Tropical Medicine and Infectious Disease

14 pages, 1890 KiB

Open AccessCase Report

Discordant Clinical Outcomes in a Monozygotic Dichorionic-Diamniotic Twin Pregnancy with Probable Zika Virus Exposure. Case Report

by Marcela Mercado, Marcela Daza, Cynthia A. Moore, Diana Valencia, Angelica Rico, Diego A. Álvarez-Diaz, Aaron C. Brault, Kelly Fitzpatrick and Sarah B. Mulkey

Trop. Med. Infect. Dis. 2020, 5(4), 188; https://doi.org/10.3390/tropicalmed5040188 - 19 Dec 2020

Cited by 2 | Viewed by 3543

Abstract

Prenatal exposure to Zika virus (ZIKV) is associated with congenital anomalies of the brain and the eye and neurodevelopmental sequelae. The spectrum of disease outcomes may relate to timing of infection as well as genetic and environmental factors. Congenital infections occurring in twin [...] Read more.

Prenatal exposure to Zika virus (ZIKV) is associated with congenital anomalies of the brain and the eye and neurodevelopmental sequelae. The spectrum of disease outcomes may relate to timing of infection as well as genetic and environmental factors. Congenital infections occurring in twin pregnancies can inform the clinical spectrum of these conditions and provide unique information regarding timing of infection and in utero environment with disease pathophysiology. Herein, we report a monozygotic dichorionic-diamniotic twin pregnancy with probable prenatal ZIKV exposure identified through the Colombian ZIKV disease surveillance system. Multidisciplinary clinical evaluations were provided to the twins during their first three years of life through a national program for children with in utero ZIKV exposure. Laboratory evidence of congenital infection as well as microcephaly, brain, eye, and neurodevelopmental compromise related to prenatal ZIKV infection were identified in only one infant of the twin pregnancy. This is the first report of monozygotic twins discordant for Zika-associated birth defects. The evaluation of the pathophysiology of discordance in disease outcome for congenital infections in twin pregnancies may lead to a better understanding of potential complex environmental and genetic interactions between the mother, her offspring, and an infectious exposure. Full article

(This article belongs to the Special Issue Zika in Infants and Children)

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3 pages, 167 KiB

Open AccessEditorial

Special Issue “The Past and Present Threat of Rickettsial Diseases”

by Daniel H. Paris

Trop. Med. Infect. Dis. 2020, 5(4), 187; https://doi.org/10.3390/tropicalmed5040187 - 16 Dec 2020

Cited by 2 | Viewed by 1855

Abstract

Historically, the rickettsioses have a track record of making substantial impact on mankind in military activities and international public health over the past centuries [...] Full article

(This article belongs to the Special Issue The Past and Present Threat of Rickettsial Diseases)

12 pages, 304 KiB

Open AccessReview

Prevention of Periprosthetic Joint Infection (PJI): A Clinical Practice Protocol in High-Risk Patients

by Ferdinando Iannotti, Paolo Prati, Andrea Fidanza, Raffaele Iorio, Andrea Ferretti, Daniel Pèrez Prieto, Nanne Kort, Bruno Violante, Gennaro Pipino, Alfredo Schiavone Panni, Michael Hirschmann, Marco Mugnaini and Pier Francesco Indelli

Trop. Med. Infect. Dis. 2020, 5(4), 186; https://doi.org/10.3390/tropicalmed5040186 - 11 Dec 2020

Cited by 41 | Viewed by 6444

Abstract

Background: Periprosthetic joint infection (PJI) represents 25% of failed total knee arthroplasties (TKA). The European Knee Associates (EKA) formed a transatlantic panel of experts to perform a literature review examining patient-related risk factors with the objective of producing perioperative recommendations in PJI high-risk [...] Read more.

Background: Periprosthetic joint infection (PJI) represents 25% of failed total knee arthroplasties (TKA). The European Knee Associates (EKA) formed a transatlantic panel of experts to perform a literature review examining patient-related risk factors with the objective of producing perioperative recommendations in PJI high-risk patients. Methods: Multiple databases (Pubmed/MEDLINE, EMBASE, Scopus, Cochrane Library) and recommendations on TKA PJI prevention measures from the International Consensus Meetings on PJI from the AAOS and AAHKS were reviewed. This represents a Level IV study. Results: Strong evidence was found on poor glycemic control, obesity, malnutrition, and smoking being all associated with increased rates of PJI. In the preoperative period, patient optimization is key: BMI < 35, diet optimization, Hemoglobin A1c < 7.5, Fructosamine < 292 mmol/L, smoking cessation, and MRSA nasal screening all showed strong evidence on reducing PJI risk. Intraoperatively, a weight-based antibiotic prophylaxis, accurate fluid resuscitation, betadine and chlorhexidine dual skin preparation, diluted povidone iodine solution irrigation, tranexamic acid administration, and monofilament barbed triclosan-coated sutures for soft tissues closure all represented effective prevention measures. In the postoperative period, failure to reach normalization of ESR, CRP, D-dimer, and IL-6 six weeks postoperatively suggested early PJI. Conclusion: The current recommendations from this group of experts, based on published evidence, support risk stratification to identify high-risk patients requiring implementation of perioperative measures to reduce postoperative PJI. Full article

(This article belongs to the Collection Infection Prevention and Control: Practical and Educational Advances)

12 pages, 521 KiB

Open AccessArticle

An Evaluation of Programmatic Community-Based Chest X-ray Screening for Tuberculosis in Ho Chi Minh City, Vietnam

by Lan Huu Nguyen, Andrew J. Codlin, Luan Nguyen Quang Vo, Thang Dao, Duc Tran, Rachel J. Forse, Thanh Nguyen Vu, Giang Truong Le, Tuan Luu, Giang Chau Do, Vinh Van Truong, Ha Dang Thi Minh, Hung Huu Nguyen, Jacob Creswell, Maxine Caws, Hoa Binh Nguyen and Nhung Viet Nguyen

Trop. Med. Infect. Dis. 2020, 5(4), 185; https://doi.org/10.3390/tropicalmed5040185 - 10 Dec 2020

Cited by 20 | Viewed by 4864

Abstract

Across Asia, a large proportion of people with tuberculosis (TB) do not report symptoms, have mild symptoms or only experience symptoms for a short duration. These individuals may not seek care at health facilities or may be missed by symptom screening, resulting in [...] Read more.

Across Asia, a large proportion of people with tuberculosis (TB) do not report symptoms, have mild symptoms or only experience symptoms for a short duration. These individuals may not seek care at health facilities or may be missed by symptom screening, resulting in sustained TB transmission in the community. We evaluated the yields of TB from 114 days of community-based, mobile chest X-ray (CXR) screening. The yields at each step of the TB screening cascade were tabulated and we compared cohorts of participants who reported having a prolonged cough and those reporting no cough or one of short duration. We estimated the marginal yields of TB using different diagnostic algorithms and calculated the relative diagnostic costs and cost per case for each algorithm. A total of 34,529 participants were screened by CXR, detecting 256 people with Xpert-positive TB. Only 50% of those diagnosed with TB were detected among participants reporting a prolonged cough. The study’s screening algorithm detected almost 4 times as much TB as the National TB Program’s standard diagnostic algorithm. Community-based, mobile chest X-ray screening can be a high yielding strategy which is able to identify people with TB who would likely otherwise have been missed by existing health services. Full article

(This article belongs to the Special Issue Innovation and Evidence for Achieving TB Elimination in the Asia–Pacific Region)

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20 pages, 1305 KiB

Open AccessArticle

Mathematical Model of the Role of Asymptomatic Infection in Outbreaks of Some Emerging Pathogens

by Nourridine Siewe, Bradford Greening, Jr. and Nina H. Fefferman

Trop. Med. Infect. Dis. 2020, 5(4), 184; https://doi.org/10.3390/tropicalmed5040184 - 09 Dec 2020

Cited by 1 | Viewed by 2621

Abstract

Preparation for outbreaks of emerging infectious diseases is often predicated on beliefs that we will be able to understand the epidemiological nature of an outbreak early into its inception. However, since many rare emerging diseases exhibit different epidemiological behaviors from outbreak to outbreak, [...] Read more.

Preparation for outbreaks of emerging infectious diseases is often predicated on beliefs that we will be able to understand the epidemiological nature of an outbreak early into its inception. However, since many rare emerging diseases exhibit different epidemiological behaviors from outbreak to outbreak, early and accurate estimation of the epidemiological situation may not be straightforward in all cases. Previous studies have proposed considering the role of active asymptomatic infections co-emerging and co-circulating as part of the process of emergence of a novel pathogen. Thus far, consideration of the role of asymptomatic infections in emerging disease dynamics have usually avoided considering some important sets of influences. In this paper, we present and analyze a mathematical model to explore the hypothetical scenario that some (re)emerging diseases may actually be able to maintain stable, endemic circulation successfully in an entirely asymptomatic state. We argue that an understanding of this potential mechanism for diversity in observed epidemiological dynamics may be of considerable importance in understanding and preparing for outbreaks of novel and/or emerging diseases. Full article

(This article belongs to the Special Issue Ebola: Preparedness and Response)

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13 pages, 4282 KiB

Open AccessArticle

Potentially Pathogenic Leptospira in the Environment of an Elephant Camp in Thailand

by Somjit Chaiwattanarungruengpaisan, Wasinee Thepapichaikul, Weena Paungpin, Kanokwan Ketchim, Sarin Suwanpakdee and Metawee Thongdee

Trop. Med. Infect. Dis. 2020, 5(4), 183; https://doi.org/10.3390/tropicalmed5040183 - 06 Dec 2020

Cited by 3 | Viewed by 2446

Abstract

Leptospira is the causative agent of leptospirosis, a globally emerging zoonotic disease. The infection is commonly acquired through contact with the contaminated environment. To extend the knowledge on environmental source of leptospirosis, we investigated the presence of Leptospira in an elephant camp setting [...] Read more.

Leptospira is the causative agent of leptospirosis, a globally emerging zoonotic disease. The infection is commonly acquired through contact with the contaminated environment. To extend the knowledge on environmental source of leptospirosis, we investigated the presence of Leptospira in an elephant camp setting where the interaction between humans, animals, and the shared environment occur particularly when engaging in recreational activities. In this study, a total of 24 environmental samples were collected from an elephant camp area in western Thailand. All samples were processed for Leptospira isolation using the EMJH medium. The identification of Leptospira species was carried out by partial 16S rRNA and secY gene sequencing. Of those 24 samples, 18 samples (75%) were culture-positive for Leptospira. The recovered leptospires were mostly derived from water and soil sampled from a river and a mud pond, the main areas for recreational activities. The majority of the isolates were classified into “Pathogens” clade (89%, 16/18) and more than half of the isolates (61%, 11/18) contained species of the “Saprophytes” clade. Notably, two soil isolates from the river beach sampling area were found to contain leptospiral DNA with high similarity to the pathogenic L. interrogans and L. santarosai. The evidence of diverse Leptospira species, particularly those belonging to the “Pathogens” clade, suggest that the shared environments of an elephant camp can serve as potential infection source and may pose a risk to the elephant camp tourists and workers. Full article

(This article belongs to the Special Issue Leptospirosis in Humans, Animals and the Environment—A “One Health” Perspective)

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12 pages, 2028 KiB

Open AccessReview

Defusing COVID-19: Lessons Learned from a Century of Pandemics

by Graciela Mujica, Zane Sternberg, Jamie Solis, Taylor Wand, Peter Carrasco, Andrés F. Henao-Martínez and Carlos Franco-Paredes

Trop. Med. Infect. Dis. 2020, 5(4), 182; https://doi.org/10.3390/tropicalmed5040182 - 30 Nov 2020

Cited by 7 | Viewed by 4720

Abstract

Amidst the COVID-19 global pandemic of 2020, identifying and applying lessons learned from previous influenza and coronavirus pandemics may offer important insight into its interruption. Herein, we conducted a review of the literature of the influenza pandemics of the 20th century; and of [...] Read more.

Amidst the COVID-19 global pandemic of 2020, identifying and applying lessons learned from previous influenza and coronavirus pandemics may offer important insight into its interruption. Herein, we conducted a review of the literature of the influenza pandemics of the 20th century; and of the coronavirus and influenza pandemics of the 21st century. Influenza and coronavirus pandemics are zoonoses that spread rapidly in consistent seasonal patterns during an initial wave of infection and subsequent waves of spread. For all of their differences in the state of available medical technologies, global population changes, and social and geopolitical factors surrounding each pandemic, there are remarkable similarities among them. While vaccination of high-risk groups is advocated as an instrumental mode of interrupting pandemics, non-pharmacological interventions including avoidance of mass gatherings, school closings, case isolation, contact tracing, and the implementation of infection prevention strategies in healthcare settings represent the cornerstone to halting transmission. In conjunction with lessons learned from previous pandemics, the public health response to the COVID-19 pandemic constitutes the basis for delineating best practices to confront future pandemics. Full article

(This article belongs to the Special Issue COVID-19: Current Challenges and Future Perspectives)

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15 pages, 2184 KiB

Open AccessArticle

Optimizing Active Tuberculosis Case Finding: Evaluating the Impact of Community Referral for Chest X-ray Screening and Xpert Testing on Case Notifications in Two Cities in Viet Nam

by Tuan Huy Mac, Thuc Huy Phan, Van Van Nguyen, Thuy Thu Thi Dong, Hoi Van Le, Quan Duc Nguyen, Tho Duc Nguyen, Andrew James Codlin, Thuy Doan To Mai, Rachel Jeanette Forse, Lan Phuong Nguyen, Tuan Ho Thanh Luu, Hoa Binh Nguyen, Nhung Viet Nguyen, Xanh Thu Pham, Phap Ngoc Tran, Amera Khan, Luan Nguyen Quang Vo and Jacob Creswell

Trop. Med. Infect. Dis. 2020, 5(4), 181; https://doi.org/10.3390/tropicalmed5040181 - 30 Nov 2020

Cited by 15 | Viewed by 3830

Abstract

To accelerate the reduction in tuberculosis (TB) incidence, it is necessary to optimize the use of innovative tools and approaches available within a local context. This study evaluated the use of an existing network of community health workers (CHW) for active case finding, [...] Read more.

To accelerate the reduction in tuberculosis (TB) incidence, it is necessary to optimize the use of innovative tools and approaches available within a local context. This study evaluated the use of an existing network of community health workers (CHW) for active case finding, in combination with mobile chest X-ray (CXR) screening events and the expansion of Xpert MTB/RIF testing eligibility, in order to reach people with TB who had been missed by the current system. A controlled intervention study was conducted from January 2018 to March 2019 in five intervention and four control districts of two low to medium TB burden cities in Viet Nam. CHWs screened and referred eligible persons for CXR to TB care facilities or mobile screening events in the community. The initial diagnostic test was Xpert MTB/RIF for persons with parenchymal abnormalities suggestive of TB on CXR or otherwise on smear microscopy. We analyzed the TB care cascade by calculating the yield and number needed to screen (NNS), estimated the impact on TB notifications and conducted a pre-/postintervention comparison of TB notification rates using controlled, interrupted time series (ITS) analyses. We screened 30,336 individuals in both cities to detect and treat 243 individuals with TB, 88.9% of whom completed treatment successfully. All forms of TB notifications rose by +18.3% (95% CI: +15.8%, +20.8%). The ITS detected a significant postintervention step-increase in the intervention area for all-form TB notification rates (IRR(β6) = 1.221 (95% CI: 1.011, 1.475); p = 0.038). The combined use of CHWs for active case findings and mobile CXR screening expanded the access to and uptake of Xpert MTB/RIF testing and resulted in a significant increase in TB notifications. This model could serve as a blueprint for expansion throughout Vietnam. Moreover, the results demonstrate the need to optimize the use of the best available tools and approaches in order to end TB. Full article

(This article belongs to the Special Issue Innovation and Evidence for Achieving TB Elimination in the Asia–Pacific Region)

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22 pages, 2663 KiB

Open AccessReview

Efficacy and Safety of Lopinavir/Ritonavir for Treatment of COVID-19: A Systematic Review and Meta-Analysis

by Saad Alhumaid, Abbas Al Mutair, Zainab Al Alawi, Naif Alhmeed, Abdul Rehman Zia Zaidi and Mansour Tobaiqy

Trop. Med. Infect. Dis. 2020, 5(4), 180; https://doi.org/10.3390/tropicalmed5040180 - 28 Nov 2020

Cited by 34 | Viewed by 5778

Abstract

(Background) Lopinavir-ritonavir (LPV/RTV) is a human immunodeficiency virus (HIV) antiviral combination that has been considered for the treatment of COVID-19 disease. (Aim) This systematic review aimed to assess the efficacy and safety of LPV/RTV in COVID-19 patients in the published research. (Methods) A [...] Read more.

(Background) Lopinavir-ritonavir (LPV/RTV) is a human immunodeficiency virus (HIV) antiviral combination that has been considered for the treatment of COVID-19 disease. (Aim) This systematic review aimed to assess the efficacy and safety of LPV/RTV in COVID-19 patients in the published research. (Methods) A protocol was developed based on the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement. Articles were selected for review from 8 electronic databases. This review evaluated the effects of LPV/RTV alone or in combination with standard care ± interferons/antiviral treatments compared to other therapies, regarding duration of hospital stay, risk of progressing to invasive mechanical, time to virological cure and body temperature normalization, cough relief, radiological progression, mortality and safety. (Results) A consensus was reached to select 32 articles for full-text screening; only 14 articles comprising 9036 patients were included in this study; and eight of these were included for meta-analysis. Most of these studies did not report positive clinical outcomes with LPV/RTV treatment. In terms of virological cure, three studies reported less time in days to achieve a virological cure for LPV/RTV arm relative to no antiviral treatment (−0.81 day; 95% confidence interval (CI), −4.44 to 2.81; p = 0.007, I² = 80%). However, the overall effect was not significant (p = 0.66). When comparing the LPV/RTV arm to umifenovir arm, a favorable affect was observed for umifenovir arm, but not statically significant (p = 0.09). In terms of time to body normalization and cough relief, no favorable effects of LPV/RTV versus umifenovir were observed. The largest trials (RECOVERY and SOLIDARITY) have shown that LPV/RTV failed to reduce mortality, initiation of invasive mechanical ventilation or hospitalization duration. Adverse events were reported most frequently for LPV/RTV (n = 84) relative to other antivirals and no antiviral treatments. (Conclusions) This review did not reveal any significant advantage in efficacy of LPV/RTV for the treatment of COVID-19 over standard care, no antivirals or other antiviral treatments. This result might not reflect the actual evidence. Full article

(This article belongs to the Special Issue COVID-19: Current Challenges and Future Perspectives)

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17 pages, 3781 KiB

Open AccessArticle

In Silico Structural and Functional Characterization of HtrA Proteins of Leptospira spp.: Possible Implications in Pathogenesis

by Brenda Bevilaqua Daroz, Luis Guilherme Virgílio Fernandes, Aline Florencio Teixeira and Ana Lucia Tabet Oller Nascimento

Trop. Med. Infect. Dis. 2020, 5(4), 179; https://doi.org/10.3390/tropicalmed5040179 - 28 Nov 2020

Cited by 2 | Viewed by 2183

Abstract

Leptospirosis is a zoonosis caused by the pathogenic bacteria of the genus Leptospira. The identification of conserved outer membrane proteins among pathogenic strains is a major research target in elucidating mechanisms of pathogenicity. Surface-exposed proteins are most probably the ones involved in [...] Read more.

Leptospirosis is a zoonosis caused by the pathogenic bacteria of the genus Leptospira. The identification of conserved outer membrane proteins among pathogenic strains is a major research target in elucidating mechanisms of pathogenicity. Surface-exposed proteins are most probably the ones involved in the interaction of leptospires with the environment. Some spirochetes use outer membrane proteases as a way to penetrate host tissues. HtrA is a family of proteins found in various cell types, from prokaryotes to primates. They are a set of proteases usually composed of a serine protease and PDZ domains, and they are generally transported to the periplasm. Here, we identified four genes—annotated as HtrA, LIC11111, LIC20143, LIC20144 and LIC11037—and another one annotated as a serine protease, LIC11112. It is believed that the last forms a functional heterodimer with LIC11111, since they are organized in one operon. Our analyses showed that these proteins are highly conserved among pathogenic strains. LIC11112, LIC20143, and LIC11037 have the serine protease domain with the conserved catalytic triad His-Asp-Ser. This is the first bioinformatics analysis of HtrA proteins from Leptospira that suggests their proteolytic activity potential. Experimental studies are warranted to elucidate this possibility. Full article

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12 pages, 3144 KiB

Open AccessArticle

Relative Frequency of Blastocystis Subtypes 1, 2, and 3 in Urban and Periurban Human Populations of Arequipa, Peru

by Kasandra Ascuña-Durand, Renzo S. Salazar-Sánchez, Ricardo Castillo-Neyra and Jorge Ballón-Echegaray

Trop. Med. Infect. Dis. 2020, 5(4), 178; https://doi.org/10.3390/tropicalmed5040178 - 27 Nov 2020

Cited by 7 | Viewed by 2548

Abstract

Blastocystis is one of the most common protozoa found in the human gut and are genetically diverse and widely distributed around the world. Nonspecific and inconsistent symptoms have been associated with this protozoon; thus, its clinical importance remains controversial. Our aim was to [...] Read more.

Blastocystis is one of the most common protozoa found in the human gut and are genetically diverse and widely distributed around the world. Nonspecific and inconsistent symptoms have been associated with this protozoon; thus, its clinical importance remains controversial. Our aim was to estimate the relative frequency of Blastocystis subtypes 1, 2, and 3, which are the predominant subtypes reported in South America, based on conserved regions of SSU rDNA sequences and determine the factors associated with them. A total of 116 Blastocystis-positive stool samples were processed using conventional PCR with Blastocystis-specific primers. We identified subtype 1 (10.3%), subtype 2 (7.8%), subtype 3 (25.0%), and mixed subtype infections (8.7%). However, we could not identify any Blastocystis subtypes in 48.3% of the samples; therefore, it is likely that other subtypes were present in the area. No association was found between any gastrointestinal symptom and single or mixed Blastocystis subtypes. We found a statistically significant association between Blastocystis subtype 2 and irritable bowel syndrome (OR = 17.8, 95% CI = 1.5–408.4, p = 0.039); however, the number of samples with IBS was small (n= 4). There was no association between the Blastocystis subtypes and any epidemiological variable studied. In rural populations, we only identified subtype 1, while in urban and periurban populations, we identified subtypes 1, 2, and 3. Full article

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8 pages, 406 KiB

Open AccessArticle

Pharyngeal Carriage of Beta-Haemolytic Streptococcus Species and Seroprevalence of Anti-Streptococcal Antibodies in Children in Bouaké, Côte d’Ivoire

by Pacôme Monemo, Nadia Demba, Fidèle S. Touré, Adjartou Traoré, Christelle Avi, Micheline A. N’Guessan, Juste O. Tadet, Arthur R. Gobey, Augustin E. Anoh, Abdoulaye Diarrassouba, Marie N. Tuo, Amadou Cissé, Jasmina Saric, Jürg Utzinger, Honoré Tia, Judith Kouassi-N’Djeundo, Sören L. Becker and Chantal Akoua-Koffi

Trop. Med. Infect. Dis. 2020, 5(4), 177; https://doi.org/10.3390/tropicalmed5040177 - 27 Nov 2020

Cited by 3 | Viewed by 2505

Abstract

The pharynx of the child may serve as a reservoir of pathogenic bacteria, including beta-haemolytic group A streptococci (GAS), which can give rise to upper airway infections and post-streptococcal diseases. The objective of this study was to determine the prevalence of beta-haemolytic Streptococcus [...] Read more.

The pharynx of the child may serve as a reservoir of pathogenic bacteria, including beta-haemolytic group A streptococci (GAS), which can give rise to upper airway infections and post-streptococcal diseases. The objective of this study was to determine the prevalence of beta-haemolytic Streptococcus spp. in pharyngeal samples stemming from children aged 3–14 years in Bouaké, central Côte d’Ivoire. Oropharyngeal throat swabs for microbiological culture and venous blood samples to determine the seroprevalence of antistreptolysin O antibodies (ASO) were obtained from 400 children in March 2017. Identification was carried out using conventional bacteriological methods. Serogrouping was performed with a latex agglutination test, while an immunological agglutination assay was employed for ASO titres. The mean age of participating children was 9 years (standard deviation 2.5 years). In total, we detected 190 bacteria in culture, with 109 beta-haemolytic Streptococcus isolates, resulting in an oropharyngeal carriage rate of 27.2%. Group C streptococci accounted for 82.6% of all isolates, whereas GAS were rarely found (4.6%). The ASO seroprevalence was 17.3%. There was no correlation between serology and prevalence of streptococci (p = 0.722). In conclusion, there is a high pharyngeal carriage rate of non-GAS strains in children from Bouaké, warranting further investigation. Full article

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13 pages, 1026 KiB

Open AccessArticle

Antibiotic Susceptibility and Molecular Characterization of Uropathogenic Escherichia coli Associated with Community-Acquired Urinary Tract Infections in Urban and Rural Settings in South Africa

by Purity Z. Kubone, Koleka P. Mlisana, Usha Govinden, Akebe Luther King Abia and Sabiha Y. Essack

Trop. Med. Infect. Dis. 2020, 5(4), 176; https://doi.org/10.3390/tropicalmed5040176 - 27 Nov 2020

Cited by 17 | Viewed by 4042

Abstract

We investigated the phenotypic and genotypic antibiotic resistance, and clonality of uropathogenic Escherichia coli (UPEC) implicated in community-acquired urinary tract infections (CA-UTIs) in KwaZulu-Natal, South Africa. Mid-stream urine samples (n = 143) were cultured on selective media. Isolates were identified using the [...] Read more.

We investigated the phenotypic and genotypic antibiotic resistance, and clonality of uropathogenic Escherichia coli (UPEC) implicated in community-acquired urinary tract infections (CA-UTIs) in KwaZulu-Natal, South Africa. Mid-stream urine samples (n = 143) were cultured on selective media. Isolates were identified using the API 20E kit and their susceptibility to 17 antibiotics tested using the disk diffusion method. Extended-spectrum β-lactamases (ESBLs) were detected using ROSCO kits. Polymerase chain reaction (PCR) was used to detect uropathogenic E. coli (targeting the papC gene), and β-lactam (bla_TEM/bla_SHV-like and bla_CTX-M) and fluoroquinolone (qnrA, qnrB, qnrS, gyrA, parC, aac(6’)-Ib-cr, and qepA) resistance genes. Clonality was ascertained using ERIC-PCR. The prevalence of UTIs of Gram-negative etiology among adults 18–60 years of age in the uMgungundlovu District was 19.6%. Twenty-six E. coli isolates were obtained from 28 positive UTI samples. All E. coli isolates were papC-positive. The highest resistance was to ampicillin (76.9%) and the lowest (7.7%) to amoxicillin/clavulanic acid and gentamycin. Four isolates were multidrug-resistant and three were ESBL-positive, all being CTX-M-positive but SHV-negative. The aac(6’)-Ib-cr and gyrA were the most detected fluoroquinolone resistance genes (75%). Isolates were clonally distinct, suggesting the spread of genetically diverse UPEC clones within the three communities. This study highlights the spread of genetically diverse antibiotic-resistant CA-UTI aetiologic agents, including multidrug-resistant ones, and suggests a revision of current treatment options for CA-UTIs in rural and urban settings. Full article

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17 pages, 349 KiB

Open AccessReview

Proposed Integrated Control of Zoonotic Plasmodium knowlesi in Southeast Asia Using Themes of One Health

by Jessica Scott

Trop. Med. Infect. Dis. 2020, 5(4), 175; https://doi.org/10.3390/tropicalmed5040175 - 20 Nov 2020

Cited by 21 | Viewed by 3627

Abstract

Zoonotic malaria, Plasmodium knowlesi, threatens the global progression of malaria elimination. Southeast Asian regions are fronting increased zoonotic malaria rates despite the control measures currently implemented—conventional measures to control human-malaria neglect P. knowlesi’s residual transmission between the natural macaque host and vector. [...] Read more.

Zoonotic malaria, Plasmodium knowlesi, threatens the global progression of malaria elimination. Southeast Asian regions are fronting increased zoonotic malaria rates despite the control measures currently implemented—conventional measures to control human-malaria neglect P. knowlesi’s residual transmission between the natural macaque host and vector. Initiatives to control P. knowlesi should adopt themes of the One Health approach, which details that the management of an infectious disease agent should be scrutinized at the human-animal-ecosystem interface. This review describes factors that have conceivably permitted the emergence and increased transmission rates of P. knowlesi to humans, from the understanding of genetic exchange events between subpopulations of P. knowlesi to the downstream effects of environmental disruption and simian and vector behavioral adaptations. These factors are considered to advise an integrative control strategy that aligns with the One Health approach. It is proposed that surveillance systems address the geographical distribution and transmission clusters of P. knowlesi and enforce ecological regulations that limit forest conversion and promote ecosystem regeneration. Furthermore, combining individual protective measures, mosquito-based feeding trapping tools and biocontrol strategies in synergy with current control methods may reduce mosquito population density or transmission capacity. Full article

13 pages, 2254 KiB

Open AccessArticle

Distribution of Phlebotomine Sandflies in the Cave Area of Satun Province, Thailand

by Suwich Thammapalo, Aulia Rahmi Pawestri, Kamal Kolaeh, Patcharida Boondej, Rittiporn Benarlee, Chamnarn Apiwathnasorn and Rawadee Kumlert

Trop. Med. Infect. Dis. 2020, 5(4), 174; https://doi.org/10.3390/tropicalmed5040174 - 20 Nov 2020

Cited by 4 | Viewed by 2494

Abstract

Leishmaniasis, a sandfly-transmitted protozoan infection, is a neglected health threat in Thailand and the information on its vector is scarce. This study aimed to identify sandfly distribution, abundance, and environmental conditions of natural breeding sites in the cave areas of Satun Province, where [...] Read more.

Leishmaniasis, a sandfly-transmitted protozoan infection, is a neglected health threat in Thailand and the information on its vector is scarce. This study aimed to identify sandfly distribution, abundance, and environmental conditions of natural breeding sites in the cave areas of Satun Province, where previous cases of leishmaniasis were reported. Sandflies were collected during a six-month period using CDC light traps and modified emergence traps. Species distribution, relative abundance, and environmental conditions of potential breeding sites were determined. Our survey of 12,790 sandflies found the highest female abundance in April–May. We identified six known species, the most prevalent being Sergentomyia anodontis. We also found S. barraudi, a potential Leishmania spp. vector, distributing in this area. Most male sandflies had partially rotated genitalia, indicating the breeding site proximity to our trap locations. Potential resting/breeding sites were discovered outside the cave during February–March, and inside during May–June. The environmental parameters showed warm climate, moderate humidity, moderately alkaline pH, moderate-to-high macronutrients, and low-to-high organic matters. In summary, our study provided the spatiotemporal distribution and environmental condition of sandfly potential breeding sites in the cave areas of Satun Province. This data may contribute to more effective vector surveillance programs in the future. Full article

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17 pages, 1181 KiB

Open AccessArticle

Microbiome Composition and Borrelia Detection in Ixodes scapularis Ticks at the Northwestern Edge of Their Range

by Janet L. H. Sperling, Daniel Fitzgerald, Felix A. H. Sperling and Katharine E. Magor

Trop. Med. Infect. Dis. 2020, 5(4), 173; https://doi.org/10.3390/tropicalmed5040173 - 18 Nov 2020

Cited by 10 | Viewed by 3461

Abstract

Lyme disease-causing Borrelia burgdorferi has been reported in 10–19% of Ixodes ticks from Alberta, Canada, where the tick vector Ixodes scapularis is at the northwestern edge of its range. However, the presence of Borrelia has not been verified independently, and the bacterial microbiome [...] Read more.

Lyme disease-causing Borrelia burgdorferi has been reported in 10–19% of Ixodes ticks from Alberta, Canada, where the tick vector Ixodes scapularis is at the northwestern edge of its range. However, the presence of Borrelia has not been verified independently, and the bacterial microbiome of these ticks has not been described. We performed 16S rRNA bacterial surveys on female I. scapularis from Alberta that were previously qPCR-tested in a Lyme disease surveillance program. Both 16S and qPCR methods were concordant for the presence of Borrelia. The 16S studies also provided a profile of associated bacteria that showed the microbiome of I. scapularis in Alberta was similar to other areas of North America. Ticks that were qPCR-positive for Borrelia had significantly greater bacterial diversity than Borrelia-negative ticks, on the basis of generalized linear model testing. This study adds value to ongoing tick surveillance and is a foundation for deeper understanding of tick microbial ecology and disease transmission in a region where I. scapularis range expansion, induced by climate and land use changes, is likely to have increasing public health implications. Full article

(This article belongs to the Special Issue The Curious World of Lyme Disease Spirochetes: From Expected to Unpredicted)

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7 pages, 242 KiB

Open AccessArticle

Integration of Traditional Healers in Human African Trypanosomiasis Case Finding in Central Africa: A Quasi-Experimental Study

by Sylvie Kwedi Nolna, Rodrigue Ntonè, Nicole Fouda Mbarga, Severin Mbainda, Willy Mutangala, Bernard Boua, Miriam Niba and Aline Okoko

Trop. Med. Infect. Dis. 2020, 5(4), 172; https://doi.org/10.3390/tropicalmed5040172 - 17 Nov 2020

Cited by 5 | Viewed by 2654

Abstract

Background: Based on the premise that Africans in rural areas seek health care from traditional healers, this study investigated a collaborative model between traditional healers and the national Human African Trypanosomiasis (HAT) programs across seven endemic foci in seven central African countries by [...] Read more.

Background: Based on the premise that Africans in rural areas seek health care from traditional healers, this study investigated a collaborative model between traditional healers and the national Human African Trypanosomiasis (HAT) programs across seven endemic foci in seven central African countries by measuring the model’s contribution to HAT case finding. Method: Traditional healers were recruited and trained by health professionals to identify HAT suspects based on its basics signs and symptoms and to refer them to the National Sleeping Sickness Control Program (NSSCP) for testing and confirmatory diagnosis. Results: 35 traditional healers were recruited and trained, 28 finally participated in this study (80%) and referred 278 HAT suspects, of which 20 (7.19%) were CATT positive for the disease. Most cases originated from Bandundu (45%) in the Democratic Republic of Congo and from Ngabe (35%) in Congo. Twelve (4.32%) patients had confirmatory diagnosis. Although a statistically significant difference was not shown in terms of case finding (p = 0.56), traditional healers were able to refer confirmed HAT cases that were ultimately cared for by NCSSPs. Conclusion: Integrating traditional healers in the control program of HAT will likely enhance the detection of cases, thereby, eventually contributing to the elimination of HAT in the most affected communities. Full article

9 pages, 1624 KiB

Open AccessArticle

Air Quality in the Working Environment and Respiratory Health of Female Congolese Stone Quarry Workers

by Ngombe Leon-Kabamba, Nlandu Roger Ngatu, Basilua Andre Muzembo, Sakatolo Kakoma, Nzaji Michel-Kabamba, Brigitta Danuser, Oscar Luboya and Tomohiro Hirao

Trop. Med. Infect. Dis. 2020, 5(4), 171; https://doi.org/10.3390/tropicalmed5040171 - 17 Nov 2020

Cited by 2 | Viewed by 2283

Abstract

Background and Aim. Environmental and occupational exposure to high dust levels are known to be associated with lung function impairment. We assessed the ambient air quality in the working environment and the respiratory health of female stone quarry workers in Lubumbashi, Democratic Republic [...] Read more.

Background and Aim. Environmental and occupational exposure to high dust levels are known to be associated with lung function impairment. We assessed the ambient air quality in the working environment and the respiratory health of female stone quarry workers in Lubumbashi, Democratic Republic of Congo (DRC) in a context of severe economic, security, and health crises. Methods. This was a case-control study conducted in three stone quarry sites. Participants were 256 dust-exposed female stone quarry workers matched to 256 unexposed female office workers and market tax collectors (N = 512). They each answered a structured respiratory health questionnaire and underwent physical examination and a lung function test with the use of a spirometer and peak flow meter. Quality of ambient air in the working environment was assessed by means of a BRAMC air quality monitor (BR-AIR-329). Results. Results showed that exposed women did not use any personal protective equipment (PPE); in quarry sites, abnormally high levels of PM_2.5 (205 ± 13.2 μg/m³ vs. 31.3 ± 10.3 μg/m³ in control sites; p < 0.001) and volatile organic compounds (VOC, 2.2 ± 0.2 μg/m³ vs. 0.5 ± 0.3 μg/m³, respectively; p < 0.01) were found. Furthermore, respiratory complaints were more common among exposed women (32.4% vs. 3.5% in controls; p < 0.01), who had abnormal chest auscultation and reduced lung capacity than controls (mean PEFR: 344.8 ± 2.26 and 405 ± 67.7 L/s, respectively; p < 0.001 Conclusion. Findings from this study show that in the midst of severe crises in the DRC, women stone quarry workers are exposed to abnormally high levels of respiratory hazards, which contribute to impaired lung function. There is a need to regulate quarry work and improve the working conditions in quarry sites in the DRC. Full article

(This article belongs to the Special Issue Occupational and Work-Related Diseases in Developing/Tropical Countries)

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10 pages, 979 KiB

Open AccessArticle

Risk Factors for Elevated Serum Lipopolysaccharide in Acute Dengue and Association with Clinical Disease Severity

by N. L. Ajantha Shyamali, Sameera D. Mahapatuna, Laksiri Gomes, Ananda Wijewickrama, Graham S. Ogg and Gathsaurie Neelika Malavige

Trop. Med. Infect. Dis. 2020, 5(4), 170; https://doi.org/10.3390/tropicalmed5040170 - 16 Nov 2020

Cited by 6 | Viewed by 2599

Abstract

Although serum lipopolysaccharide (LPS) was shown to associate with development of severe dengue, the reasons for high LPS and its subsequent involvement in disease pathogenesis are not known. We assessed serum LPS, C-reactive protein (CRP), and procalcitonin in patients with acute dengue fever [...] Read more.

Although serum lipopolysaccharide (LPS) was shown to associate with development of severe dengue, the reasons for high LPS and its subsequent involvement in disease pathogenesis are not known. We assessed serum LPS, C-reactive protein (CRP), and procalcitonin in patients with acute dengue fever (DF = 129) and dengue haemorrhagic fever (DHF = 64) and correlated these observations with the presence of comorbid illnesses, and clinical disease severity. Serum LPS levels were significantly (p = 0.01) higher in patients with DHF, compared to those with DF. In total, 45 (70%) of those with DHF and 63 (49%) of those with DF had detectable LPS and therefore, the presence of LPS was significantly associated with DHF (p = 0.005, OR = 2.48, 95% CI: 1.29 to 4.64). Those with metabolic diseases, 22/29 (75.9%) and those with atopic diseases 17/22 (77.3%) were significantly more likely to have detectable LPS levels (p = 0.025, OR = 2.9, 95% CI-1.17 to 7.59 and p = 0.039, OR = 3.06, 95% CI-1.07 to 7.81 respectively). Those with detectable LPS levels were also more likely to develop shock and severe thrombocytopenia. Patients with detectable LPS were more likely to have elevated CRP levels and were more likely to develop DHF. Procalcitonin levels too were significantly (p = 0.009) higher in those with DHF compared to those with DF and were more likely to be high in those with detectable serum LPS. Since serum LPS levels were higher in patients with DHF and significantly more likely to be present in those with comorbid illnesses, the possible role of LPS in disease pathogenesis should be further investigated. Full article

(This article belongs to the Special Issue Epidemiology of Dengue: Past, Present and Future (Volume II))

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25 pages, 880 KiB

Open AccessReview

AAV Vectored Immunoprophylaxis for Filovirus Infections

by Amira D. Rghei, Laura P. van Lieshout, Lisa A. Santry, Matthew M. Guilleman, Sylvia P. Thomas, Leonardo Susta, Khalil Karimi, Byram W. Bridle and Sarah K. Wootton

Trop. Med. Infect. Dis. 2020, 5(4), 169; https://doi.org/10.3390/tropicalmed5040169 - 09 Nov 2020

Cited by 10 | Viewed by 3740

Abstract

Filoviruses are among the deadliest infectious agents known to man, causing severe hemorrhagic fever, with up to 90% fatality rates. The 2014 Ebola outbreak in West Africa resulted in over 28,000 infections, demonstrating the large-scale human health and economic impact generated by filoviruses. [...] Read more.

Filoviruses are among the deadliest infectious agents known to man, causing severe hemorrhagic fever, with up to 90% fatality rates. The 2014 Ebola outbreak in West Africa resulted in over 28,000 infections, demonstrating the large-scale human health and economic impact generated by filoviruses. Zaire ebolavirus is responsible for the greatest number of deaths to date and consequently there is now an approved vaccine, Ervebo, while other filovirus species have similar epidemic potential and remain without effective vaccines. Recent clinical success of REGN-EB3 and mAb-114 monoclonal antibody (mAb)-based therapies supports further investigation of this treatment approach for other filoviruses. While efficacious, protection from passive mAb therapies is short-lived, requiring repeat dosing to maintain therapeutic concentrations. An alternative strategy is vectored immunoprophylaxis (VIP), which utilizes an adeno-associated virus (AAV) vector to generate sustained expression of selected mAbs directly in vivo. This approach takes advantage of validated mAb development and enables vectorization of the top candidates to provide long-term immunity. In this review, we summarize the history of filovirus outbreaks, mAb-based therapeutics, and highlight promising AAV vectorized approaches to providing immunity against filoviruses where vaccines are not yet available. Full article

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6 pages, 184 KiB

Open AccessArticle

2018 Zika Health Brigade: Delivering Critical Health Screening in the U.S. Virgin Islands

by Shana Godfred-Cato, S. Nicole Fehrenbach, Megan R. Reynolds, Romeo R. Galang, Dan Schoelles, Lessely Brown-Shuler, Braeanna Hillman, Leah DeWilde, Andra Prosper, Amy Hudson, Cynthia A. Moore and Esther M. Ellis

Trop. Med. Infect. Dis. 2020, 5(4), 168; https://doi.org/10.3390/tropicalmed5040168 - 09 Nov 2020

Cited by 5 | Viewed by 2082

Abstract

In 2017, Hurricanes Irma and Maria caused significant damage to the United States Virgin Islands (USVI), heightening the challenges many residents faced in accessing adequate healthcare and receiving recommended Zika virus screening services. To address this challenge, the USVI Department of Health (DOH) [...] Read more.

In 2017, Hurricanes Irma and Maria caused significant damage to the United States Virgin Islands (USVI), heightening the challenges many residents faced in accessing adequate healthcare and receiving recommended Zika virus screening services. To address this challenge, the USVI Department of Health (DOH) requested technical assistance from the Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration (HRSA), and the American Academy of Pediatrics (AAP) to organize a health brigade to bring needed medical care to an underserved population. It also established the development of important partnerships between federal and private partners as well as between clinical providers and public health entities such as the Epidemiology & Disease Reporting, Maternal Child Health (MCH), and Infant and Toddlers Programs within the DOH, and local clinicians. This health brigade model could be replicated to ensure recommended evaluations are delivered to populations that may have unmet medical needs due to the complexity of the conditions and/or rural location. Full article

(This article belongs to the Special Issue Zika in Infants and Children)

16 pages, 609 KiB

Open AccessArticle

Quality, Equity and Utility of Observational Studies during 10 Years of Implementing the Structured Operational Research and Training Initiative in 72 Countries

by Rony Zachariah, Stefanie Rust, Pruthu Thekkur, Mohammed Khogali, Ajay MV Kumar, Karapet Davtyan, Ermias Diro, Srinath Satyanarayana, Olga Denisiuk, Johan van Griensven, Veerle Hermans, Selma Dar Berger, Saw Saw, Anthony Reid, Abraham Aseffa, Anthony D Harries and John C Reeder

Trop. Med. Infect. Dis. 2020, 5(4), 167; https://doi.org/10.3390/tropicalmed5040167 - 06 Nov 2020

Cited by 7 | Viewed by 2601

Abstract

Introduction: Observational studies are often inadequately reported, making it difficult to assess their validity and generalizability and judge whether they can be included in systematic reviews. We assessed the publication characteristics and quality of reporting of observational studies generated by the Structured Operational [...] Read more.

Introduction: Observational studies are often inadequately reported, making it difficult to assess their validity and generalizability and judge whether they can be included in systematic reviews. We assessed the publication characteristics and quality of reporting of observational studies generated by the Structured Operational Research and Training Initiative (SORT IT). Methods: A cross-sectional analysis of original publications from SORT IT courses. SORT IT is a global partnership-based initiative aimed at building sustainable capacity for conducting operational research according to country priorities and using the generated evidence for informed decision-making to improve public health. Reporting quality was independently assessed using an adapted version of ‘Strengthening the Reporting of Observational Studies in Epidemiology’ (STROBE) checklist. Results: In 392 publications, involving 72 countries, 50 journals, 28 publishers and 24 disease domains, low- and middle-income countries (LMICs) first authorship was seen in 370 (94%) and LMIC last authorship in 214 (55%). Publications involved LMIC-LMIC collaboration in 90% and high-income-country-LMIC collaboration in 87%. The majority (89%) of publications were in immediate open access journals. A total of 346 (88.3%) publications achieved a STROBE reporting quality score of >85% (excellent), 41 (10.4%) achieved a score of 76–85% (good) and 5 (1.3%) a score of 65–75% (fair). Conclusion: The majority of publications from SORT IT adhere to STROBE guidelines, while also ensuring LMIC equity and collaborative partnerships. SORT IT is, thus, playing an important role in ensuring high-quality reporting of evidence for informed decision-making in public health. Full article

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14 pages, 1671 KiB

Open AccessArticle

Preliminary Characterization of Triatomine Bug Blood Meals on the Island of Trinidad Reveals Opportunistic Feeding Behavior on Both Human and Animal Hosts

by Alexandra Hylton, Daniel M. Fitzpatrick, Rod Suepaul, Andrew P. Dobson, Roxanne A. Charles and Jennifer K. Peterson

Trop. Med. Infect. Dis. 2020, 5(4), 166; https://doi.org/10.3390/tropicalmed5040166 - 04 Nov 2020

Cited by 6 | Viewed by 3165

Abstract

Chagas disease is a neglected tropical disease caused by infection with Trypanosoma cruzi. The parasite is endemic to the Americas, including the Caribbean, where it is vectored by triatomine bugs. Although Chagas disease is not considered a public health concern in the Caribbean [...] Read more.

Chagas disease is a neglected tropical disease caused by infection with Trypanosoma cruzi. The parasite is endemic to the Americas, including the Caribbean, where it is vectored by triatomine bugs. Although Chagas disease is not considered a public health concern in the Caribbean islands, studies in Trinidad have found T. cruzi-seropositive humans and T. cruzi-infected triatomine bugs. However, little is known about triatomine bug host preferences in Trinidad, making it difficult to evaluate local risk of vector-borne T. cruzi transmission to humans. To investigate this question, we collected triatomine bugs in Trinidad and diagnosed each one for T. cruzi infection (microscopy and PCR). We then carried out a blood meal analysis using DNA extracted from each bug (PCR and sequencing). Fifty-five adult bugs (54 Panstrongylus geniculatus and one Rhodnius pictipes) were collected from five of 21 sample sites. All successful collection sites were residential. Forty-six out of the 55 bugs (83.6%) were infected with T. cruzi. Fifty-three blood meal hosts were successfully analyzed (one per bug), which consisted of wild birds (7% of all blood meals), wild mammals (17%), chickens (19%), and humans (57%). Of the 30 bugs with human blood meals, 26 (87%) were from bugs infected with T. cruzi. Although preliminary, our results align with previous work in which P. geniculatus in Trinidad had high levels of T. cruzi infection. Furthermore, our findings suggest that P. geniculatus moves between human and animal environments in Trinidad, feeding opportunistically on a wide range of species. Our findings highlight a critical need for further studies of Chagas disease in Trinidad in order to estimate the public health risk and implement necessary preventative and control measures. Full article

(This article belongs to the Special Issue One Health and Neglected Tropical Diseases)

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22 pages, 741 KiB

Open AccessReview

A Brief History of the Major Rickettsioses in the Asia–Australia–Pacific Region: A Capstone Review for the Special Issue of TMID

by Daniel H. Paris, Daryl J. Kelly, Paul A. Fuerst, Nicholas P. J. Day and Allen L. Richards

Trop. Med. Infect. Dis. 2020, 5(4), 165; https://doi.org/10.3390/tropicalmed5040165 - 27 Oct 2020

Cited by 9 | Viewed by 3014

Abstract

The rickettsioses of the “Far East” or Asia–Australia–Pacific region include but are not limited to endemic typhus, scrub typhus, and more recently, tick typhus or spotted fever. These diseases embody the diversity of rickettsial disease worldwide and allow us to interconnect the various [...] Read more.

The rickettsioses of the “Far East” or Asia–Australia–Pacific region include but are not limited to endemic typhus, scrub typhus, and more recently, tick typhus or spotted fever. These diseases embody the diversity of rickettsial disease worldwide and allow us to interconnect the various contributions to this special issue of Tropical Medicine and Infectious Disease. The impact of rickettsial diseases—particularly of scrub typhus—was substantial during the wars and “police actions” of the last 80 years. However, the post-World War II arrival of effective antibiotics reduced their impact, when recognized and adequately treated (chloramphenicol and tetracyclines). Presently, however, scrub typhus appears to be emerging and spreading into regions not previously reported. Better diagnostics, or higher population mobility, change in antimicrobial policies, even global warming, have been proposed as possible culprits of this phenomenon. Further, sporadic reports of possible antibiotic resistance have received the attention of clinicians and epidemiologists, raising interest in developing and testing novel diagnostics to facilitate medical diagnosis. We present a brief history of rickettsial diseases, their relative importance within the region, focusing on the so-called “tsutsugamushi triangle”, the past and present impact of these diseases within the region, and indicate how historically, these often-confused diseases were ingeniously distinguished from each another. Moreover, we will discuss the importance of DNA-sequencing efforts for Orientia tsutsugamushi, obtained from patient blood, vector chiggers, and rodent reservoirs, particularly for the dominant 56-kD type-specific antigen gene (tsa56), and whole-genome sequences, which are increasing our knowledge of the diversity of this unique agent. We explore and discuss the potential of sequencing and other effective tools to geographically trace rickettsial disease agents, and develop control strategies to better mitigate the rickettsioses. Full article

(This article belongs to the Special Issue The Past and Present Threat of Rickettsial Diseases)

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11 pages, 1053 KiB

Open AccessPerspective

The TB REACH Initiative: Supporting TB Elimination Efforts in the Asia-Pacific

by Jacob Creswell, Amera Khan, Mirjam I Bakker, Miranda Brouwer, Vishnu Vardhan Kamineni, Christina Mergenthaler, Marina Smelyanskaya, Zhi Zhen Qin, Oriol Ramis, Robert Stevens, K Srikanth Reddy and Lucie Blok

Trop. Med. Infect. Dis. 2020, 5(4), 164; https://doi.org/10.3390/tropicalmed5040164 - 26 Oct 2020

Cited by 6 | Viewed by 3715

Abstract

After many years of TB ‘control’ and incremental progress, the TB community is talking about ending the disease, yet this will only be possible with a shift in the way we approach the TB response. While the Asia-Pacific region has the highest TB [...] Read more.

After many years of TB ‘control’ and incremental progress, the TB community is talking about ending the disease, yet this will only be possible with a shift in the way we approach the TB response. While the Asia-Pacific region has the highest TB burden worldwide, it also has the opportunity to lead the quest to end TB by embracing the four areas laid out in this series: using data to target hotspots, initiating active case finding, provisioning preventive TB treatment, and employing a biosocial approach. The Stop TB Partnership’s TB REACH initiative provides a platform to support partners in the development, evaluation and scale-up of new and innovative technologies and approaches to advance TB programs. We present several approaches TB REACH is taking to support its partners in the Asia-Pacific and globally to advance our collective response to end TB. Full article

(This article belongs to the Special Issue Innovation and Evidence for Achieving TB Elimination in the Asia–Pacific Region)

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12 pages, 986 KiB

Open AccessArticle

Islands of Tuberculosis Elimination: An Evaluation of Community-Based Active Case Finding in North Sumatra, Indonesia

by Elvi S. Siahaan, Mirjam I. Bakker, Ratna Pasaribu, Amera Khan, Tripti Pande, Alwi Mujahit Hasibuan and Jacob Creswell

Trop. Med. Infect. Dis. 2020, 5(4), 163; https://doi.org/10.3390/tropicalmed5040163 - 26 Oct 2020

Cited by 6 | Viewed by 4393

Abstract

Community-based active case finding (ACF) is needed to reach key/vulnerable populations with limited access to tuberculosis (TB) care. Published reports of ACF interventions in Indonesia are scarce. We conducted an evaluation of a multicomponent community-based ACF intervention as it scaled from one district [...] Read more.

Community-based active case finding (ACF) is needed to reach key/vulnerable populations with limited access to tuberculosis (TB) care. Published reports of ACF interventions in Indonesia are scarce. We conducted an evaluation of a multicomponent community-based ACF intervention as it scaled from one district to nine in Nias and mainland North Sumatra. Community and health system support measures including laboratory strengthening, political advocacy, sputum transport, and community awareness were instituted. ACF was conducted in three phases: pilot (18 months, 1 district), intervention (12 months, 4 districts) and scale-up (9 months, 9 districts). The pilot phase identified 215 individuals with bacteriologically positive (B+) TB, representing 42% of B+ TB notifications. The intervention phase yielded 509, representing 54% of B+ notifications and the scale-up phase identified 1345 individuals with B+ TB (56% of notifications). We observed large increases in B+ notifications on Nias, but no overall change on the mainland despite district variation. Overall, community health workers screened 377,304 individuals of whom 1547 tested positive, and 95% were initiated on treatment. Our evaluation shows that multicomponent community-based ACF can reduce the number of people missed by TB programs. Community-based organizations are best placed for accessing and engaging hard to reach populations and providing integrated support which can have a large positive effect on TB notifications. Full article

(This article belongs to the Special Issue Innovation and Evidence for Achieving TB Elimination in the Asia–Pacific Region)

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23 pages, 1213 KiB

Open AccessReview

Rabies as a Public Health Concern in India—A Historical Perspective

by Sreejith Radhakrishnan, Abi Tamim Vanak, Pierre Nouvellet and Christl A. Donnelly

Trop. Med. Infect. Dis. 2020, 5(4), 162; https://doi.org/10.3390/tropicalmed5040162 - 21 Oct 2020

Cited by 24 | Viewed by 9821

Abstract

India bears the highest burden of global dog-mediated human rabies deaths. Despite this, rabies is not notifiable in India and continues to be underprioritised in public health discussions. This review examines the historical treatment of rabies in British India, a disease which has [...] Read more.

India bears the highest burden of global dog-mediated human rabies deaths. Despite this, rabies is not notifiable in India and continues to be underprioritised in public health discussions. This review examines the historical treatment of rabies in British India, a disease which has received relatively less attention in the literature on Indian medical history. Human and animal rabies was widespread in British India, and treatment of bite victims imposed a major financial burden on the colonial Government of India. It subsequently became a driver of Pasteurism in India and globally and a key component of British colonial scientific enterprise. Efforts to combat rabies led to the establishment of a wide network of research institutes in India and important breakthroughs in development of rabies vaccines. As a result of these efforts, rabies no longer posed a significant threat to the British, and it declined in administrative and public health priorities in India towards the end of colonial rule—a decline that has yet to be reversed in modern-day India. The review also highlights features of the administrative, scientific and societal approaches to dealing with this disease in British India that persist to this day. Full article

(This article belongs to the Special Issue One Health and Neglected Tropical Diseases)

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26 pages, 2367 KiB

Open AccessReview

Vector-Focused Approaches to Curb Malaria Transmission in the Brazilian Amazon: An Overview of Current and Future Challenges and Strategies

by Elerson Matos Rocha, Ricardo de Melo Katak, Juan Campos de Oliveira, Maisa da Silva Araujo, Bianca Cechetto Carlos, Roberto Galizi, Frederic Tripet, Osvaldo Marinotti and Jayme A. Souza-Neto

Trop. Med. Infect. Dis. 2020, 5(4), 161; https://doi.org/10.3390/tropicalmed5040161 - 20 Oct 2020

Cited by 6 | Viewed by 8184

Abstract

In Brazil, malaria transmission is mostly confined to the Amazon, where substantial progress has been made towards disease control in the past decade. Vector control has been historically considered a fundamental part of the main malaria control programs implemented in Brazil. However, the [...] Read more.

In Brazil, malaria transmission is mostly confined to the Amazon, where substantial progress has been made towards disease control in the past decade. Vector control has been historically considered a fundamental part of the main malaria control programs implemented in Brazil. However, the conventional vector-control tools have been insufficient to control or eliminate local vector populations due to the complexity of the Amazonian rainforest environment and ecological features of malaria vector species in the Amazon, especially Anopheles darlingi. Malaria elimination in Brazil and worldwide eradication will require a combination of conventional and new approaches that takes into account the regional specificities of vector populations and malaria transmission dynamics. Here we present an overview on both conventional and novel promising vector-focused tools to curb malaria transmission in the Brazilian Amazon. If well designed and employed, vector-based approaches may improve the implementation of malaria-control programs, particularly in remote or difficult-to-access areas and in regions where existing interventions have been unable to eliminate disease transmission. However, much effort still has to be put into research expanding the knowledge of neotropical malaria vectors to set the steppingstones for the optimization of conventional and development of innovative vector-control tools. Full article

(This article belongs to the Special Issue Malaria Elimination: Managing Implementation of the Interventions for Success)

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11 pages, 216 KiB

Open AccessArticle

Hand Hygiene Knowledge and Practices among Domestic Hajj Pilgrims: Implications for Future Mass Gatherings Amidst COVID-19

by Hashim Mahdi, Amani Alqahtani, Osamah Barasheed, Amjad Alemam, Mohammed Alhakami, Ibrahim Gadah, Hadeel Alkediwi, Khadijah Alzahrani, Lujain Fatani, Lamis Dahlawi, Saeed Alsharif, Ramon Shaban, Robert Booy and Harunor Rashid

Trop. Med. Infect. Dis. 2020, 5(4), 160; https://doi.org/10.3390/tropicalmed5040160 - 16 Oct 2020

Cited by 16 | Viewed by 4646

Abstract

This study examined Hajj pilgrims’ knowledge and reported practice of hand hygiene. In Hajj 2019, a cross-sectional survey was undertaken in Mina, Makkah, Saudi Arabia, of domestic Saudi pilgrims aged ≥18 years by using a self-administered Arabic questionnaire that captured data on pilgrims’ [...] Read more.

This study examined Hajj pilgrims’ knowledge and reported practice of hand hygiene. In Hajj 2019, a cross-sectional survey was undertaken in Mina, Makkah, Saudi Arabia, of domestic Saudi pilgrims aged ≥18 years by using a self-administered Arabic questionnaire that captured data on pilgrims’ socio-demographics, hand hygiene knowledge, and reported practices of hand cleaning following certain actions. A total of 348 respondents aged 18 to 63 (median 32) years completed the survey, of whom 200 (57.5%) were female. The mean (±standard deviation (SD)) hand hygiene knowledge score was 6.7 (±SD 1.9). Two hundred and seventy one (77.9%) and 286 (82.2%) of respondents correctly identified that hand hygiene can prevent respiratory and gastrointestinal infections respectively, but 146 (42%) were not aware that it prevents hand-foot-mouth disease. Eighty-eight (25.3%) respondents erroneously reported that hand hygiene prevents HIV. Washing hands with water and soap was the most preferred method practiced before a meal (67.5% (235/348)), after a meal (80.2% (279/348)), after toilet action (81.6% (284/348)), when hands were visibly soiled (86.2% (300/348)), and after waste disposal (61.5% (214/348)). Hajj pilgrims demonstrated a good knowledge and practice of hand hygiene, but there are gaps that are vital to control outbreaks such as COVID-19. Full article

(This article belongs to the Special Issue Travel and Tropical Medicine)

13 pages, 886 KiB

Open AccessReview

A One Health Approach for Guinea Worm Disease Control: Scope and Opportunities

by Matthew R. Boyce, Ellen P. Carlin, Jordan Schermerhorn and Claire J. Standley

Trop. Med. Infect. Dis. 2020, 5(4), 159; https://doi.org/10.3390/tropicalmed5040159 - 13 Oct 2020

Cited by 14 | Viewed by 7543

Abstract

Guinea worm disease (GWD) is a neglected tropical disease that was targeted for eradication several decades ago because of its limited geographical distribution, predictable seasonality, straightforward diagnosis, and exclusive infection of humans. However, a growing body of evidence challenges this last attribute and [...] Read more.

Guinea worm disease (GWD) is a neglected tropical disease that was targeted for eradication several decades ago because of its limited geographical distribution, predictable seasonality, straightforward diagnosis, and exclusive infection of humans. However, a growing body of evidence challenges this last attribute and suggests that GWD can affect both humans and animal populations. The One Health approach emphasizes the relatedness of human, animal, and environmental health. We reviewed epidemiological evidence that could support the utility of a One Health approach for GWD control in the six countries that have reported human GWD cases since 2015—Angola, Cameroon, Chad, Ethiopia, Mali, and South Sudan. Human GWD cases have dramatically declined, but recent years have seen a gradual increase in human case counts, cases in new geographies, and a rapidly growing number of animal infections. Taken together, these suggest a need for an adjusted approach for eradicating GWD using a framework rooted in One Health, dedicated to improving disease surveillance and in animals; pinpointing the dominant routes of infection in animals; elucidating the disease burden in animals; determining transmission risk factors among animals and from animals to humans; and identifying practical ways to foster horizontal and multidisciplinary approaches. Full article

(This article belongs to the Special Issue One Health and Neglected Tropical Diseases)

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