American Journal of Tropical Medicine and Hygiene最新文献

{"title":"Clinical Characteristics and Management of Four Cases of Visceral Leishmaniasis-Associated Hemophagocytic Lymphohistiocytosis.","authors":"Meng Tian, Jing Li, Shuzhi Dai, Lijuan Ma","doi":"10.4269/ajtmh.25-0530","DOIUrl":"10.4269/ajtmh.25-0530","url":null,"abstract":"<p><p>The aim for the present study was to analyze clinical features, diagnostic approaches, and therapeutic strategies for visceral leishmaniasis (VL)-associated hemophagocytic lymphohistiocytosis (HLH) in pediatric patients. The clinical characteristics and test results of the children were summarized. Among the four patients, three resided in VL-endemic regions, and one had traveled to a VL-endemic region. All patients presented with recurrent fever (>38.5°C), hepatosplenomegaly, and decreased hemoglobin (HGB) levels ([78.75 ± 8.50] g/L) and platelet (PLT) counts ([59.50 ± 17.48] × 109/L). Before a definitive diagnosis could be made, patients exhibited progressive declines in white blood cell counts, HGB levels, and PLT counts, along with elevated triglyceride, serum cytokine (interleukin [IL]-6, IL-10, IL-2R, and tumor necrosis factor α) levels. Bone marrow aspirate smears revealed hemophagocytosis and Leishmania donovani (LD) bodies in all cases: two were diagnosed via direct identification of LD bodies, one was diagnosed through re-examination of bone marrow smears after confirming a travel history, and one was diagnosed via re-examination prompted by metagenomic next-generation sequencing, which revealed leishmaniasis. All the patients were initially diagnosed with HLH and received HLH-directed immunochemotherapy before VL diagnosis, with suboptimal response. After confirmation of VL, sodium stibogluconate therapy was initiated, resulting in a partial response in all cases. Etiological investigation is critical for HLH diagnosis. For VL-associated HLH, sodium stibogluconate as targeted therapy rapidly controls HLH, facilitates immunosuppression withdrawal, and significantly improves patient outcomes. White blood cell count, HGB level, PLT count, and lactate dehydrogenase level may serve as critical prognostic biomarkers for VL-associated HLH.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"882-888"},"PeriodicalIF":1.6,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13153628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147519717","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":"The Effect of Head of Household Occupation and Activity at Sunrise and Sunset on Malaria Prevalence in Sussundenga, Mozambique.","authors":"Ben Jorgenson, Dominique E Earland, Albino F Bibe, Anísio Novela, Vali Muhiro, João L Ferrão, Kelly M Searle","doi":"10.4269/ajtmh.25-0655","DOIUrl":"10.4269/ajtmh.25-0655","url":null,"abstract":"<p><p>There is evidence that outdoor occupations and being active outdoors at night increase the risk of malaria infection. This study aimed to examine the associations between both head of household occupation and whether an individual was active at sunrise and/or sunset on the outcome of malaria infection separately and to determine if there was an interaction between the two exposures. We used data from a cross-sectional study in Sussundenga, Mozambique of 297 individuals within 84 households. Generalized linear mixed models were used to calculate the associations between each of the exposures and malaria infection as well as their interaction. After adjustment, the difference in predicted malaria prevalence comparing those in which the head of household had an outdoor versus indoor occupation was 0.015 (95% CI: -0.12 to 0.15). The difference in predicted malaria prevalence among those active at sunrise and sunset was 0.10 (95% CI: -0.063 to 0.26) and those active at either time was 0.011 (95% CI: -0.11 to 0.13) compared with those active at neither time. In the interaction model, the difference in malaria prevalence between those with the head of household having an outdoor versus indoor occupation was 0.33 (95% CI: 0.037-0.62) greater in those active at sunrise and sunset compared with those not active at either time. Although the test for additive interaction was not statistically significant or indicative of any clear association, the magnitude may indicate that those with different head of household occupation and outdoor times could have different malaria risk.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"899-904"},"PeriodicalIF":1.6,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13153629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147519765","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":"The Paradox of Progress: A Field Epidemiologist's Tale of Hepatitis A in Transition.","authors":"Kunal Pise, Shilpa Tomar","doi":"10.4269/ajtmh.25-0671","DOIUrl":"10.4269/ajtmh.25-0671","url":null,"abstract":"","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"819-820"},"PeriodicalIF":1.6,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13153631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147519749","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":"Knufia epidermidis Infection: A Case Report and Literature Review.","authors":"Yanhong Sun, Qing Zhao, Yong Zhang, Fangfang Bao, Furen Zhang","doi":"10.4269/ajtmh.25-0086","DOIUrl":"10.4269/ajtmh.25-0086","url":null,"abstract":"<p><p>A 16-year-old male patient was admitted to the study hospital with a 6-month history of two itchy, round, xerotic lesions affecting the skin on his wrists. A definite diagnosis was not made in the local hospital, and antibiotics were administered without improvement. Using mycological culture and intergenic transcriptional space sequencing, the patient was diagnosed with a Knufia epidermidis (K. epidermidis) infection and successfully treated with itraconazole at a dosage of 200 mg/day and acitretin at a dosage of 20 mg/day for 2 weeks. It is worth noting that K. epidermidis is a pathogen that can cause cutaneous infections. Doctors should be aware of this disease to avoid misdiagnosis.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"973-974"},"PeriodicalIF":1.6,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13153587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147519808","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":"Nodding Syndrome: The Need to Strengthen Epilepsy Care in Onchocerciasis-Endemic Areas and to Investigate the Pathogenesis of Onchocerciasis-Associated Epilepsy.","authors":"Amber Hadermann, Robert Colebunders","doi":"10.4269/ajtmh.26-0041","DOIUrl":"10.4269/ajtmh.26-0041","url":null,"abstract":"","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"805-807"},"PeriodicalIF":1.6,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13153621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147508843","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":"Enhancing Snakebite Surveillance Through Molecular Tools: Development of Species-Specific Polymerase Chain Reaction Primers for Snakes in Japan.","authors":"Yoshihiro Aoki, Yoshinao Kubo, Ken Yoshimura, Atsushi Sakai, Kensuke Takahashi, Shuhei Yamano, Chris Smith, Koichi Hayakawa, Osamu Tasaki, Ulrich Kuch, Koya Ariyoshi","doi":"10.4269/ajtmh.25-0701","DOIUrl":"10.4269/ajtmh.25-0701","url":null,"abstract":"<p><p>Polymerase chain reaction (PCR)-based species identification methods could enhance snakebite surveillance, especially in regions where multiple venomous snake species with similar clinical presentations coexist. We developed species-specific PCR primers targeting mitochondrial cytochrome b gene sequences for five snake species commonly found in Japan: Elaphe climacophora, Elaphe quadrivirgata, Gloydius blomhoffii, Rhabdophis tigrinus, and Protobothrops flavoviridis. The PCR method successfully detected snake DNA from tissue samples with high specificity, showing minimal crossreactivity between species. Only P. flavoviridis primers showed crossreaction with E. climacophora DNA at the target size, whereas G. blomhoffii primers produced weak amplification of E. climacophora DNA at a different size than expected. Some nonspecific bands were detected with human DNA, but these were substantially weaker and different in size compared with specific amplification products. The method also successfully detected snake DNA from noninvasive samples, including oral swabs, samples from venom collection containers (where snakes had deposited saliva during venom extraction procedures), and bite sites on dead mice. The minimum detectable DNA concentrations ranged from 0.02 to 4.5 pg/µL across different species. Although our current method requires separate PCR reactions for each species and needs further validation with clinical specimens, it provides a foundation for molecular-based snake species identification. This approach could particularly benefit regions in which accurate species identification is crucial for appropriate antivenom selection, effective clinical management, and well-informed interventional research. Future studies should focus on validating this method with clinical specimens and developing multiplex PCR systems for more practical surveillance applications.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"989-994"},"PeriodicalIF":1.6,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13153585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147508818","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":"Nodding Syndrome: Shifting the Focus from Cause to Treatment.","authors":"Matthew D Myers, Torie P Hagin, Sanjana Ramchandran, Sally M Yan, Riya N Soni, Emmanuel Latim, Nilam J Soni","doi":"10.4269/ajtmh.25-0692","DOIUrl":"10.4269/ajtmh.25-0692","url":null,"abstract":"<p><p>Nodding Syndrome (NS) is a debilitating neurodegenerative disease plaguing children in sub-Saharan Africa, with the highest prevalence in northern Uganda and South Sudan. The disease is characterized by head nodding, seizures, cognitive impairment, and physical wasting. Despite decades of research, the exact etiology of NS remains unclear. Some evidence suggests a link to Onchocerca volvulus infection, vitamin deficiency, and war-related displacement. Although the etiology remains unclear, effective treatment has been demonstrated with a combination of anticonvulsants, nutritional supplementation, and psychological/social therapy. Comprehensive care has been shown to slow disease progression and even reverse symptoms in some patients. NS presents complex challenges beyond its clinical scope, including stigma, caregiver burden, and political mistrust. Though researching the exact etiology of NS shall continue, sufficient resources should be allocated to implement multidisciplinary care programs and prioritize symptomatic treatment to improve the lives of children and families affected by this devastating condition.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"814-818"},"PeriodicalIF":1.6,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13153623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147508792","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":"COVID-19 in Villages of the Peruvian Amazon: A Survey of Local Public Health Beliefs and Behaviors.","authors":"Ahmed Alhussni, Lewis Greenan-Barrett, Derwin Soler Davila Guerra, Devon Graham","doi":"10.4269/ajtmh.25-0257","DOIUrl":"10.4269/ajtmh.25-0257","url":null,"abstract":"<p><p>Peru had one of the highest COVID-19 mortality rates globally, with the largest region, Loreto, facing unique public health challenges. This survey investigated the changes in health care access, health beliefs, and the COVID-19 behavioral responses in these communities to improve pandemic resilience. The survey was conducted as part of routine data collection from 100 adults attending Project Amazonas mobile health clinics in April 2022 in seven villages along the Ampiyacu River in Loreto. Data on demographics, health care access, public health beliefs, and societal behavioral responses to COVID-19 were analyzed and compared with previous surveys from 1999 and 2012. Fifty-four percent of the respondents reported difficulty accessing medical care, primarily due to distance. Lifetime doctor consultations increased from those recorded in 2012 and 97% of those surveyed had received two doses of the COVID-19 vaccine. The majority of participants used both traditional and modern medicine, with 47% consulting a doctor and 7% visiting a shaman for COVID-19. This survey shows high vaccine uptake and adherence to preventive measures, such as mask-wearing and social distancing, with some variation by gender. However, challenges in health care access and the use of ineffective treatments suggest there are areas to improve pandemic resilience in these communities. Local clinic expansion and training of village health promoters using new digital resources could help with this effort.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"944-950"},"PeriodicalIF":1.6,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13153584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147484383","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":"Fifteen-Year Evolution of Chronic Cutaneous Leishmaniasis Mimicking Other Dermatoses.","authors":"Luisa Hurtado-Rossi, Melissa Gutierrez-Gomez, Alvaro J Martinez-Valencia, Jonny A García-Luna","doi":"10.4269/ajtmh.25-0575","DOIUrl":"10.4269/ajtmh.25-0575","url":null,"abstract":"<p><p>Cutaneous leishmaniasis is an endemic parasitic infection in Colombia that typically presents as ulcerated skin lesions, although atypical variants can mimic diverse dermatosis leading to misdiagnosis and delayed treatment. We report the case of a 32-year-old woman with a 15-year history of progressive granulomatous and exophytic tumor-like plaques involving her lower face and neck. She was initially misdiagnosed with lymphocutaneous sporotrichosis and treated unsuccessfully with itraconazole for 1 year. The chronic facial involvement during her formative years resulted in major aesthetic and psychosocial consequences. Histopathology and direct smear ultimately confirmed Leishmania spp. infection. She received intramuscular meglumine antimoniate with marked clinical improvement. This case illustrates the diagnostic challenges of atypical chronic cutaneous leishmaniasis and emphasizes the need for thorough evaluation in endemic regions. Early recognition and appropriate management are essential to avoid therapeutic delays and long-term psychosocial impact.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"865-869"},"PeriodicalIF":1.6,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13153630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147484389","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":"Subclinical Leptospiral Infections and Antibody Waning During Pregnancy: A Population-Based Cohort Study from Rural Sri Lanka.","authors":"Suneth Agampodi, Dinesha Jayasundara, Janith Warnasekara, Thilini Agampodi, Indika Senavirathna, Dilrukshi Menike, Digantha Aswaddumage, Madushika Sewwandi, Chamila Kappagoda, Anuruddhi Premalal, Hwa Young Kim, Shashanka Rajapakse, Raphaël M Zellweger","doi":"10.4269/ajtmh.25-0553","DOIUrl":"10.4269/ajtmh.25-0553","url":null,"abstract":"<p><p>Leptospirosis is a zoonotic infection with significant mortality, yet its burden is underestimated due to diagnostic limitations. The dynamics of naturally acquired anti-Leptospira antibodies, particularly during pregnancy, remain poorly understood. This study examined the seroincidence of leptospiral infection among a cohort of pregnant women and characterized longitudinal antibody kinetics in an endemic setting. Paired sera were collected from a population-based pregnancy cohort in Anuradhapura, Sri Lanka. Women were enrolled before 12 weeks of gestation and followed up between 25-28 weeks. Data on sociodemographics, self-reported febrile illness, and hospital admissions were collected. Microscopic agglutination testing (MAT) was performed against 11 Leptospira serovars. Seroincidence was defined as seroconversion from non-reactive (<1:50) to reactive (≥1:50). Antibody kinetics were assessed using Gaussian accelerated failure time and proportional odds logistic regression models. Among 3,374 recruited women, 1,338 had paired samples. Of 1,245 seronegative at baseline, 22 (1.8%) seroconverted, yielding a seroincidence rate of 52.8/1,000 person-years (95% CI: 31.2-76.8), using the ≥1:50 definition; using a ≥1:100 cutoff, the seroincidence rate was 14.4 per 1,000 person-years (95% CI: 5.3-31.4). No significant differences in pregnancy outcomes were observed between seroconverts and non-seroconverts. Among 93 women with baseline antibody titers ≥1:50, 14 (15.1%) seroreverted to <1:50, 12 (12.9%) showed a decline in titers but remained ≥1:50, 56 (60.2%) remained unchanged, and 11 (11.8%) showed an increase in antibody titers. Antibody decay rates ranged from +0.353 to -0.789 log2 units/30 days (mean: -0.074), with faster decay at higher baseline titers. This study reveals frequent, asymptomatic Leptospira exposure and rapid antibody decline during pregnancy, highlighting substantial silent transmission and the limitations of current surveillance tools in endemic settings.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"848-856"},"PeriodicalIF":1.6,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13153586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147484333","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}