprae, predominantly affecting vulnerable populations. This study analysed the spatial and spatiotemporal distribution of leprosy cases in northeast Brazil and their epidemiological characteristics. An ecological study used reported cases from the Notifiable Diseases Information System between 2013 and 2022. The incidence rate was the main indicator. Global and local Moran's I indices assessed spatial autocorrelation, while spatiotemporal scan statistics identified high-risk clusters. Results were significant at p<0.05. During the study period, 140 881 cases were reported, with the highest incidences in Maranhão, Pernambuco and Bahia. Individuals 40-69 y of age, males and those self-declared as brown race/colour were most affected. Borderline and Virchowian forms were most frequently reported (n=58 211 [41.32%] and n=24 195 [17.17%], respectively). Grade 0 accounted for most notifications, with a prevalence of 135.86 and an incidence rate of 9.72. Positive spatial autocorrelation was identified (I=0.052683). High-high clusters occurred in most states, except Sergipe, Alagoas, Paraíba and Rio Grande do Norte. Spatiotemporal analysis revealed a primary cluster comprising municipalities in Maranhão, Piauí, Bahia, Pernambuco and Ceará. These findings identify priority areas for surveillance and control in northeast Brazil.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}