American Journal of Tropical Medicine and Hygiene最新文献

{"title":"Large Tuberculous Mass Lesions Involving the Brain: Outcomes and Management.","authors":"Prasannakumar Palanikumar, Priyanka Gautam, Harshad Arvind Vanjare, Nagaraj Veerasamy, Mithun Mohan George, Leeberk Raja Inbaraj, Edmond Jonathan Gandham, Ajith Sivadasan, Rajiv Karthik, Abi Manesh","doi":"10.4269/ajtmh.24-0376","DOIUrl":"10.4269/ajtmh.24-0376","url":null,"abstract":"<p><p>The optimal management of large tuberculous mass lesions (LTML) involving the central nervous system remains unclear. We conducted a single-center, retrospective, observational study that assessed the outcomes of patients with LTML from January 2010 to February 2023. An LTML was defined as a tuberculoma or tubercular abscess exceeding or equal to 3 cm. The primary outcome was independence in activities of daily living, as assessed by the modified Rankin Scale (mRS) at a follow-up of 6 months. Forty-six patients were identified during the study period. Their mean age was 27.6 ± 12 years, the median duration of antituberculous therapy (ATT) was 18 months, and the median duration of follow-up was 20 months (interquartile range 15.7-40). The favorable outcomes were 76.9% (10/13) for ATT alone, 62.5% (10/16) for ATT with steroids, 87.5% (7/8) for ATT with surgery, and 66.9% (6/9) for ATT, steroids, and surgery. The median mRS at baseline in the study was 2 (1-3), and at the 6 month follow-up, it was 1 (0-2). Adding steroids or surgical intervention to ATT did not significantly improve primary outcomes (P = 0.637). Further large-scale studies are necessary to confirm these preliminary observations.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762745","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":"Uropathogens and Their Antimicrobial Resistance Profile at a Pediatric Tertiary Care Hospital in Kathmandu, Nepal.","authors":"Sohani Bajracharya, Ajaya Basnet, Nayanum Pokhrel, Aashish Gupta, Laxmi Kant Khanal","doi":"10.4269/ajtmh.24-0624","DOIUrl":"10.4269/ajtmh.24-0624","url":null,"abstract":"<p><p>Urinary tract infections (UTIs) are treated based on local antimicrobial susceptibility patterns; however, growing antimicrobial resistance necessitates continuous monitoring. This retrospective study examined the prevalence of pediatric UTIs, identified causative pathogens, and evaluated their antibiograms and resistance patterns. We examined the demographic data, microbiological profiles, and antimicrobial susceptibility results (September 2019-August 2021) of pediatric patients (neonates to 14 years) with positive urine culture results at Kanti Children's Hospital, Kathmandu, Nepal, using SPSS version 17.0 (IBM Corp., Armonk, NY). Among 8,072 urine specimens, 575 (7.1%) (95% CI: 6.6-7.7) tested positive for significant infections, primarily from outpatients (88.2%) and males (54.1%), with a median age of 2 years. Most UTIs (93.0%; 535/575) were caused by bacteria, primarily Escherichia coli (78.5%; 420/535). Cumulative resistance rates were 92.4% for penicillin, 69.3% for cephalosporins, 39.7% for quinolones, 30.2% for carbapenems, and 14.3% for aminoglycosides. One hundred sixty-eight (40.0%) E. coli strains and four (33.3%) Pseudomonas aeruginosa strains were multidrug-resistant. Seven (9.0%) Klebsiella pneumoniae strains were extensively drug-resistant (XDR), and 15 (21.1%) were extended-spectrum β-lactamase (ESBL) producers. Multidrug-resistant strains (36.5%; 210/575), XDR strains (22.6%; 15/575), and ESBL producers (14.4%; 83/575) showed >70.0% resistance to ampicillin, cefotaxime-clavulanate, and cefixime. Over the years, resistance to β-lactams has risen, whereas resistance to aminoglycosides, carbapenems, and cotrimoxazole has decreased. Resistance to quinolones has remained consistent. Pediatric UTIs were least common in this hospital, with the majority caused by E. coli. Multidrug-resistant bacteria were more prevalent than XDR and ESBL-producing bacteria. Although resistance to β-lactam antibiotics increased over the years, resistance to aminoglycosides, carbapenems, and cotrimoxazole declined.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762814","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":"Advancing Global Health Security through Rapid Operational Research on Diagnostics during Outbreaks.","authors":"Ezekiel Boro, Anne Hoppe, Daniel G Bausch","doi":"10.4269/ajtmh.24-0213","DOIUrl":"10.4269/ajtmh.24-0213","url":null,"abstract":"","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":"112 4_Suppl","pages":"1-2"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11965714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778880","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":"Perspective of Quilombola Communities in Brazil on a Yellow Fever Outbreak and Vaccination.","authors":"Aline Carralas Queiroz Leão, Sueli F Raymundo, Gabriel Fialkovitz, Luciana Vilas Boas Casadio, Tamar Roemer, Katia Regina Pisciotta, Anna S Levin","doi":"10.4269/ajtmh.24-0519","DOIUrl":"10.4269/ajtmh.24-0519","url":null,"abstract":"<p><p>In 2016-2019, Brazil faced the most important yellow fever (YF) outbreak in recent decades. In 2019, cases were concentrated in Ribeira Valley, in the southeast region of Brazil, and largely affected rural Quilombola communities, which can trace their origins to escaped, freed, or abandoned slaves in the mid-1800s, and which traditionally practice subsistence agriculture. We aimed to explore aspects of the YF outbreak and vaccination from the perspective of the Quilombola communities. This was a cross-sectional descriptive study conducted in two Quilombola communities in Ribeira Valley (Sapatu and Nhunguara), using an interviewer-administered questionnaire that included both closed and open-ended questions. Thematic reflective analysis principles were applied for qualitative analysis. We adopted a theoretical domains framework to identify and categorize reported facilitators and barriers to YF vaccination. A total of 226 participants were enrolled: 46% male, median age 44 years. Eighty participants reported acute illness during the outbreak; fever, headache, myalgia, and nausea were the most common symptoms. Only eight participants reported laboratory-confirmed YF. Almost all participants (96.5%) reported YF vaccination. Less than two-thirds of the participants were vaccinated before the first case in the Ribeira Valley; over a third were vaccinated after the death of a community leader. The themes were: concerns about the vaccine, difficulty in accessing healthcare, perception of disease risk, knowledge about disease severity, cultural beliefs, and influence of leaders. The outbreak in the Ribeira Valley may have been averted with an understanding of the vaccination decision-making process, influenced by individual, sociocultural, and contextual factors.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762811","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":"Lumbar Brucella Spondylodiscitis with Extensive Vertebral Abscesses.","authors":"Shutao Gao, Yukun Hu, Weibin Sheng","doi":"10.4269/ajtmh.24-0619","DOIUrl":"10.4269/ajtmh.24-0619","url":null,"abstract":"","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762747","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":"Serotypes and Antimicrobial Resistance Patterns of Invasive Non-Typhoidal Salmonella in Uganda.","authors":"John Bosco Kalule, Valeria Nakintu Zalwango, Pauline Kyazike, Samuel Majalija","doi":"10.4269/ajtmh.24-0772","DOIUrl":"10.4269/ajtmh.24-0772","url":null,"abstract":"<p><p>Drug-resistant invasive non-typhoidal Salmonella poses a significant challenge to the management of acute febrile illnesses in Uganda. However, the characteristics of invasive non-typhoidal Salmonella strains are not yet well understood. This study aimed to determine the serotypes and antimicrobial resistance patterns of invasive non-typhoidal Salmonella isolates from a local health center in Uganda. Invasive non-typhoidal Salmonella isolates archived over 5 years from febrile patients at a local health center were characterized for serotypes and antimicrobial susceptibility patterns using conventional methods. Among the 80 archived isolates, 18 serotypes of invasive non-typhoidal Salmonella were identified, with Salmonella Typhimurium (42.5%), Salmonella Enteritidis (20%), and Salmonella Haifa (8.8%) being the most prevalent. A total of 81.3% (65/80) of the isolates exhibited resistance to at least one antibiotic, with the highest resistance rates observed for streptomycin (72.5%), trimethoprim-sulfamethoxazole (66.2%), and ampicillin (56.2%). The most common antimicrobial resistance profile, found in 23.1% (15/65) of resistant isolates, was Amp-C-S10-S300-SXT. Notably, 81.5% of the drug-resistant isolates were multi-drug resistant. Invasive non-typhoidal Salmonella in this setting have a high rate of antimicrobial resistance to commonly used antibiotics. Improved treatment guidelines could be adapted for better clinical outcomes.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762812","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":"Chronic Chagas Disease in the Brazilian Amazon: Serological Survey, Clinical Follow-Up, and Associated Risk Factors.","authors":"Susan Smith-Doria, Laise Kelma Costa Magalhães, Laylah Kelre Costa Magalhães, Suzane Ribeiro Prestes, Alba Regina Jorge Brandão, Emily de Sousa Moura, Elsa Isela Guevara Moctezuma, Monica Regina Hosanahh da Silva E Silva, Katia do Nascimento Couceiro, Yuliana Padrón-Antonio, Victor Irungu Mwangi, Jessica Vanina Ortiz, Leíla Ines Aguiar Raposo Câmara Coelho, Adriano Gomes-Silva, Henrique Silveira, João Marcos Bemfica Barbosa Ferreira, Jorge Augusto de Oliveira Guerra, Maria das Graças Vale Barbosa Guerra","doi":"10.4269/ajtmh.24-0549","DOIUrl":"https://doi.org/10.4269/ajtmh.24-0549","url":null,"abstract":"<p><p>The prevalence and characteristics of chronic Chagas disease (CCD) in the Amazon Region remain underexplored. This study aimed to describe the challenges encountered during a serological survey and follow-up of CCD, while also highlighting potential risk factors in the Amazon Region. The serological survey involved residents of periurban and rural areas of Manaus in the Brazilian Amazon. All participants were invited to complete a clinical, epidemiological, and demographic questionnaire and provide a blood sample for anti-Trypanosoma cruzi (T. cruzi) IgG tests. A total of 1,845 participants were included, of whom 43 were identified as having presumed CCD, based on having at least two positive serological tests. Only 35 underwent complementary tests, and five had cardiac alterations not consistent with CCD. The main risk factors associated with CCD were age ≥20 years, living in periurban areas, reporting the presence of the insect vector inside the household, entering the forest, consumption of bushmeat, and having undergone blood transfusion. In the Amazon, the population is exposed to the sylvatic T. cruzi life cycle and is unaware of the associated risk factors. The divergent serology results raise doubts about the reliability of the commercial serological tests used for CCD screening in the region. Surveillance for CCD is important in the Amazon.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143707909","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":"Prevalence of Human Papillomavirus and Genotype Correlation with Cervical Lesions at the University Teaching Hospital of Kigali.","authors":"Evode Mbabazi, Jean Bosco Munyemana, Julienne Mukashema, Emmanuel Bazimaziki, Marie Claire Ndayisaba, Taofeek Tope Adegboyega, Belson Rugwizangoga","doi":"10.4269/ajtmh.24-0760","DOIUrl":"https://doi.org/10.4269/ajtmh.24-0760","url":null,"abstract":"<p><p>Cervical cancer remains a major health problem, especially in low- and middle-income countries (LMICs), with human papillomavirus (HPV) infection serving as the primary precursor. Despite global efforts to combat cervical cancer, including vaccination, a critical knowledge gap persists regarding HPV prevalence, genotype distribution, and their correlation with cervical lesions in LMICs. This study has assessed the prevalence of HPV infection, identified the most common HPV genotypes, and evaluated their correlation with cervical lesions at the University Teaching Hospital of Kigali, Rwanda. A total of 473 women were screened for HPV infection, with further evaluation of cervical lesions in HPV-positive women. The overall HPV prevalence was 74 of 473 (15.6%), with the highest concentration among women aged 41-45 years (29.7%). HPV genotypes 16 and 18 were most prevalent (7.6% each). Cyto-histological examination showed 23.6% cancerous lesions and 37.2% benign lesions in women with HPV-positive results. Women with high-risk HPV (HR-HPV) infections had a 2.67-fold increased risk of developing cancerous lesions compared with those with low-risk HPV infections (95% CI: 1.08-6.58, P = 0.033). Notably, 21.6% of HPV-positive women were also HIV-positive, highlighting the coinfection of these two viruses. In conclusion, this study demonstrates a varied distribution of HPV genotypes among Rwandan women and a significant association between HR-HPV types and cervical lesions. These findings emphasize the need for tailored cervical cancer prevention strategies, including targeted surveillance, vaccination, and enhanced screening in Rwanda and similar resource-limited settings.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708011","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":"Evaluation of Microfilaremic Individuals after Mass Drug Treatment with Ivermectin, Diethylcarbamazine, and Albendazole for Lymphatic Filariasis in Papua New Guinea.","authors":"Joycelyn Salo, Simon Westby, Ronnie Wakol, Nelly Sanuku, Krufinta Bun, Moses Laman, Christopher L King","doi":"10.4269/ajtmh.24-0382","DOIUrl":"https://doi.org/10.4269/ajtmh.24-0382","url":null,"abstract":"<p><p>After mass drug administration (MDA) for lymphatic filariasis, which involved a single coadministered dose of ivermectin plus diethylcarbamazine and albendazole (IDA), concerns arose regarding individuals who remained microfilaremic. This situation raised questions about the efficacy of the drugs and whether some individuals had not ingested them. In East New Britain Province, Papua New Guinea (PNG), where 81.7% of the population received IDA, 10 individuals were found to have microfilaremia 12 months after the first round of MDA in an area that had a high baseline of microfilaremia (n = 29 microfilariae [Mf] positive pre-MDA). Of these 10 individuals, 7 reported having taken the IDA medication. When Mf detection was repeated 18 months later, all 10 individuals remained Mf positive. Additionally, three more Mf-positive household members were identified, and they also reported taking the IDA. These Mf-positive individuals were then retreated with IDA under direct observation. At 7 and/or 14 months after retreatment, all initially Mf-positive individuals, except for one, were found to be Mf free. Upon further questioning, it was revealed that all but one individual admitted to not taking the initial MDA. Thus, IDA effectively clears Mf in this region of PNG, and the persistent microfilaremia after MDA is primarily because of individuals failing to take the medications as prescribed.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708006","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":"Combating Child Undernutrition through Community Participation and Action: Reviving Ballabgarh Mixture at Rural Villages of Haryana, India.","authors":"Ankit Chandra","doi":"10.4269/ajtmh.24-0649","DOIUrl":"https://doi.org/10.4269/ajtmh.24-0649","url":null,"abstract":"","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655812","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}