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

{"title":"Predicting challenges and opportunities in improving snakebite envenoming management in Ghana.","authors":"Eric Nyarko, Usamudeen Siiba, Aashna Uppal, Nicholas Amani Hamman, Nuhu Mohammed, Paul Kingpriest, Trudie Lang","doi":"10.1093/trstmh/trag043","DOIUrl":"10.1093/trstmh/trag043","url":null,"abstract":"<p><strong>Background: </strong>Snakebite envenoming (SBE) is a neglected tropical disease and a major public health crisis in Africa. We integrated a maximum difference experimental design and machine learning (ML) models to predict challenges and opportunities for improving SBE management in Ghana.</p><p><strong>Methods: </strong>This cross-sectional study included 137 healthcare workers, identified through multistage sampling, from August to December 2024 in two districts of the Eastern Region, Ghana. We employed five-fold cross-validation and analysed the dataset using 12 ML models.</p><p><strong>Results: </strong>The most significant obstacle to managing SBE was 'delayed health-seeking behaviour by patients', followed by 'high cost of treatment' and 'inadequacy/shortage of antivenom'. On the opportunity side, 'increasing public awareness and knowledge about snakebite prevention and initial management before reaching a healthcare facility' was deemed crucial. Other opportunities such as 'conducting research into alternative management for snakebite to complement or replace antivenoms' and 'increasing awareness and knowledge about snakebite management among healthcare workers' were also recognized as trade-offs.</p><p><strong>Conclusions: </strong>This study significantly contributes to the existing research on artificial intelligence/ML, as previous studies have not quantified the challenges and opportunities in managing SBE. Policymakers and healthcare providers can use these findings to implement strategies such as promoting better health-seeking behaviours, subsidizing treatment costs, ensuring access to effective antivenom and raising public awareness about snakebite prevention and initial care.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"787-793"},"PeriodicalIF":1.6,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782234","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":"Antimicrobial susceptibility and virulence profile of Vibrio cholerae from Delhi, India: effect of floods on epidemiology.","authors":"Belinda Jothi, Rushika Saksena, Monika Matlani, Anandi Goel, Manish Kumar, Diksha Saini, Ayurshi Patil, Pramod Kumar","doi":"10.1093/trstmh/trag057","DOIUrl":"10.1093/trstmh/trag057","url":null,"abstract":"<p><strong>Background: </strong>Cholera remains endemic in India, with outbreaks frequently intensifying during the monsoon due to flooding and disruption of water and sanitation systems. Recent floods in Delhi have raised concerns regarding changing epidemiology, antimicrobial resistance (AMR) and circulation of virulent Vibrio cholerae lineages.</p><p><strong>Methods: </strong>This was a retrospective analysis of V. cholerae isolates obtained from stool samples at a tertiary care hospital in Delhi from May 2018 to December 2024. Isolates were identified by conventional methods and serotyping. Antimicrobial susceptibility testing was conducted using disk diffusion as per Clinical and Laboratory Standards Institute guidelines. Molecular characterization was performed for virulence genes (ctxB, tcpA, rtxA) and ctxB sequencing.</p><p><strong>Results: </strong>Eighty-five V. cholerae isolates were analysed, predominantly affecting children (78.8%), with a post-monsoon peak. All isolates belonged to serogroup O1, serotype Ogawa, El Tor biotype. High resistance was observed to co-trimoxazole (77.6%) and ampicillin (55.3%), with moderate resistance to ciprofloxacin (24.7%); all isolates remained susceptible to azithromycin and ceftazidime. Virulence genes were detected in most sequenced isolates and ctxB sequencing revealed mutations consistent with contemporary epidemic lineages.</p><p><strong>Conclusions: </strong>The study demonstrates persistent circulation of toxigenic V. cholerae O1 Ogawa strains in Delhi, with seasonal clustering following floods and evolving AMR patterns. Continuous surveillance integrating phenotypic and molecular data is essential to guide therapy and strengthen cholera control in flood-prone urban settings.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"735-740"},"PeriodicalIF":1.6,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147869497","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":"Brief history of ophidiology and ophidism in Colombia.","authors":"Carlos A Cañas, Santiago Castaño-Valencia, Fernando Castro-Herrera","doi":"10.1093/trstmh/trag051","DOIUrl":"10.1093/trstmh/trag051","url":null,"abstract":"<p><p>This review traces the historical trajectory of ophidiology (the study of snakes) and ophidism (snakebite envenoming) within the Colombian context. Despite the profound cultural and scientific significance of the human-serpent relationship in the region, the relevant literature remains fragmented, with foundational historical works neither digitized nor readily accessible. To address this, we conducted a narrative review of primary sources spanning from the pre-Colombian era to the present. Our methodology involved sourcing material from specialized libraries, historical archives, personal collections and contemporary scientific databases. The analysis identifies and contextualizes pivotal contributions across distinct historical periods, from early archeological evidence and colonial accounts to foundational eighteenth-century works and the formalized scientific studies of the last two centuries. The review culminates by highlighting how modern Colombian research, including significant international collaborations, is now producing influential work on snake biology, venoms and envenoming that commands global attention.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"746-763"},"PeriodicalIF":1.6,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13339087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acquired haemophilia B in Kyasanur Forest disease: a case series of isolated prolonged activated partial thromboplastin time.","authors":"Nitin Gupta, Sushma Belurkar, Muralidhar Varma, Anjely Sebastian, Chiranjay Mukhopadhyay, Tirlangi Praveen Kumar","doi":"10.1093/trstmh/trag078","DOIUrl":"https://doi.org/10.1093/trstmh/trag078","url":null,"abstract":"<p><strong>Background: </strong>Kyasanur Forest disease (KFD) is a tick-borne viral haemorrhagic fever in which thrombocytopaenia and transaminitis are well recognized, but the basis of coagulation abnormalities remains incompletely understood. Isolated prolongation of the activated partial thromboplastin time (APTT) with a normal prothrombin time (PT) has been frequently observed, although the mechanism remains unclear.</p><p><strong>Case series: </strong>We describe nine patients with confirmed KFD who had isolated prolonged APTT with normal PT during the acute phase of illness. The patients ranged in age from 29 to 78 years, and seven were female. The duration of fever before admission ranged from 3 to 8 days. One patient had epistaxis, while the remaining patients had no clinically evident bleeding manifestations. APTT ranged from 37.0 to 74.8 s. In all patients, mixing studies showed correction with aged serum but not with adsorbed plasma, suggesting isolated factor IX deficiency. Factor assays confirmed reduced factor IX activity, ranging from 24.0% to 48.4%, with preserved or elevated factor VIII levels. Factor IX inhibitor screening was negative in the two patients tested. On follow-up, APTT normalized in all patients. Repeat factor IX activity was available in eight patients and had returned to within the reference range in seven.</p><p><strong>Conclusions: </strong>This case series suggests that transient acquired factor IX deficiency is an important explanation for isolated APTT prolongation in acute KFD. Recognition of this pattern may help distinguish selective intrinsic pathway dysfunction from disseminated intravascular coagulation and may guide appropriate coagulation support in severe disease.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148369998","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":"Comment on: Impact of Wolbachia-infected Aedes aegypti on dengue incidence in endemic regions.","authors":"Mayur Hemchandra Ingale, Archana Dhyani, Rajnish Kumar, Heena Arora","doi":"10.1093/trstmh/trag071","DOIUrl":"https://doi.org/10.1093/trstmh/trag071","url":null,"abstract":"","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148353744","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":"Dengue molecular dynamics: viral load and serotype shifts predict severity and death in Kolkata, Eastern India.","authors":"Suman Kundu, Swagata Ganguly Bhattacharjee, Arup Kumar Pattanayak, Indira Dey Pal, Dipankar Maji, Kaushik Pramanik","doi":"10.1093/trstmh/trag027","DOIUrl":"10.1093/trstmh/trag027","url":null,"abstract":"<p><strong>Background: </strong>Dengue manifestations range from mild fever to fatal shock, driven by viral virulence and host responses. While Kolkata is hyperendemic, data linking specific serotypes and viral load to clinical outcomes remains limited.</p><p><strong>Methods: </strong>This prospective observational study (January 2024-June 2025) analysed 120 dengue serology-reactive patients at a Kolkata teaching hospital. Viral nucleic acid was extracted for serotyping and quantification via the molecular method. Patients were stratified by severity using World Health Organization 2009 criteria.</p><p><strong>Results: </strong>Dengue 2 serotype (DENV-2) was dominant (45.8%), followed by dengue 3 serotype (DENV-3) (33.3%) and coinfections (20.0%). Severe cases had significantly lower mean cycle threshold (Ct) values (23.4 vs 28.1; p<0.001). Multivariate analysis identified high viral load as an independent predictor of severity (adjusted odds ratio 0.89 per unit Ct decrease, p=0.003), indicating an 11% risk increase per unit Ct decrease. Notably, DENV-3 exhibited a strong trend toward higher mortality (adjusted odds ratio 3.31, p=0.08), accounting for 53.8% of fatal cases despite lower viraemia.</p><p><strong>Conclusions: </strong>The study identifies a 'prevalence-virulence dissociation' where DENV-2 dominates numerically but DENV-3 drives mortality. Quantitative viral load is a robust prognostic marker. Integrating real-time molecular surveillance and Ct threshold into triage protocols is vital for mitigating fatal outcomes in hyperendemic regions.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"652-658"},"PeriodicalIF":1.6,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147460217","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":"Epidemiological characterisation of dengue fever across Saudi Arabia.","authors":"Reem A Bin Suaydan, Waleed S Al Salem, Eitezaz A Zaki, Zenaida S Stead, Lama Alrasheed, Roua A Alsubki","doi":"10.1093/trstmh/trag031","DOIUrl":"10.1093/trstmh/trag031","url":null,"abstract":"<p><strong>Background: </strong>Dengue fever is an emerging public health threat in Saudi Arabia. To guide evidence-based vector control, this study aimed to characterise the epidemiological and clinical patterns of infections across key regions in the Kingdom between 2022 and 2024.</p><p><strong>Methods: </strong>A total of 2850 serum samples from suspected dengue patients were collected from hospitals in seven regions in Saudi Arabia. RNA extraction and dengue virus detection were conducted using standardised reverse transcription polymerase chain reaction (RT-PCR) protocols. Statistical analysis was applied to identify the sociodemographic predictors of PCR-confirmed dengue.</p><p><strong>Results: </strong>Among the 2850 individuals tested, 1447 (50.8%) were PCR positive. Most cases (n=1269) occurred in 2023, with Makkah alone recording 801 cases. Males represented 73.5% of PCR-positive cases, while non-Saudi nationals accounted for 47.7%. Multivariable regression showed significantly lower odds of positivity among females (odds ratio [OR] 0.65 [95% confidence interval {CI} 0.55 to 0.76], p<0.001) and higher odds among non-Saudi nationals (OR 1.17 [95% CI 1.00 to 1.38], p=0.050). Despite the relatively low caseloads, Jazan and Asir had higher adjusted odds compared with Madinah.</p><p><strong>Conclusions: </strong>Dengue transmission shows strong geographic, demographic and seasonal variation, with evidence of epidemic activity in 2023. These findings underscore the need for targeted vector control and enhanced surveillance in high-risk regions.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"673-684"},"PeriodicalIF":1.6,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147677029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A cohort study of the duration of immunity to yellow fever after 4 years of primary vaccination in children and adults.","authors":"Camylla Veloso Valença Saucha, Raquel de Vasconcellos Carvalhaes de Oliveira, Maria de Lourdes de Sousa Maia, Eduardo Sérgio Soares Sousa, Patrícia Mouta Nunes de Oliveira, Janaína Reis Xavier, Thalita da Matta de Castro, Robson Leite de Souza Cruz, Waleska Dias Schwarcz, Renata Carvalho Pereira, Adriana de Souza Azevedo, Ana Maria Bispo de Filippis, Clara Lucy de Vasconcellos Ferroco, Maria de Fatima de Sousa Andrade, Marisol Simões, José Cerbino Neto, Olindo Assis Martins-Filho, Ana Carolina Campi-Azevedo, Sheila Maria Barbosa de Lima, Luiz Antonio Bastos Camacho","doi":"10.1093/trstmh/trag026","DOIUrl":"10.1093/trstmh/trag026","url":null,"abstract":"<p><strong>Background: </strong>Lifelong protective immunity from a single dose of yellow fever (YF) vaccine remains controversial. We evaluated variations in YF neutralizing antibody titres over 4 years after primary vaccination.</p><p><strong>Methods: </strong>A cohort study was conducted in three municipalities in northeastern Brazil. The 17DD vaccine was administered between 2016 and 2018. Blood samples were collected to measure YF neutralizing antibodies before, 30-45 d, 1 y and 4 y after vaccination. Generalized linear mixed models with a Tweedie distribution were constructed for children and adults separately to estimate variation in antibody titres over the 4-y period.</p><p><strong>Results: </strong>Of the 4761 individuals, 2753 were children between 9 months and 4 y of age and 2008 adults ages 18-50 y. Four years after vaccination, seropositivity rates were 67.9% and 72.1% in children 9-23 months and 2-4 y, respectively, and 91.2% and 94.4% in adults 18-35 and 36-50 y, respectively. The ratio of means for neutralizing antibody titres 4 y after vaccination decreased to about one-third of that observed at 30-45 d after vaccination.</p><p><strong>Conclusions: </strong>The evidence of waning immunity after a single dose of YF vaccine appears to support revaccination if primary vaccination targets infants and toddlers in endemic countries.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"641-651"},"PeriodicalIF":1.6,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147460277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chikungunya-associated rhabdomyolysis: a case series of three patients from Sri Lanka.","authors":"Arjuna P De Silva, Krishanni Prabagar","doi":"10.1093/trstmh/trag030","DOIUrl":"10.1093/trstmh/trag030","url":null,"abstract":"<p><strong>Background: </strong>Chikungunya virus (CHIKV) is an arbovirus causing febrile illness with musculoskeletal symptoms. Although self-limiting, Chikungunya can result in rhabdomyolysis, with the risk of acute kidney injury.</p><p><strong>Methods: </strong>We report three elderly men with comorbidities who developed rhabdomyolysis during the 2025 outbreak.</p><p><strong>Results: </strong>Clinical features included fever, myalgia, confusion, quadriplegia and muscle oedema; creatine phosphokinase (CPK) ranged from 1105 to 46810 U/L. RT-PCR confirmed CHIKV in two cases. All were managed with intravenous fluids and renal and electrolyte monitoring, with variable recovery.</p><p><strong>Conclusions: </strong>Rhabdomyolysis is under-recognized; clinicians should maintain high suspicion in older patients with comorbidities, monitor CPK and treat promptly.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"718-721"},"PeriodicalIF":1.5,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594920","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":"Typhoid knowledge, prevention practices, and vaccine awareness in high-risk communities of Lilongwe, Malawi.","authors":"Adriano Focus Lubanga, Akim Nelson Bwanali, Chitemwa Moyo, Watipatso Kamanga, Enerico Chrispin, Frank Kambili, Leonard Naphazi Kambewa, Jonathan S Chung, SungJae Chung, Dowon Chung, Kaylin Choe, Jungwook Choi, Vitumbiko Mkandawire, Cynthia Chitule Msonthi, Thomas Nyirenda","doi":"10.1093/trstmh/trag023","DOIUrl":"10.1093/trstmh/trag023","url":null,"abstract":"<p><strong>Background: </strong>Typhoid fever remains a significant public health challenge in Malawi, particularly in urban and peri-urban areas with limited access to safe water, sanitation and hygiene. Although the typhoid conjugate vaccine has been introduced into the national immunization schedule, data on community knowledge, attitudes and practices (KAP) toward typhoid and its prevention remain scarce. This study assessed KAP levels among high-risk populations in Lilongwe to inform targeted public health interventions.</p><p><strong>Methods: </strong>A cross-sectional community-based study was conducted in May 2025 across selected urban and peri-urban areas of Lilongwe. A total of 390 participants were interviewed using a structured KAP questionnaire guided by the Health Belief Model. Data were analysed using SPSS and Stata, with logistic regression applied to identify sociodemographic predictors of KAP outcomes.</p><p><strong>Results: </strong>Only 8.2% of respondents demonstrated adequate knowledge of typhoid, 17.7% had positive attitudes and 6.7% reported good preventive practices. Older age (adjusted odds ratio [AOR] 1.65 [95% confidence interval {CI} 1.07 to 2.55]) and higher education (AOR 3.67 [95% CI 1.62 to 8.30]) were positively associated with knowledge and attitudes toward typhoid prevention. Gender (AOR 0.24 [95% CI 0.08 to 0.72]) and higher household income (AOR 2.61 [95% CI 1.17 to 6.02]) were significantly associated with better preventive practices. Awareness of the typhoid conjugate vaccine was low at 16.7%, although 64.4% expressed a willingness to vaccinate their children.</p><p><strong>Conclusions: </strong>Substantial gaps exist in community KAP and vaccine awareness related to typhoid. Strengthened health education and improved community sensitization on typhoid vaccination are urgently needed.</p>","PeriodicalId":23218,"journal":{"name":"Transactions of The Royal Society of Tropical Medicine and Hygiene","volume":" ","pages":"623-632"},"PeriodicalIF":1.5,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147356566","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}