American Journal of Tropical Medicine and Hygiene最新文献

{"title":"Program Evaluation of Community Case Management with Reactive Test and Treat for Malaria in a High-Transmission Setting.","authors":"Austin Weynand, Manuela Hauser, Caitlin Bond, James Sichivula Lupiya, Dickson Phiri, Bruce Phiri, Molly Mantus, Benjamin Kussin-Shoptaw, Mike Chaponda, Mbanga Muleba, Jean-Bertin B Kabuya, Gershom Chongwe, William J Moss, Matthew M Ippolito","doi":"10.4269/ajtmh.24-0405","DOIUrl":"10.4269/ajtmh.24-0405","url":null,"abstract":"<p><p>Community case management (CCM) combined with reactive test-and-treat (RTAT) for malaria was implemented by the National Malaria Elimination Program in a holoendemic region of Zambia. We assessed the impact of CCM + RTAT activities on malaria care seeking, health facility cases, and hospital mortality. We analyzed data from community surveys, a health facility-based passive surveillance network, and a hospital-based severe malaria surveillance system to compare metrics across the program eras (July 2016-July 2018, August 2018-October 2019, and November 2019-July 2021). Geospatial mapping was used to visualize trends in referrals and mortality. Clinical profiles of 696 hospitalized children with malaria were compared and in-hospital mortality were analyzed across periods using multiple logistic regression. There were more frequent health contacts for malaria reported by community members and a corresponding decrease in health facility malaria cases during CCM + RTAT. Pediatric patients admitted to the hospital with malaria during CCM + RTAT had less severe disease and shorter lengths of stay and in-hospital mortality was lower (odds ratio: 0.24, 95% CI: 0.07-0.84, P = 0.025). Geospatial mapping of the home villages of children hospitalized with malaria showed a wider catchment during CCM + RTAT than before or after. In this high malaria transmission setting, CCM + RTAT increased access to care, shifted malaria case burden from health facilities to community health workers, and improved in-hospital outcomes for malaria, likely from earlier referral. However, RTAT + CCM in this high-transmission area proved unsustainable because of excessive consumption of malaria commodities.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"1207-1214"},"PeriodicalIF":1.9,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963873","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":"Partnership to Develop an Inter-Disciplinary Schistosomiasis Research Training Program in Uganda.","authors":"Damalie Nakanjako, Moses Egesa, Helen Byakwaga, Casim Umba Tolo, Anatol Maranda Byaruhanga, Prudence Beinamaryo, Grace Banturaki, Lydia Nakiyingi, Ponsiano Ocama, Moses R Kamya, Alison M Elliott","doi":"10.4269/ajtmh.24-0645","DOIUrl":"https://doi.org/10.4269/ajtmh.24-0645","url":null,"abstract":"<p><p>The WHO 2021-2030 roadmap for neglected tropical diseases (NTDs) and the 2022 Kigali Declaration urge academic research institutions to unite in combating NTDs, including schistosomiasis, and emphasize the importance of strategic partnerships to free more than 1 billion people who require interventions against NTDs. We conducted stakeholder meetings to understand the landscape of schistosomiasis research training in Uganda and the existing collaborations with research institutions in sub-Saharan Africa, Europe, the United Kingdom, and the United States. In focus group discussions (involving 33 individuals from four institutions), key challenges were summarized into four emerging themes: 1) limited physical infrastructure for schistosomiasis research and training, 2) a low critical mass of scientists with competencies in schistosomiasis research, 3) a limited scope of current schistosomiasis research, and 4) limited advocacy and community engagement for schistosomiasis control. National and international partnerships, as well as partnerships between academics and implementers, should be harnessed to establish a vibrant network for schistosomiasis research training in resource-limited settings where the disease remains endemic.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958174","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":"Scabies: A Catastrophe that Befalls Bangladesh amidst Floods.","authors":"Sakan Binte Imran","doi":"10.4269/ajtmh.24-0684","DOIUrl":"https://doi.org/10.4269/ajtmh.24-0684","url":null,"abstract":"","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952222","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":"Migratory Soft-Tissue Swelling Owing to Subcutaneous Dirofilariasis.","authors":"Chudapa Sereeaphinan, Suchanan Hanamornroongruang, Panitta Sitthinamsuwan, Patsharaporn T Sarasombath, Chuda Rujitharanawong","doi":"10.4269/ajtmh.24-0799","DOIUrl":"10.4269/ajtmh.24-0799","url":null,"abstract":"<p><p>Dirofilariasis is an emerging zoonotic infection caused by filarial nematodes from the Dirofilaria genus, typically transmitted through mosquito bites. This case is unique because of the migratory nature of subcutaneous nodules, a presentation seldom associated with Dirofilaria infections. A 51-year-old Thai female presented with migratory subcutaneous nodules on her left arm. Initially misdiagnosed as cellulitis, she received empirical antibiotics, showing only partial improvement, and subsequently developed new nodules. A skin biopsy revealed nematode segments, and molecular identification confirmed Dirofilaria repens using polymerase chain reaction targeting the filarial mitochondrial 12s ribosomal RNA and internal transcribed spacer 1 genes. Treatment with a 3-week course of 400 mg oral albendazole resulted in complete resolution of the lesions. This case underscores the importance of molecular diagnostics when morphological identification is challenging as it enables accurate species identification, enhances disease management, and supports optimized treatment of unusual presentations of dirofilariasis.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"1231-1234"},"PeriodicalIF":1.9,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963860","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":"Concomitant Splenic Tuberculosis and Epstein-Barr Virus-Related T-Cell Leukemia/Lymphoma in a 28-Year-Old Pregnant Woman in South Sudan.","authors":"Hannah B Wild, Joseph Aumuller, Joseph Kuei, Mel Simon, Anna Palm, Jacob Pendergrast, Jean-Pierre Letoquart, Jefferson Terry, Shahrzad Joharifard","doi":"10.4269/ajtmh.25-0033","DOIUrl":"10.4269/ajtmh.25-0033","url":null,"abstract":"<p><p>This case report presents a rare instance of concomitant splenic tuberculosis (TB), Epstein-Barr virus (EBV)-related T-cell leukemia/lymphoma, and malaria in a 28-year-old pregnant woman at a Médecins Sans Frontières-supported hospital in South Sudan. The patient was admitted with splenomegaly, anorexia, weakness, and transfusion-refractory anemia. She tested positive for malaria and was treated appropriately. Because of ongoing consumptive anemia, cachexia, and weakness severely impacting her quality of life, the patient underwent splenectomy. A diagnosis of TB was ultimately confirmed post-splenectomy through histopathological analysis and molecular testing. Gross findings from the pathologic analysis of a splenic sample revealed miliary deposits, necrotizing granulomas, and atypical lymphocytic infiltrates consistent with TB and EBV-associated leukemia/lymphoma. Despite temporary improvement post-operatively and the initiation of TB therapy, the patient discontinued treatment and was lost to follow-up, likely resulting in mortality. This report presents an unusual combination of concomitant pathologies that underscore the diagnostic challenges and complexity of managing overlapping infectious and hematological disorders in resource-limited settings.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"1267-1272"},"PeriodicalIF":1.9,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959420","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":"Symptoms and Management of Painful Progressive Swelling in Eswatini Snakebite Patients: A Prospective Observational Study.","authors":"Jonathan Steinhorst, Thea Litschka-Koen, Bianca Ascenção, Lindelwa Mmema, Nondumiso Shongwe, James Murray, Harry VanderWal, Rafael Cuginotti de Oliveira, Trevor Sithole, Sara Padidar, Nicholas R Casewell, Jonathan Pons, Robert A Harrison, David G Lalloo, Ymkje Stienstra","doi":"10.4269/ajtmh.24-0671","DOIUrl":"10.4269/ajtmh.24-0671","url":null,"abstract":"<p><p>In Eswatini, bites from snakes with cytotoxic venoms inflict substantial morbidity on humans through blistering, swelling, and tissue necrosis. Despite its widespread use, there is little evidence regarding the efficacy of antivenom in preventing snakebite-induced tissue damage. We conducted a prospective observational study in nine hospitals in Eswatini to describe and quantify symptoms of local tissue toxicity. Our secondary aim was to examine the use of antivenom. Data from 125 snakebite patients with extensive or rapidly progressive swelling were analyzed. The median increase in circumference of envenomed limbs was 12%. Necrosis developed in 31 (25%) patients, primarily in distal extremities. Seventy patients (56%) received South African Institute for Medical Research (SAIMR) Polyvalent antivenom (South African Vaccine producers, Johannesburg South Africa), which was administered for indications related to local tissue damage. Upon hospital presentation, patients treated with antivenom exhibited slightly more severe swelling. Ten out of 11 patients with necrosis upon admission received antivenom. At least seven patients developed necrosis after admission despite previous antivenom therapy. In this nonrandomized observational study, no relationship was observed between the rate at which swelling receded and antivenom treatment. Adverse reactions to antivenom occurred in 49% of patients. Although our analysis has its limitations, it emphasizes the compelling need for research into the indications for and outcomes of antivenom treatment for local tissue damage.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"1345-1354"},"PeriodicalIF":1.9,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956047","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":"Reversible Neurological Toxicity Owing to Metronidazole Use.","authors":"Rahul Bajaj, Anuj Prabhakar, Deba Prasad Dhibar, Harpreet Singh, Vikas Suri, Ashish Bhalla","doi":"10.4269/ajtmh.24-0809","DOIUrl":"https://doi.org/10.4269/ajtmh.24-0809","url":null,"abstract":"","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959713","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 and Outcomes of Meningitis among Adults in Three Ugandan Referral Hospitals, 2018-2023: A Prospective Cohort Study in a High-HIV Endemic Setting.","authors":"Timothy Mugabi, Suzan Namombwe, Biyue Dai, Elizabeth Nalintya, Laura J Nsangi, Mable Kabahubya, Sarah M Najjuka, Samuel Okurut, Olivie C Namuju, Enos Kigozi, Kisakye D Kabbale, Bakka Wilber, Samuel Jjunju, Conrad Muzoora, Lillian Tugume, Martineau Louine, Michael R Wilson, Nathan C Bahr, Fiona V Cresswell, David B Meya, Jayne Ellis, David R Boulware, Radha Rajasingham","doi":"10.4269/ajtmh.24-0373","DOIUrl":"10.4269/ajtmh.24-0373","url":null,"abstract":"<p><p>Studies describing the global burden of meningitis often exclude HIV- or tuberculosis (TB)-related etiologies, thereby presenting a limited view of meningitis etiology in low- and middle-income countries. This study provides an updated evaluation of the etiology of meningitis and treatment outcomes in Uganda given advancements in molecular and TB diagnostics. We conducted a prospective observational cohort study from December 2018 to October 2023, for which adults with suspected meningitis were recruited from three referral hospitals in Uganda. We used a comprehensive diagnostic algorithm to determine microbiological etiologies of cases. Participants were followed through hospital discharge, and mortality was summarized by meningitis etiology. We enrolled 1,577 participants with suspected meningitis, of whom 96% (n = 1,511/1,577) had HIV infection and 51% (n = 772/1,577) were antiretroviral therapy naive. The median CD4 cell count was 39 cells/µL (interquartile range: 14-97 cells/µL). Cryptococcal meningitis was the most frequently diagnosed etiology of meningitis (62%) followed by TB meningitis (21%). Inpatient mortality was highest among participants diagnosed with possible TB meningitis (32%) followed by probable TB meningitis (29%) and bacterial meningitis (24%). Among the 4% (n = 66/1,577) of HIV-seronegative participants, TB meningitis was the most frequently (38%) diagnosed cause of meningitis. Despite improvements in access to HIV therapy, cryptococcal meningitis and tuberculous meningitis persist as the most common etiologies of meningitis in Uganda. Improved access to meningitis diagnostics and treatments is critically needed to mitigate the morbidity and mortality, particularly in the resource-limited settings of HIV and TB endemic regions.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"1273-1279"},"PeriodicalIF":1.9,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953717","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":"Costs, Coverage, and Acceptability of Azithromycin Mass Administration to Children 1-11 Versus 1-59 Months Old to Reduce Mortality: A Cluster-Randomized Trial in Niger.","authors":"Ahmed M Arzika, Ramatou Maliki, Abdou Amza, Alio Karamba, Nasser Gallo, Bawa Aichatou, Ismael I Sara, Diallo Beidi, Laminou M Haroun, Farissatou Oumarou, Carolyn Brandt, Brittany Peterson, Elodie Lebas, Emily Colby, William Nguyen, Zijun Liu, Benjamin F Arnold, Thomas M Lietman, Meagan C Fitzpatrick, Kieran S O'Brien","doi":"10.4269/ajtmh.24-0723","DOIUrl":"10.4269/ajtmh.24-0723","url":null,"abstract":"<p><p>Azithromycin mass drug administration (MDA) for 1- to 59-month-olds reduces child mortality. However, guidelines restrict eligibility to 1- to 11-month-olds because of concerns about antimicrobial resistance. This cluster-randomized implementation trial was conducted in parallel with a larger efficacy trial and compared implementation outcomes between these approaches. Rural communities in Niger were randomly assigned to receive biannual azithromycin MDA for either 1- to 59-month-olds or 1- to 11-month-olds over 1 year. The primary outcome was the community-level cost per dose delivered. Secondary outcomes included reach (coverage), as well as acceptability, appropriateness, and feasibility according to participants and providers. In November 2020, 40 eligible communities were randomly assigned to each arm, with 37 communities in the 1- to 59-month arm and 39 communities in the 1- to 11-month arm contributing to analyses. The mean cost per dose delivered was $6.50 lower (95% CI -$10.40 to -$3.70; P-value <0.001) in the 1- to 59-month arm ($1.60; 95% CI $1.00 to $2.30) compared with the 1- to 11-month arm ($8.20; 95% CI $7.60 to $8.80). Treatment coverage was similar by arm and exceeded 90% in both distributions. More caregivers in the 1- to 59-month arm found the intervention acceptable (mean difference 4.2%; 95% CI 0 to 8.4%; P-value 0.04) and appropriate (3.4%; 95% CI 0.1 to 6.8%; P-value 0.04) compared with the 1- to 11-month arm. When combining arms, all groups indicated that including 1- to 59-month-olds was more acceptable, appropriate, and feasible than restricting to 1- to 11-month-olds. No serious adverse events were reported. Overall, including 1- to 59-month-olds resulted in a lower cost per dose delivered than restricting to 1- to 11-month-olds. Community groups perceived both interventions to be acceptable, appropriate, and feasible, but they strongly preferred the 1- to 59-month treatment.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"1355-1363"},"PeriodicalIF":1.9,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810295","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 Submicroscopic Malaria Parasitemia, Soil-Transmitted Helminths, and Their Coinfections Among Forest-Fringed Orang Asli Communities in Peninsular Malaysia.","authors":"Nurmanisha Abdull-Majid, Nan Jiun Yap, Mian Zi Tee, Yi Xian Er, Romano Ngui, Yvonne Ai-Lian Lim","doi":"10.4269/ajtmh.24-0718","DOIUrl":"10.4269/ajtmh.24-0718","url":null,"abstract":"<p><p>Malaysia's malaria rate has declined but remains a public health concern, with limited investigations into malaria and coinfections with soil-transmitted helminth (STH) infections. A cross-sectional study using convenience sampling in Orang Asli villages enrolled 437 villagers aged 1-83 years based on their willingness to participate. Blood samples were tested microscopically for malaria, followed by nested polymerase chain reaction (PCR), and stool samples were screened microscopically for STH eggs. Body temperature, demographic, and socioeconomic data were collected. Malaria parasite was detectable only via PCR, with a 15.3% prevalence, indicating submicroscopic malaria parasitemia; none of the positive cases presented fever. The identified species included Plasmodium vivax (8.7%), Plasmodium cynomolgi (5.5%), Plasmodium knowlesi (4.3%), Plasmodium falciparum (1.8%), Plasmodium inui (0.2%), and Plasmodium malariae (0.2%). Females had significantly higher rates of submicroscopic malaria parasitemia (19.6%) compared with males (9.3%, P = 0.003). STH infections were highly prevalent (71.4%), with Trichuris trichiura (65.2%), Ascaris lumbricoides (35.0%), and hookworm (14.6%). STH infection was associated with age (P <0.001), peaking in individuals aged 10-19 years (86.2%) and 1-9 years (83.0%), as well as with students (84.3% versus 60.8% in employed and 60.3% in unemployed; P <0.001) and low-income households (76.4% versus 61.7% in higher-income households; P = 0.002). Submicroscopic malaria parasitemia and STH coinfections were present in 8.9% of participants, with higher rates in low-income households (12.6% versus 5.2% in higher-income, P = 0.010). The Negrito tribe exhibited the highest prevalence of submicroscopic malaria parasitemia, STH, and coinfections (P <0.05). This study highlights the need for integrated malaria and STH control strategies, particularly for the Negrito tribe.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"1391-1399"},"PeriodicalIF":1.9,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810302","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}