American Journal of Tropical Medicine and Hygiene最新文献

{"title":"Treatment of Relapsed Plasmodium vivax with High-Dose Atovaquone-Proguanil in the Setting of Long-Term Rifampin Use.","authors":"Basil A McIntosh, Shreena P Advani, Andrea C Morales-Lara, Eli P Wilber","doi":"10.4269/ajtmh.26-0413","DOIUrl":"10.4269/ajtmh.26-0413","url":null,"abstract":"<p><p>A 58-year-old man with a past medical history significant for cerebrovascular accident with residual quadriplegia and feeding-tube dependence, latent tuberculosis infection, and prior treated malaria who developed relapsed Plasmodium vivax infection while receiving rifampin-based therapy for latent tuberculosis is discussed. Although standard-dose atovaquone-proguanil remained a reasonable treatment option, an increased-dose regimen was selected given concern that rifampin-induced hepatic enzyme induction would lower atovaquone-proguanil plasma concentrations. The patient was treated with atovaquone-proguanil 2,000 mg/800 mg daily (double the standard dose of both components) for 6 days (double the standard 3-day duration) from hospital day 4 to hospital day 9. Primaquine 30 mg daily (standard dose) was started on hospital day 5 and continued for 14 days. This regimen achieved complete resolution of parasitemia and sustained clinical cure at follow-up.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13590953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975482","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":"Low Generation Culex quinquefasciatus from Texas and Culex pipiens from New Jersey Are Incompetent Vectors for Oropouche Virus.","authors":"Erik Turner, Nicole Foley, Casey Parker-Crockett, Linda Kothera, Emily Davis, Matylda Lally, Cassandra Durden, Joan L Kenney","doi":"10.4269/ajtmh.26-0251","DOIUrl":"10.4269/ajtmh.26-0251","url":null,"abstract":"<p><p>During the 2024 Oropouche virus (OROV) outbreak in South America, mosquito surveillance led to the identification of pools of Culex quinquefasciatus infected with the virus. Because of the outbreak strain's status as a novel reassortment and the novel sequela discovered during this outbreak, concerns arose about Culex species as potential vectors in the continental United States. To assess the risk posed by Cx. quinquefasciatus and the closely related species Culex pipiens, the vector competence of mosquitoes reared from eggs collected in Dallas, TX, and New Jersey was examined. Three replicates of an infectious bloodmeal were offered to Cx. quinquefasciatus at generations F2, F4, and F9, resulting in 0/305 individuals with midgut infections. One infectious bloodmeal was offered to Cx. pipiens at generation F4, with 0/120 resulting midgut infections. These data, which align with other recent publications, indicate that United States populations of Cx. quinquefasciatus and Cx. pipiens are not competent vectors of the outbreak strain of OROV.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13590957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148928656","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":"Cost-Effective Diagnostic Algorithms for Ugandan Patients with Solid Tumors Who Develop Chemotherapy-Associated Febrile Illness.","authors":"Elizabeth A Gulleen, Immaculate Mbarusha, Dennis Mubiru, Bernadette Pedun, Margaret Lubwama, Nixon Niyonzima, Simon Sekyanzi, Abrahams Omoding, Christopher C Moore, Warren Phipps, Radha Rajasingham","doi":"10.4269/ajtmh.26-0069","DOIUrl":"10.4269/ajtmh.26-0069","url":null,"abstract":"<p><p>In low- and middle-income settings, microbiologic evaluation of chemotherapy-associated febrile illness is limited by cost. Cost-effective diagnostic algorithms could streamline evaluation for chemotherapy-associated febrile illness where comprehensive testing is not possible, particularly in HIV- and tuberculosis (TB)-endemic settings. In this study, we created a decision analytic model to evaluate costs, diagnostic yield, and cost-effectiveness of diagnostic algorithms for adult inpatients with solid tumors who developed chemotherapy-associated febrile illness in Uganda. Given the high prevalence of HIV, TB, and malaria, diagnostics included serum cryptococcal antigen (CrAg) lateral flow assay, Alere TB urinary lipoarabinomannan (LAM), malaria rapid testing, and aerobic blood cultures. We considered the following testing algorithms: 1) a comprehensive approach where all tests were performed on all participants and 2) stepwise algorithms where tests were performed in series and stopped with the first positive result. Prevalence data and test performance were taken from the published literature. A comprehensive testing strategy yielded 32.2% correct diagnoses at a cost of $97.85 per correct diagnosis. Of the stepwise strategies, testing CrAg first yielded the cheapest strategy at a cost of $85.49 per correct diagnosis and the highest number of appropriate diagnoses (29.9%). The incremental cost-effectiveness ratio was $234 per additional correct diagnosis for the comprehensive strategy when compared with the sequential strategy. Although comprehensive diagnostic testing is optimal for patients who experience chemotherapy-associated febrile illness, if this strategy is unavailable, stepwise testing with CrAg first and then, TB LAM is optimal to maximize correct diagnosis and minimize costs.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13595417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910355","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":"How Long is the Last Mile? The Path to Guinea Worm Elimination in Chad: A Simulation Modeling Study.","authors":"Hannah K Smalley, Pinar Keskinocak, Maryann G Delea, Obiora A Eneanya, Jessica M van Loben Sels, Ouakou Tchindebet, Adam Weiss","doi":"10.4269/ajtmh.26-0289","DOIUrl":"10.4269/ajtmh.26-0289","url":null,"abstract":"<p><p>Guinea worm disease (GWD) is on track to be the first parasitic infectious disease to be eradicated. Substantial progress has been made, from 3.5 million human cases reported annually in the 1980s to only 10 in 2025. However, 684 animal infections were reported in 2025, the majority of which were in dogs. While animal infections continue, the human population remains at risk; elimination requires interrupting infections in both humans and animals. In the present study, agent-based simulation modeling was used to evaluate the time to elimination of GWD among domestic dogs in Chad. Infections were projected over 20 years in a variety of scenarios that accounted for current interventions, namely reactive and proactive tethering, Abate® water treatments, and novel domestic dog diagnostics. Simulation results indicated that high levels of interventions were needed to achieve the elimination of GWD in dogs in Chad; they suggested that elimination could be achieved in 7 years (95% empirical interval: 3-10 years) with \"high\" levels of proactive tethering and 90% Abate impact, whereas lower levels of these interventions extended the time to elimination beyond 20 years. Importantly, tools such as novel dog diagnostics (under development) could accelerate progress when paired with frequent testing and sustained tethering of dogs that have tested positive. Although challenges remain, intensified application of proven strategies combined with innovative tools offers a path to eliminating GWD in dogs and ultimately achieving global eradication.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13590952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910596","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":"Skin Carotenoid Scores Reflect Immune Status among Children Living with HIV in Tanzania.","authors":"Wilbert Mbuya, Thobias Boniphace, Michael Mwagala, Peter Agrea, Nazareth M Mbilinyi, Nancy E Moran, Andrew R DiNardo, Mkunde Chachage","doi":"10.4269/ajtmh.26-0169","DOIUrl":"10.4269/ajtmh.26-0169","url":null,"abstract":"<p><p>Many individuals living with HIV experience persistent inflammation despite antiretroviral treatment, increasing their risk for cardiovascular diseases, cognitive decline, and other noncommunicable diseases. Carotenoids can inhibit this inflammation by reducing lipid peroxidation. Carotenoid intake and plasma concentrations can be approximated using a noninvasive cutaneous spectrophotometer. This study quantified skin carotenoid levels in Tanzanian children ages 5 to 15 years old (N = 185) both with and without HIV. Over 95% had low to moderate skin carotenoid scores (<400 units). In children living with HIV, higher viral loads were linked to lower skin carotenoid scores (rho = -0.57, P <0.001), whereas higher CD4 counts correlated with increased skin carotenoid scores (rho = 0.52, P <0.001). Overall, carotenoid levels were low and associated with immune status, suggesting that elevated carotenoid scores correlate with lower inflammation in children living with HIV. Future studies investigating dietary carotenoid interventions to support immune function are warranted.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910539","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":"Obesity-Associated Inflammatory Reprogramming Impairs a Granulomatous Response to Leishmania infantum.","authors":"Natalie C Jarvis, Grace M Gutzman, Yani Chen, Bayan Zhanbolat, Karen I Cyndari, Mary E Wilson","doi":"10.4269/ajtmh.26-0170","DOIUrl":"10.4269/ajtmh.26-0170","url":null,"abstract":"<p><p>The demographics of leishmaniasis in Brazil have shifted in recent decades, coinciding with dietary changes and an increase in overweight/obesity. Cutaneous leishmaniasis becomes more treatment refractory in obese individuals, highlighting the impact of obesity on disease outcome. The impact of the overweight/obese state on infection with Leishmania infantum, which causes visceral leishmaniasis (VL), is unclear. We previously showed that an obesity-prone diet restricts L. infantum expansion in the livers of mice, but the immunological basis remained unexplored. Herein, we investigated whether this reflected improved granuloma formation and parasite control or a response to diet-induced hepatic steatosis and inflammation. To evaluate hepatic responses to VL during obesity, mice were maintained on a high-fat, high-cholesterol (HFHC) diet or a control diet before and throughout L. infantum infection. High-fat, high-cholesterol feeding significantly reduced hepatic parasite burdens but increased splenic parasite burdens. Control animals developed well-organized hepatic granulomas before local resolution, whereas HFHC-fed mouse livers developed diffuse inflammation and early fibrosis consistent with steatohepatitis. They completely failed to form mature granulomas. Quantitative analysis confirmed organized granulomas in 100% of infected control mice, whereas HFHC-fed infected mice showed no or else loosely aggregated, immature infiltrates in their livers. Transcriptional profiling revealed a pronounced inflammatory response in naïve HFHC-fed livers that was minimally exacerbated by infection. These data suggest that diet-induced obesity does not prevent an inflammatory response to the parasite. Rather, the obesity diet impairs formation of the tissue-specific granulomatous response that might normally contain L. infantum locally in the liver.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13590954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910602","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":"Decreasing the Burden of West Nile Virus Disease: The Need for More Prevention Measures.","authors":"Randall J Nett, Aaron C Brault, Casey Parker-Crockett, J Erin Staples","doi":"10.4269/ajtmh.26-0404","DOIUrl":"10.4269/ajtmh.26-0404","url":null,"abstract":"<p><p>After the introduction of West Nile virus (WNV) in 1999, the virus became endemic in the United States, causing approximately 1,300 severe neurological disease cases and 130 deaths annually. WNV is also responsible for a substantial disease burden in Canada, Europe, and countries around the Mediterranean Sea. WNV prevention currently relies on personal protective behaviors (PPBs) and mosquito control, but these measures have been inadequate to substantially reduce WNV disease cases or deaths. Additional measures are also necessary to diagnose, treat, prevent, and control WNV disease. Human WNV vaccine, anti-WNV monoclonal antibody used as preexposure prophylaxis in patients at higher risk for severe WNV disease, and more rapidly detecting WNV infection, among other measures, will be critical to help combat WNV disease morbidity and mortality. Partners in government, academia, and private industry should collaborate to ensure optimal use and availability of current and additional lifesaving measures.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13590958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910408","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":"Post-Coronavirus Disease Condition among Nonhospitalized Patients in Honduras: A Prospective Cohort Study: 2022-2023.","authors":"Charles Daniel Schnorr, Omar Antonio Diaz Poujol, Salomé Garnier, Berta Alvarez, Kathryn W Roberts, Michael de St Aubin, Saul Cruz, Lorenzo Pavon, Angela Ochoa, Homer Mauricio Mejía Santos, Yisela Martinez, Jonatán Ochoa, Rachel Budhwani, Devan Dumas, Sogeiry Solis, Margaret Baldwin, Emily Zielinski Gutierrez, Shiony Midence, Alcides Martinez, Avi Hakim, Eric Nilles","doi":"10.4269/ajtmh.26-0302","DOIUrl":"10.4269/ajtmh.26-0302","url":null,"abstract":"<p><p>To characterize the burden of and identify risk factors for post-coronavirus disease (COVID) condition among high-risk, nonhospitalized patients in Honduras, patients with acute coronavirus disease 2019 (COVID-19) who were discharged from five urban triage facilities were prospectively recruited. These patients were recruited between May and September 2022. Inclusion criteria included a positive COVID-19 antigen test result and either age greater than 60 years or age greater than 45 years with elevated risk for severe COVID-19. Follow-up was conducted at 3 and 4.5 months by telephone. Multivariable logistic regression was used to identify predictors of post-COVID condition. At enrollment, 98% of participants had received two or more doses of the COVID vaccine. Three months after enrollment, 464/1,133 participants (41%) reported ongoing symptoms. Female sex (adjusted odd ratio [aOR]: 1.68, 95% CI: 1.29-2.19), three or more comorbidities (aOR: 1.62, 95% CI: 1.03-2.55), and the number of symptoms at enrollment (aOR: 2.41, 95% CI: 1.59-3.71 for 7-9 symptoms; aOR 3.61, 95% CI: 2.25-5.86 for 10 or more symptoms) were predictive of ongoing symptoms. A total of 4.5 months after enrollment, 258/852 patients (30%) reported ongoing symptoms. Female sex (aOR: 1.82, 95% CI: 1.31-2.54), the number of comorbidities (aOR: 1.87, 95% CI: 1.07-3.36 for two comorbidities; aOR: 2.38, 95% CI: 1.33-4.39 for three or more comorbidities), the number of enrollment symptoms (aOR: 1.73, 95% CI: 1.05-2.95 for 7-9 symptoms; aOR: 2.59, 95% CI: 1.45-4.71 for 10 or more symptoms), and three versus four vaccine doses (aOR: 1.54, 95% CI: 1.06-2.22) were predictive of ongoing symptoms. These findings raise concern for an under-recognized burden of post-COVID condition in Honduras. Further research is needed to determine if findings from this high-risk cohort are indicative of post-COVID condition burden among other populations in the region.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13590946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910514","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":"Occupational Leptospirosis in Urban Sanitation: Lessons for Early Recognition and Worker Protection.","authors":"Abigail Graham, Sarah Hill, Carly Kaplan, Zachary C LeBlanc, Nancyanne Schmidt","doi":"10.4269/ajtmh.26-0203","DOIUrl":"10.4269/ajtmh.26-0203","url":null,"abstract":"<p><p>Leptospirosis is a globally distributed disease associated with recreational aquatic activities; environmental exposure; and a range of occupational exposures, including animal handling, sanitation work, military operations, and sewer maintenance. We report a case of severe leptospirosis in a New York City sanitation worker after exposure to contaminated water. Because of the nonspecific presentation of his infection and the nuances of diagnostic testing, the patient presented to multiple care settings before leptospirosis was diagnosed. This case illustrates the importance of clinician awareness of urban leptospirosis and its broadening epidemiology in the United States, the time-dependent performance of diagnostic testing, and opportunities to improve personal protective equipment recommendations for sanitation employees.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13590944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910508","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 Duty to Act.","authors":"Emily Sickbert-Bennett, Philip J Rosenthal, Cesar A Arias, Gonzalo M Bearman, Paul E Sax, Graeme Forrest, David P Calfee, Romney M Humphries, Stanley Maloy, Ravi Jhaveri, Ira Blader, Ashley Shade, Roger Bedimo, Cynthia L Sears, Paul Katz, Barbara Resnick","doi":"10.4269/ajtmh.26-0512","DOIUrl":"10.4269/ajtmh.26-0512","url":null,"abstract":"","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886020","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}