American Journal of Tropical Medicine and Hygiene最新文献

{"title":"A Clinico-Microbiological Profile of Patients with Acute Cholangitis.","authors":"Souradeep Chowdhury, Sagnik Biswas, Soumya J Mahapatra, Deepak Gunjan, Ankur Goyal, Hitender Gautam, Bimal Kumar Das, Raju Sharma, Sanjeev Sinha, Benu Dhawan","doi":"10.4269/ajtmh.25-0488","DOIUrl":"10.4269/ajtmh.25-0488","url":null,"abstract":"<p><p>The aim for the present study was to determine the clinico-microbiological profile and antimicrobial susceptibility patterns of organisms isolated from bile aspirates during endoscopic retrograde cholangiopancreatography (ERCP) in patients with acute cholangitis. In this prospective, observational, single-center study, bile aspirates and blood from consecutive patients undergoing ERCP for acute cholangitis were collected for culture. Demographic, outcome, and microbiological data were collected. Multivariate logistic regression was used to identify factors associated with adverse outcomes. Bile aspirates from 117 patients were collected; 95 (81.2%) yielded positive culture results, and 101 isolates were identified. Gram-negative organisms were the most frequently isolated, with Escherichia coli (E. coli; 50.5%), Pseudomonas spp. (21.8%), and Klebsiella spp. (15.8%), being the most common. Extended-spectrum beta-lactamase production and carbapenem resistance were observed in 79.1% and 29.2% of Gram-negative isolates, respectively. Among 64/117 (54.7%) concurrent blood cultures, 11 (17.2%) were positive. A biliary endoscopic sphincterotomy had been conducted previously in 43 cases (36.8%) and was associated with a higher frequency of E. coli and carbapenem-resistant Klebsiella pneumoniae (CRKP). Multivariate analysis revealed that male sex (odds ratio [OR]: 4.2; P = 0.05) and malignant biliary obstruction (OR: 8.1; P = 0.005) were independently associated with worse outcomes. Bile cultures frequently yield multidrug-resistant organisms in acute cholangitis. A previous biliary sphincterotomy increases the risk of drug-resistant infections, particularly CRKP. These findings highlight the importance of local microbiological surveillance and individualized empirical therapy.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"832-836"},"PeriodicalIF":1.6,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147430333","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":"Recurrent Cellulitis Presenting with Unilateral Leg Edema Mimicking Filarial Elephantiasis.","authors":"Manasvin Onwan, Kantarat Wattanawinitchai, Sakarn Charoensakulchai","doi":"10.4269/ajtmh.25-0587","DOIUrl":"10.4269/ajtmh.25-0587","url":null,"abstract":"","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"810-811"},"PeriodicalIF":1.6,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147430239","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":"Documentation Gaps in Animal Bite Reexposure Cases: Economic and Public Health Implications in a Tertiary Anti-Rabies Clinic in North India.","authors":"Aman Dev Singh, Simmi Oberoi, Neha Kaler, Hemkiran Singh, Japneet Kaur","doi":"10.4269/ajtmh.25-0773","DOIUrl":"10.4269/ajtmh.25-0773","url":null,"abstract":"<p><p>Rabies is a vaccine-preventable but fatal zoonotic disease. In India, where animal bite incidents are common, many reexposed patients do not have documentation of prior postexposure prophylaxis. This results in unnecessary administration of anti-rabies vaccines (ARVs) and rabies immunoglobulin (RIG), which leads to waste of resources and increased healthcare costs. This study aimed to quantify the burden and underlying causes of missing documentation in rabies reexposure cases. A prospective cross-sectional observational study was conducted at a tertiary Anti-Rabies Clinic in North India from August 2024 to November 2024, enrolling 200 patients with category 2 or 3 animal bites. Data were collected through validated questionnaires and analyzed using descriptive and inferential statistics. Of 61 patients with a prior bite exposure history, 78.7% lacked documentation, with the primary reasons being loss of documents (56.2%) and lack of awareness (31.2%). Undocumented patients incurred 2.18 times higher treatment costs, spending ₹13,200 on ARVs and ₹12,960 on RIG. Significant associations were found between documentation status and occupation (P = 0.02) and time since the last bite (P = 0.002). The high rates of undocumented prior rabies exposure contribute to avoidable biological and financial burdens on healthcare systems. This study suggests integrating digital health tools such as short messaging service reminders, mobile applications, and centralized electronic health records to lower costs and improve case management, thereby enhancing the efficiency of rabies prevention programs in resource-limited settings.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"961-965"},"PeriodicalIF":1.6,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363810","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":"Diversity of Strongyloides stercoralis Isolates from Humans in Iran.","authors":"Zohreh Fakhrieh-Kashan, Meysam Sharifdini, Farzaneh Zahabiun, Eshrat Beigom Kia","doi":"10.4269/ajtmh.25-0554","DOIUrl":"10.4269/ajtmh.25-0554","url":null,"abstract":"<p><p>Strongyloides stercoralis (S. stercoralis), the etiological agent of strongyloidiasis, is a medically important intestinal nematode that can cause life-threatening disseminated infections, particularly in immunocompromised individuals. Despite its clinical significance, limited information is available on the genetic diversity, population structure, and phylogenetic relationships of this parasite, especially in endemic regions. Therefore, generating molecular data from different geographic areas is essential for better understanding transmission patterns and epidemiology. In the present study, the intraspecies genetic diversity of S. stercoralis isolates obtained from humans in endemic regions of Iran was investigated by using mitochondrial and nuclear genetic markers. Fecal samples were collected from infected individuals in four provinces of Iran and examined using standard parasitological methods. Molecular analysis was performed through polymerase chain reaction amplification of the mitochondrial cytochrome c oxidase subunit 1 (Cox1) gene and the nuclear 18S recombinant DNA [rDNA] hypervariable regions (HVR I and IV). The obtained sequences were analyzed and aligned using Chromas (Technelysium Pty Ltd, Brisbane, Australia), BioEdit (Tom Hall, North California State University, NC), and CLC Genomics Workbench 11 (QIAGEN Sciences Inc., Germantown, MD), compared with reference sequences from GenBank, and phylogenetic trees were constructed using MEGA version 7.0 (MEGA Software GmbH, Dortmund, Germany). Haplotype networks were visualized with PopART version 1.7 (University of Otago, Dunedin, New Zealand). Analysis of 40 human isolates revealed 13 Cox1 haplotypes, of which 11 were newly identified in the present study. Notably, one haplotype clustered closely with dog-derived isolates from Japan and Cambodia. Isolates from Hormozgan Province formed distinct clades compared with other regions. Furthermore, 18S rDNA analysis revealed shared HVR-I and HVR-IV haplotypes between human and canine isolates, suggesting zoonotic transmission. Overall, the findings reveal considerable genetic diversity and regional differentiation of S. stercoralis in Iran, highlighting the need for broader multigene studies to clarify transmission dynamics and support effective control strategies.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"923-929"},"PeriodicalIF":1.6,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147347116","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":"Surgical Retrieval of Grains in a Case of Cystic Actinomycetoma.","authors":"Deepti Singh, Sowmya Susan, Sheetanshu Kumar","doi":"10.4269/ajtmh.25-0581","DOIUrl":"10.4269/ajtmh.25-0581","url":null,"abstract":"","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"812-813"},"PeriodicalIF":1.6,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147347066","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":"Detection of Multiple Dengue Virus Serotypes Circulating in Somalia.","authors":"Titus Tugume, Bernard Erima, Graham A Matulis, Hannah Kibuuka, Ambrose K Musinguzi, Joseph Asea, James Kiyengo, Edison Mworozi, William R Dorman, Hadish H Yohannes, Haley P Smith, Korey L Delp, Fred Wabwire-Mangen, Timothy E Egbo, Eric Garges, Michael von Fricken, Christopher P Stefan, Jeffrey W Koehler, Denis K Byarugaba","doi":"10.4269/ajtmh.25-0445","DOIUrl":"10.4269/ajtmh.25-0445","url":null,"abstract":"<p><p>Dengue virus (DENV) is widely distributed across Africa but underreported due to limited surveillance and diagnostic capacity. Under an acute febrile illness surveillance protocol, we collected and screened 374 samples from patients with fever in Mogadishu, Somalia. Samples were screened for DENV serotypes using real-time reverse transcription polymerase chain reaction, and positive samples were sequenced and phylogenetically analyzed. We identified 55 samples containing orthoflavivirus RNA (14.7%). Of these 55 samples, three dengue serotypes, DENV serotype 1 (DENV-1, n = 24), DENV serotype 2 (DENV-2, n = 21), and DENV serotype 3 (DENV-3, n = 12), were identified. Two cases of coinfections were detected: 1) between DENV-1 and DENV-2 and 2) between DENV-2 and DENV-3. DENV-1 had two genetic clusters, both related to lineages from Asia. DENV-2 grouped within a set of sequences from Asia and Africa, particularly close to a DENV-2 outbreak in Kenya. The DENV-3 grouped with isolates from Oceania Asia, clustering with a case of dengue fever identified in Italy in 2023 and Ethiopia in 2023. Our findings suggest concurrent infections of the three serotypes with DENV-3 being more widely spread in East Africa.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"951-955"},"PeriodicalIF":1.6,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147347131","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":"Rash and Eschar in Japanese Spotted Fever.","authors":"Taiki Nishiba, Kazuhisa Yokota","doi":"10.4269/ajtmh.25-0644","DOIUrl":"10.4269/ajtmh.25-0644","url":null,"abstract":"","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"808-809"},"PeriodicalIF":1.6,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147347074","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":"Dengue's Clinical Course in One of Colombia's Most Endemic Areas: Impact of Endemic and Epidemic Periods.","authors":"Gisel Viviana Osorio-Cuéllar, Juliana Quintero, Alvaro Andres Gaitan, Carlos Torres-Martínez, Marcela Daza, Gustavo Clemen, Luz Elena Muñoz Garzón, José Oñate, Mauricio Bernal-Sanchez, Martín Cañón Muñoz","doi":"10.4269/ajtmh.25-0158","DOIUrl":"10.4269/ajtmh.25-0158","url":null,"abstract":"<p><p>Dengue is a viral disease with a broad spectrum of clinical manifestations. Its severity is associated with risk factors such as periods of endemicity, although the extent of this contribution is unclear. In the present study, the characteristics of the clinical course and differences in the occurrence of severe and lethal outcomes were assessed by the degree of endemicity in patients with dengue treated in health institutions in Cali, Colombia, between 2019 and 2022. A longitudinal, observational-historical, single-cohort study was conducted. Analysis involved evaluating clinical complications during epidemic and endemic periods. Mortality, cumulative incidence of hospital or intensive care unit (ICU) admission, and survival time were estimated using the competing risks method. A total of 1,038 dengue cases were included. Patients with severe dengue and those with warning signs (WS) were consulted up to 6 or 5 days after symptom onset, respectively. A hospital stay of 2.0 days (Quartile [Q]1-Q3: 2-4 days) and an ICU stay of 4.5 days (SD ± 3.9 days) were estimated. A mortality rate of 5.5% was obtained for severe dengue, and a mortality rate of 0.4% was identified for patients with WS. In 2020 and 2021, the probability of hospitalization was 20% from initial contact. The likelihood of dying within 10 days after initial contact was 0% in 2019 and 11.2% (95% CI: 4.0-22.5%) in 2020. The incidence of hospitalization, number of hospital days, and ICU stays due to dengue varied by epidemiological year in a high-endemicity area. The probability of severe and lethal clinical outcomes was higher during 2020 and 2021.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"724-737"},"PeriodicalIF":1.6,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13045547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147300825","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":"Prospective Genomic Surveillance of Severe Febrile Illness in Tanzanian Children Identifies High Mortality and Resistance to First-Line Antibiotics in Bloodstream Infections.","authors":"Teresa B Kortz, Victoria T Chu, Raya Y Mussa, Erasto M Sunzula, Victoria M Mlele, Cecilia L Msemwa, Lushona K Mathias, Namala P Mkopi, Ryan J Ward, Kathleen S Sun, Jazmin M Baez Maidana, Anneka M Hooft, Juma A Mfinanga, Joseph L DeRisi, Hendry R Sawe, Joel P Manyahi, Charles R Langelier","doi":"10.4269/ajtmh.25-0522","DOIUrl":"10.4269/ajtmh.25-0522","url":null,"abstract":"<p><p>Severe febrile illness (SFI), a major cause of child mortality in Sub-Saharan Africa (SSA), is frequently caused by bloodstream infections (BSI), increasingly caused by antimicrobial-resistant organisms. However, antimicrobial resistance (AMR) prevalence and patterns in this population are largely unknown. We conducted a prospective cohort study of children aged 28 days to 14 years with SFI at a referral hospital in Tanzania (July 2022-September 2023) to determine the prevalence, pathogen profile, and AMR patterns of BSIs. Blood cultures were performed on all participants. Isolates underwent AMR testing and whole genome sequencing (WGS) to identify AMR genes and assess genetic relatedness. The association between BSI and mortality was assessed using logistic regression. Among the 392 enrolled children (median age 17.8 months), 5.2% (n = 20) had culture-confirmed BSI, with a case fatality rate of 45%. Gram-negative bacteria predominated (Escherichia coli, Klebsiella pneumoniae), with 79% of isolates exhibiting phenotypic resistance to ceftriaxone, a first-line antimicrobial. WGS revealed extended-spectrum β-lactamase genes (CTX-M-15, CTX-M-27) in most Enterobacterales isolates and identical isolates among 2/4 patients with Streptococcus pneumoniae and 2/3 Candida albicans infections. Children with BSI had significantly higher mortality than those without BSI (adjusted odds ratio 3.9; 95% CI: 1.5-10.1, P <0.01). These findings emphasize the urgent need for expanded AMR surveillance systems, empiric antibiotic regimens tailored to local AMR patterns, and culture-independent diagnostics in SSA. These data are critical for understanding the cause of severe infection and have the potential to guide policy aimed at reducing child mortality from BSI.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"767-773"},"PeriodicalIF":1.6,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13045537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147300820","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":"Catch-Up Screening to Improve Detection of Congenital Chagas Disease in a Nonendemic Setting.","authors":"Anna Boté-Casamitjana, Joanna Martin, Jackie Touray, Natalie Elkheir, Laura Eve Nabarro, Sarah Eisen, David A J Moore","doi":"10.4269/ajtmh.25-0656","DOIUrl":"10.4269/ajtmh.25-0656","url":null,"abstract":"<p><p>Mother-to-child transmission of Trypanosoma cruzi, the parasitic cause of Chagas disease, occurs in 5-10% of affected pregnancies. Congenital infection is usually asymptomatic, so if maternal infection is not suspected, the affected newborn may go undetected. As detection and antiparasitic treatment in early life result in much higher cure rates than treatment later in life, it is important to explore opportunities for catch-up testing of children born to women found to have T. cruzi infection. We piloted a multidisciplinary adult-pediatric disease referral pathway and developed a clinic to screen children of women diagnosed with Chagas disease. We evaluated the impact, acceptability, and patient experience of the pathway, including exploration of barriers to accessing prior testing. Of the 28 referred children, 23 (82%) attended the clinic, 22 (79%) were tested, and 1 child was diagnosed with congenital infection. The service was deemed effective and beneficial by both healthcare professionals and parents.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":"716-719"},"PeriodicalIF":1.6,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13045532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147300878","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}