American Journal of Tropical Medicine and Hygiene最新文献

{"title":"Analysis of Confirmed Leptospirosis Cases in Hawai'i Identifies Spatial and Environmental Patterns of Incidence.","authors":"Ian A McMillan, Grayson N Kallas, Jourdan K P McMillan, Lauren T Guest, Sandra P Chang, Janet M Berreman, Sarah K Kemble, Michael H Norris","doi":"10.4269/ajtmh.25-0267","DOIUrl":"https://doi.org/10.4269/ajtmh.25-0267","url":null,"abstract":"<p><p>Leptospirosis is a neglected zoonotic disease caused by pathogenic Leptospira species, and it is one of the leading causes of zoonotic bacterial infections globally. It is routinely underdiagnosed or misdiagnosed as other febrile infections, like dengue or malaria. Hawai'i has consistently had one of the highest rates of leptospirosis in the United States. Here, we present the trends associated with cases of confirmed leptospirosis that were acquired in the state of Hawai'i between 2012 and 2024. County-level analysis shows consistency with previously observed spatial trends, identifying higher case rates on the islands of Kaua'i and Hawai'i ranging from 17.74 to 30.90 cases per 100,000 population. To increase spatial resolution, cases were analyzed at the Moku level (i.e., district), identifying localized rates up to 244.78 cases per 100,000 population. This analysis identified that the northeastern region of Maui has the highest case rate in Hawai'i, which has the highest case rate of all states. The northeastern coasts of each island tend to have higher rates of leptospirosis that also correlate with higher annual rainfall. Serological analysis identified that the dominant serogroups in human disease were Australis and Icterohaemorrhagiae. The main infecting Leptospira serovars were Bratislava, Icterohaemorrhagiae, Georgia, Canicola, and Australis. Dominant infecting serovars were associated with infections throughout the state, except in the case of Canicola, which was localized to the islands of Maui and Hawai'i. Overall, this work identified regions of higher human leptospirosis incidence throughout the Hawaiian Islands, correlating clinical incidence with precipitation and serovar reactivity across the state.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939178","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":"Changing Attitudes and Motivations Around Coronavirus Disease 2019 Vaccination Within an Agricultural Community in Southwest Guatemala.","authors":"Neudy Rojop, Blair Weikel, Molly M Lamb, Diva M Barrientos, Melissa Gomez, Daniel Olson","doi":"10.4269/ajtmh.25-0149","DOIUrl":"https://doi.org/10.4269/ajtmh.25-0149","url":null,"abstract":"<p><p>Guatemala has one of the lowest coronavirus disease 2019 vaccination rates in the Americas, with rural communities experiencing disproportionately low coverage. A 2021-2022 vaccine knowledge and behaviors survey of households in a rural community in southwest Guatemala revealed that access was a significant barrier, particularly among women and those who did not work outside the home. For the present study, a follow-up survey was conducted in 2023 to assess changes in vaccine access, hesitancy, and motivations. Both surveys were completed by 199 people. Among those eligible for vaccination at enrollment, the proportion vaccinated increased from 47% to 77%. The primary motivations for vaccination remained protecting family and friends, although concern for personal health increased. Regression models did not identify significant predictors of vaccine uptake, although household size approached significance. The findings highlight the importance of ongoing efforts to improve vaccine access and information, particularly in addressing the significant proportion of individuals who are uncertain about their motivations for vaccination.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939133","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":"Scapular Tuberculosis.","authors":"Kenta Nakamoto, Shinnosuke Fukushima, Kohei Oguni, Hideharu Hagiya","doi":"10.4269/ajtmh.25-0313","DOIUrl":"https://doi.org/10.4269/ajtmh.25-0313","url":null,"abstract":"","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939195","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":"Etiology of Severe Pneumonia in Intubated Children: A Case-Control Study in Children 1-24 Months of Age in a Tertiary Hospital in South India.","authors":"Roshni Julia Rajan, Valsan Philip Verghese, Balaji Veeraraghavan, Jacob John, Gagandeep Kang, Asha Mary Abraham, Ira Praharaj, Ekta Rai, Gowri S Mahasampath, John Mathai, Reju Thomas, Debasis Adhikari, Indira Agarwal, Sarah Mathai, Kala Ebenezer, Winsley Rose","doi":"10.4269/ajtmh.24-0041","DOIUrl":"https://doi.org/10.4269/ajtmh.24-0041","url":null,"abstract":"<p><p>Identification of the etiological agent in severe pneumonia is limited by factors such as the poor yield from blood samples and the presence of colonizers in the respiratory tract. Samples from the lower respiratory tract could be more representative of the etiological agent causing pneumonia. We conducted a case-control study to determine the etiology of community-acquired severe pneumonia requiring intubation. This case-control study was conducted from 2017 to 2019 at Christian Medical College, Vellore. The cases included children between 1 and 24 months of age who were intubated for community-acquired severe pneumonia. The controls included children undergoing intubation for elective surgeries. Tracheal aspirates and nasopharyngeal swabs were obtained from all cases and controls. Additionally, a nonbronchoscopic bronchoalveolar lavage was obtained from all cases. The total nucleic acid extracted from all samples was tested for multiple respiratory pathogens using CDC-developed TaqMan Array Cards (Thermo Fisher Scientific, Waltham, MA) on the QuantStudio 12K Flex platform (Thermo Fisher Scientific). A total of 100 samples were collected from the 34 cases, and 64 samples were collected from the 32 controls. Respiratory syncytial virus and Streptococcus pneumoniae (S. pneumoniae) were the most commonly isolated pathogens. Respiratory syncytial virus detection rates were significantly higher in cases compared with controls in nasopharyngeal (odds ratio: 10.45; 95% CI: 1.25-88.25) samples. Streptococcus pneumoniae was more frequently detected in nasopharyngeal samples in cases than controls; however, this difference was not statistically significant. Respiratory syncytial virus and S. pneumoniae were the most commonly isolated pathogens in cases of severe pneumonia that required intubation in children between 1 and 24 months of age in Vellore, India.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939243","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":"Developing an Artificial Intelligence Chatbot for Snake Image Classification and Accuracy Improvement.","authors":"Po-Chun Chuang, Ye-In Chang, Tein-Shun Tsai, Chih-Hsiang Hung, Chia-En Li","doi":"10.4269/ajtmh.25-0101","DOIUrl":"https://doi.org/10.4269/ajtmh.25-0101","url":null,"abstract":"<p><p>Snakebites pose a significant global health challenge. The timely and accurate identification of snake species is essential for guiding antivenom administration. Our goal was to evaluate the effectiveness of a machine learning model for classifying snake species using images collected from the external environment and a preprocessing method to enhance accuracy. In this study, we developed a deep learning model for snake species identification in Taiwan based on the Swin Transformer v2 architecture, applying transfer learning to 12,000 images sampled from a dataset of 30,573 labeled images collected by the authors from sources such as Flickr, iNaturalist, and local databases before October 2023. An external test set of 2,400 images, collected through the XX (LINE) chatbot and Facebook groups between November 2023 and April 2024, was used to evaluate real-world performance. To address challenges in external test set images, we introduced a preprocessing method called test-time object detection and cropping (TT-ODC). Without preprocessing, the model achieved 95.6% accuracy on the validation set but dropped to 83.3% on the external test set. Applying TT-ODC improved external test accuracy to 89.8%, closely matching human annotation performance (90.3%). These findings revealed that integrating a Swin Transformer v2-based model into the LINE chatbot enhances snake species identification and improves real-world accuracy. The TT-ODC method effectively bridges the gap between experimental (validation set) and real-world (external test set) performance, providing a practical tool for clinical snakebite management.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939188","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":"Strongyloides Hyperinfection Treated with Subcutaneous Ivermectin in a Patient with an Inborn Error of Immunity.","authors":"Peter Conlon, Fergal Howley, Dana Al Sharqi, Andrew Beverland, Fionnuala Cox, Aisling Brown, Eoghan de Barra","doi":"10.4269/ajtmh.25-0146","DOIUrl":"https://doi.org/10.4269/ajtmh.25-0146","url":null,"abstract":"<p><p>Strongyloides hyperinfection can be challenging to diagnose and treat. Although it is typically described in cases of secondary immunodeficiency, it has not previously been reported in a case of inborn error of immunity. Diagnosis via microscopy can be time-consuming and challenging, and serology results may be negative in the setting of hypogammaglobulinemia. Oral ivermectin is an effective treatment for strongyloidiasis and is commonly used in low-endemicity countries. However, its efficacy is limited in cases of malabsorption. Subcutaneous administration of ivermectin is widespread in veterinary medicine, but it is not licensed for use in humans. The use of subcutaneous ivermectin in the treatment of Strongyloides hyperinfection is described in a man with hypogammaglobulinemia secondary to common variable immune deficiency and associated severe malnutrition in the context of chronic Strongyloides-related malabsorption. The diagnostic challenges in low-endemicity settings and therapeutic considerations when oral therapy is unsuccessful are also discussed.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939250","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":"Evidence of Autochthonous Human Strongyloides stercoralis in South Carolina.","authors":"Matthew S Haldeman, Henry Heidt, Salomé-Joëlle Gass, Melissa S Nolan","doi":"10.4269/ajtmh.25-0209","DOIUrl":"10.4269/ajtmh.25-0209","url":null,"abstract":"<p><p>Strongyloides stercoralis, a soil-transmitted helminth, was historically known to persist throughout the southeastern United States, but data regarding current prevalence are lacking. This project aimed to evaluate potential seroprevalence and epidemiologic risk factors for Strongyloides infections among South Carolina (SC) residents. First, a cross-sectional serosurvey was conducted on banked serum samples, and seroprevalence status was compared with associated health questionnaires. Seropositive participants were contacted for follow-up confirmation and management. Second, a retrospective chart abstraction was performed within the state's largest health care system, comparing medical records among patients testing positive for Strongyloides with two matched controls over a 5-year period. From the initial cross-sectional serosurvey, 5.0% (n = 78 of 1,572) of sera tested positive for Strongyloides antibodies. Significant differences in race/ethnicity and education level were noted between positive and negative residents. Geospatial analysis revealed statistical hot spots in northwestern and central SC. Follow-up participation of seropositives was low (n = 14 of 78); however, five of these participants (36%) were positive on confirmation testing. Of these, three had evidence of autochthonous transmission. Conversely, the retrospective chart abstraction revealed 26 patients with confirmed laboratory diagnosis of Strongyloides infection, of which 6 had evidence of autochthonous transmission. We found a small but nonnegligible burden of autochthonous Strongyloides infection among SC residents. Further study is needed to better characterize the clinical burden and epidemiologic risk factors for locally acquired S. stercoralis. This information may provide contemporary data to inform future targeted public health interventions for at-risk populations in the southeastern United States.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144881883","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":"High Prevalence, Genetic Diversity and Temporal Differentiation of Plasmodium vivax in a Remote Hard-to-Reach Community from the Peruvian Amazon Region.","authors":"Roberson Ramirez, Katherine Torres, Pamela Rodríguez, Carlos Acosta, Mitchel Guzmán-Guzmán, Alejandro Llanos-Cuentas, Joseph M Vinetz, Ananias A Escalante, Dionicia Gamboa","doi":"10.4269/ajtmh.24-0662","DOIUrl":"10.4269/ajtmh.24-0662","url":null,"abstract":"<p><p>Assessing parasite population genetic diversity and structure in remote areas is essential for understanding malaria transmission and guiding interventions toward elimination. This study monitored the genetic diversity and population structure of Plasmodium vivax as part of a longitudinal surveillance in Santa Emilia, a hard-to-reach community in Loreto, Peru. A total of 221 of 3,434 P. vivax samples collected through active and passive case detection between 2015 and 2016 were genotyped using 16 neutral microsatellites. Additionally, 139 genotyped samples from 2013, previously reported, were included for comparison. Malaria prevalence (microscopic and submicroscopic), genetic diversity, population differentiation, structure, bottleneck analysis, and relatedness between years were evaluated. We found 56% P. vivax prevalence by quantitative real-time polymerase chain reaction, with 44% submicroscopic infections in 2015 and 2016. Genetic diversity and population differentiation were high between 2013, 2015, and 2016. Parasites from 2015 to 2016 had a lower Jost D. In 2013 and 2015, more than 40% of infections were polyclonal infections, but only 29% were polyclonal infections in 2016. Moderate linkage disequilibrium was found over time. Four populations were detected in 2013, 2015, and 2016, with increasing admixture in 2015-2016. Genetically related parasites with clonal expansion suggest that there was no recent bottleneck. Santa Emilia has a persistent high genetic diversity and structured, temporally differentiated clonal populations over the time periods of the study. This analysis highlights the complexity of parasite dynamics in this remote area of malaria transmission, making it a challenging area for the malaria elimination plan in Peru.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144881885","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":"Donor-Derived Dengue Virus Transmission in Kidney Transplant-A Report of Three Cases.","authors":"Brenda Aceves-Sánchez, Ricardo Espinosa-González, Carlos Antonio Castro-Almanza, Alfredo Ponce-de-León, Guillermo M Ruiz-Palacios, Pilar Ramos-Cervantes, Carla M Román-Montes, Luis Eduardo Morales-Buenrostro, Mario Vilatobá, María F González-Lara","doi":"10.4269/ajtmh.25-0060","DOIUrl":"10.4269/ajtmh.25-0060","url":null,"abstract":"<p><p>Donor-derived dengue virus transmission is a rare but serious concern in hyperendemic regions, such as Mexico. Despite the risk, no standardized guidelines exist for dengue screening or organ acceptance criteria for donors. This report includes three kidney transplant recipients who developed dengue virus infection post-transplant. Case 1: Recipient 1 was a 41-year-old man with chronic kidney disease (CKD) who received a second kidney transplant from a donor with a history of dengue. He developed severe dengue and recovered with supportive care. Recipient 2 was a 41-year-old woman with rheumatoid arthritis and diabetic nephropathy who received the other kidney from the same donor. She died due to severe dengue, which caused respiratory failure and coagulopathy. Case 2: A 40-year-old woman with CKD secondary to polycystic kidney disease developed mild dengue after a 4-week surgical delay due to the donor's dengue infection and recovered with supportive care. These cases highlight the urgent need for guidelines that address donor-derived dengue transmission in transplant patients. The current algorithm used for evaluating at-risk donors and recipients of solid organ transplantation at the study center is presented. Evidence of donor-derived dengue virus transmission in the literature is limited. Decisions regarding organ procurement from potential donors should be evidence-based; however, there are no international guidelines designed to assist clinicians in this context. In the current study, three cases of donor-derived dengue virus transmission after kidney transplantation in an endemic region of Mexico are described.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144881881","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":"Geographical Risk of Disease Mortality during the US Civil War.","authors":"G Dennis Shanks, Michael Waller","doi":"10.4269/ajtmh.25-0273","DOIUrl":"10.4269/ajtmh.25-0273","url":null,"abstract":"<p><p>Infectious diseases killed more Union soldiers than combat (2:1 ratio) during the US Civil War, 1861-1865, but this mortality was unevenly distributed across 2,000 individual regimental units. Historical disease mortality rates by US state were obtained from old administrative records from the US Civil War. When disease casualties were assigned to individual states on the basis of where the regiments were recruited, distinct geographical patterns emerged, varying by a factor of 10. More rural areas experienced higher disease mortality rates, especially in southern and border states. A strong correlation (R2 = 0.58; P <0.01) between Civil War disease mortality and the proportion of farming occupations by state was found by using data from the 1860 Census. Low population density also correlated with higher disease mortality rates, but the area of farmland or wheat production in 1860 did not. Elevated disease mortality among Black and Indian (Native American) soldiers was comparable to that of White Union soldiers recruited from the Confederate states and was much higher than that of soldiers from more urban states in the Northern and Eastern regions. Disease mortality during the US Civil War varied greatly between groups, with epidemiological isolation prior to the war associated with higher mortality and urban living or prior military service associated with lower mortality. This difference is likely due to varied immunity to infectious pathogens.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144881884","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}