Journal of Tropical Medicine http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Clinical, Molecular, and Epidemiological Analysis of Dengue Cases during a Major Outbreak in the Midwest Region of Minas Gerais, Brazil Thu, 10 Jul 2014 07:02:45 +0000 http://www.hindawi.com/journals/jtm/2014/276912/ This study aims to perform the first molecular and clinical-epidemiological analysis of dengue cases in Divinopolis, MG, Brazil. Data from 4,110 cases of dengue were accessed and 190 clinical samples were collected for molecular analyses. In this study, 2.7% of the men and 3.0% of the women were admitted to hospital. There was no association between gender and hospital admission. The symptoms observed in this study are according to the Health Ministry, but fever was present in 82.2% and not in 100% of cases. The chance of hospital admission was 1.55 higher in patients with any kind of bleeding (334) and 2.4% of individuals without bleeding were also hospitalized due to other warning signs. In the molecular analyses, 23% of the samples were positive for DENV. DENV-2 and DENV-3 were identified in 2010, DENV-3 in 2011, DENV-1 in 2012, and DENV-1 and DENV-4 in 2013. DENV detection was possible in samples with only one day of symptoms. This first report of dengue data in Divinópolis provided more insight into the viral types and effects of disease in the city, confirming the need for caution in assessing cases of suspected dengue and for revision of the criteria proposed by the Health Ministry to classify cases of the disease. Juliana Cristina Duarte Braga, Leandro César da Silva, Jacqueline Domingues Tibúrcio, Mirna de Abreu e Silva, Lailah Horácio Sales Pereira, Karina Rocha Dutra, Jaqueline Maria Siqueira Ferreira, Débora de Oliveira Lopes, and Luciana Lara dos Santos Copyright © 2014 Juliana Cristina Duarte Braga et al. All rights reserved. Prevalence of Brucellosis among Women Presenting with Abortion/Stillbirth in Huye, Rwanda Sun, 29 Jun 2014 09:41:29 +0000 http://www.hindawi.com/journals/jtm/2014/740479/ The incidence of human brucellosis is not documented in Rwanda despite several reports on the disease in cattle. Because brucellosis has been associated with abortion, the aim of this study was to investigate the prevalence of positive serology in women presenting with abortion and/or stillbirth. The study was done in Huye District, in the Southern Province of Rwanda, and the patients were recruited from both the University Teaching Hospital of Butare (CHUB) and Kabutare District Hospital. Serum samples were collected and the Rose Bengal plate test (RBPT) was performed on each sample. A questionnaire was also used to investigate potential contacts with animals and/or consumption of raw milk. A total of 60 women were recruited and 15 (i.e., 25%) were Brucella seropositive. The questionnaire showed that those with seropositivity either were in contact with domestic animals (cattle, goat, or sheep) or were consuming raw cow’s milk. Human brucellosis appears to be of public health importance in Rwanda and more attention should be drawn on the disease. The current study provides a basis for larger studies to establish the incidence of human brucellosis in Rwanda. More mechanistic studies will also demonstrate the pathogenicity of Brucella in human placentas. Nadine Rujeni and Léonidas Mbanzamihigo Copyright © 2014 Nadine Rujeni and Léonidas Mbanzamihigo. All rights reserved. Thrombocytopenia in Plasmodium vivax Malaria: How Significant? Tue, 17 Jun 2014 10:46:00 +0000 http://www.hindawi.com/journals/jtm/2014/567469/ Introduction. Thrombocytopenia is frequently noticed with P. falciparum malaria but is less reported and studied with P. vivax. Materials and Methods. The study was conducted in the Department of Medicine, SBKS MI & RC, Pipariya. We included patients who were diagnosed with vivax malaria. The data regarding their clinical and hematological profile was collected and analysed. Result. A total of 66 patients were included. 42 (63%) had platelet count <100000/mm3. Mean platelet count was 1,18,650, range being 8000/mm3–6,10,000/mm3. Amongst those with thrombocytopenia, 16 (38.09%) had anemia, 14 (33.33%) had serum creatinine >1.2 gm/dL, 15 (35.71%) had jaundice (s. bilirubin > 1.2), 2 (4.76%) had altered sensorium, 6 (14.28%) had ARDS, 2 needed ventilator support, and 1 expired. Amongst those with normal platelet count, 5 (20.83%) had anemia and 1 had jaundice whereas none had elevated s. creatinine, altered sensorium, or lung involvement. Conclusion. Thrombocytopenia is now being seen more commonly with vivax malaria. Patients with platelet count <1 lac/cumm have more severe disease. Arti Muley, Jitendra Lakhani, Saurabh Bhirud, and Abhinam Patel Copyright © 2014 Arti Muley et al. All rights reserved. Clinical, Laboratory, and Management Profile in Patients of Liver Abscess from Northern India Wed, 04 Jun 2014 12:14:44 +0000 http://www.hindawi.com/journals/jtm/2014/142382/ Objective. To describe the clinical profile, microbiological aetiologies, and management outcomes in patients with liver abscess. Methods. A cross-sectional study was conducted from May, 2011, to April, 2013, on 200 consecutive liver abscess patients at PGIMER and Dr. RML Hospital, New Delhi. History, examination, and laboratory investigations were recorded. Ultrasound guided aspiration was done and samples were investigated. Chi-square test and multivariate regression analysis were performed to test association. Results. The mean age of patients was 41.13 years. Majority of them were from lower socioeconomic class (67.5%) and alcoholic (72%). The abscesses were predominantly in right lobe (71%) and solitary (65%). Etiology of abscess was 69% amoebic, 18% pyogenic, 7.5% tubercular, 4% mixed, and 1.5% fungal. Percutaneous needle aspiration was done in 79%, pigtail drainage in 17%, and surgical intervention for rupture in 4% patients. Mortality was 2.5%, all reported in surgical group. Solitary abscesses were amoebic and tubercular whereas multiple abscesses were pyogenic (). Right lobe was predominantly involved in amoebic and pyogenic abscesses while in tubercular abscesses left lobe involvement was predominant (). Conclusions. The commonest presentation was young male, alcoholic of low socioeconomic class having right lobe solitary amoebic liver abscess. Appropriate use of minimally invasive drainage techniques reduces mortality. Soumik Ghosh, Sourabh Sharma, A. K. Gadpayle, H. K. Gupta, R. K. Mahajan, R. Sahoo, and Naveen Kumar Copyright © 2014 Soumik Ghosh et al. All rights reserved. Frequency and Clinical Manifestations of Dengue in Urban Medellin, Colombia Thu, 29 May 2014 09:28:32 +0000 http://www.hindawi.com/journals/jtm/2014/872608/ A dengue fever surveillance study was conducted at three medical facilities located in the low-income district of San Javier in Medellin, Colombia. During March 2008 to 2009, 781 patients with fever regardless of chief complaint were recruited for acute dengue virus infection testing. Of the 781 tested, 73 (9.3%) were positive for dengue infection. Serotypes DENV-2 (77%) and -3 (23%) were detected by PCR. One patient met the diagnostic criteria for dengue hemorrhagic fever. Only 3 out of 73 (4.1%) febrile subjects testing positive for dengue infection were diagnosed with dengue fever by the treating physician. This study confirms dengue virus as an important cause of acute febrile illness in Medellin, Colombia, but it is difficult to diagnose without dengue diagnostic testing. Berta Nelly Restrepo, Mark E. Beatty, Yenny Goez, Ruth E. Ramirez, G. William Letson, Francisco J. Diaz, Leidy Diana Piedrahita, and Jorge E. Osorio Copyright © 2014 Berta Nelly Restrepo et al. All rights reserved. Evaluation of the In Vitro and In Vivo Antioxidant Potentials of Aframomum melegueta Methanolic Seed Extract Thu, 15 May 2014 07:27:04 +0000 http://www.hindawi.com/journals/jtm/2014/159343/ Aframomum melegueta Schum (Zingiberaceae) is a perennial herb widely cultivated for its valuable seeds in the tropical region of Africa. The present study evaluated the antioxidant effects of methanolic seed extract of A. melegueta. The antioxidant effects were evaluated using in vitro, 2, 2-diphenylpicrylhydrazine photometric assay and in vivo serum catalase, superoxide dismutase and thiobarbituric acid reactive substance assay method. The extract (25–400 μg/mL concentration) produced concentration dependent increase in antioxidant activity in 2, 2-diphenylpicrylhydrazine photometric assay. The extract (400 mg/kg) showed a significant () increase in serum catalase and superoxide dismutase activity when compared with the control group. The extract (400 mg/kg) showed a significant () decrease in the serum level of thiobarbituric acid reactive substance when compared with the control group. These findings suggest that the seed of A. melegueta has potent antioxidant activity which may be responsible for some of its reported pharmacological activities and can be used as antioxidant supplement. Samuel Okwudili Onoja, Yusuf Ndukaku Omeh, Maxwell Ikechukwu Ezeja, and Martins Ndubuisi Chukwu Copyright © 2014 Samuel Okwudili Onoja et al. All rights reserved. Early Treatment with Intranasal Neostigmine Reduces Mortality in a Mouse Model of Naja naja (Indian Cobra) Envenomation Wed, 14 May 2014 10:05:26 +0000 http://www.hindawi.com/journals/jtm/2014/131835/ Objective. Most snakebite deaths occur prior to hospital arrival; yet inexpensive, effective, and easy to administer out-of-hospital treatments do not exist. Acetylcholinesterase inhibitors can be therapeutic in neurotoxic envenomations when administered intravenously, but nasally delivered drugs could facilitate prehospital therapy for these patients. We tested the feasibility of this idea in experimentally envenomed mice. Methods. Mice received intraperitoneal injections of Naja naja venom 2.5 to 10 times the estimated LD50 and then received 5 μL neostigmine (0.5 mg/mL) or 5 μL normal saline by nasal administration. Animals were observed up to 12 hours and survivors were euthanized. Results. 100% of control mice died. Untreated mice injected with 2.5× LD50 Naja naja died at average 193 minutes after injection, while 10 of 15 (67%) of treated mice survived and were behaviorally normal by 6 hours (). In the 5× LD50 group, survival was prolonged from 45 minutes to 196 minutes () and for 10× LD50 mice, survival increased from 30 to 175 minutes (). Conclusion. This pilot suggests that intranasal drugs can improve survival and is the first direct demonstration that such an approach is plausible, suggesting means by which treatment could be initiated before reaching the hospital. Further investigation of this approach to neurotoxic and other types of envenomation is warranted. Matthew R. Lewin, Stephen P. Samuel, David S. Wexler, Philip Bickler, Sakthivel Vaiyapuri, and Brett D. Mensh Copyright © 2014 Matthew R. Lewin et al. All rights reserved. Contaminated Pond Water Favors Cholera Outbreak at Haibatpur Village, Purba Medinipur District, West Bengal, India Mon, 12 May 2014 07:04:47 +0000 http://www.hindawi.com/journals/jtm/2014/764530/ Health workers reported an increased number of diarrhea cases at Haibatpur village on June 17, 2012. This outbreak was investigated with the following objectives: to confirm the existence of diarrhea outbreak, to find out the risk factors, and propose control measures. Cases were listed; spot map and epidemic curve were drawn. Attack rate was calculated by age and sex and risk factors were found out by calculating odds ratio (OR) with 95% confidence interval (CI). Rectal swabs were taken and water specimens were collected for laboratory test. Forty-one cases of patients were identified with overall attack rate (AR) was 5% (41/780). AR among men was higher 6% (25/404) than women. There was no death. V. cholerae 01 Eltor Ogawa was isolated from one (1/4) stool specimen. Spot map showed cases clustered around two ponds which were contaminated with coliform organisms. The underground water was a bit saline in nature. Using pond water for preparation of fermented rice (Panta Bhat) (OR 4.73, 95% CI 1.69–13.51), washing utensil in pond water (OR 7.31, 95% CI 1.77–42.29) were associated with cholera outbreak. Health education was done to villagers. Disinfection of two ponds with bleaching powder was done. We proposed supplying of safe drinking water and repairing defective deep tube well to village. Dilip Kumar Biswas, Rama Bhunia, Dipankar Maji, and Palash Das Copyright © 2014 Dilip Kumar Biswas et al. All rights reserved. Strategies to Overcome Antileishmanial Drugs Unresponsiveness Wed, 30 Apr 2014 12:55:42 +0000 http://www.hindawi.com/journals/jtm/2014/646932/ In the absence of effective vector control measures and vaccines against leishmaniasis, effective chemotherapy remains the mainstay of treatment. As the armoury of antileishmanial drugs is limited, strategies should be made to target the emergence of drug resistance. The loss of efficacy of antimonials such as sodium stibogluconate in the Indian subcontinent which has been the mainstay of treatment for more than six decades has raised concern to save the other drugs. In the current review, we highlight various steps which could be implemented to halt the increasing unresponsiveness of drugs such as monitoring of therapy in the form of rational dosing and duration of treatment, understanding the mechanism of action of the drugs and drug resistance, identification of markers of resistance, distribution of drugs free of cost, evolution of effective combination therapy and immunotherapy, and proper management of HIV/VL coinfection and post-kala-azar dermal leishmaniasis (PKDL). Strong support from governmental agencies and local communities in the form of education and orientation programmes for feasibility of implementing these strategies and affordability within the context of their health systems is needed in controlling and preventing leishmaniasis. Shyam Sundar, Anup Singh, and Om Prakash Singh Copyright © 2014 Shyam Sundar et al. All rights reserved. Cryptosporidiosis in Iranian Farm Workers and Their Household Members: A Hypothesis about Possible Zoonotic Transmission Sun, 27 Apr 2014 13:19:53 +0000 http://www.hindawi.com/journals/jtm/2014/405875/ Objectives. The prevalence of Cryptosporidium and the risk factors of zoonotic transmission in Najafabad, Isfahan, Iran dairy farms were examined. Methods. One fecal sample was collected from all calves less than 6 months old in eight dairy farms around Najafabad (Isfahan province, Central Iran) as well as individuals working in these farms and their household members. A two-step nested PCR protocol was used to amplify the 18S rRNA gene (830 bp). Results. Cryptosporidium was identified in the stool of 36 (prevalence 8.5%) of 96 farm workers and 326 household members. Furthermore, 31 (14.2%) of 218 calf samples were positive. Cryptosporidium parvum was identified in 15 (72%) of the positive farm workers and 10 (65%) of the positive household members. Of the positive calves, 20 (64.5%) were infected with C. parvum, indicating possible zoonotic transmission in these farms. Contact with calves ( < 0.0001) was the most significant risk factor of C. parvum infection. A considerable negative association was observed between C. parvum infection and cleaning of shoes/boots after daily work ( = 0.004), hand washing ( = 0.013), and use of piped water ( < 0.006). In the multivariate analysis with logistic regression, only contact with calves was significant. Conclusion. Zoonotic transmission of C. parvum due to contact with calves is predominant among farm workers and their household members of this region and appropriate health measures must be applied to control the infection and decrease of zoonotic transmission of this parasite. Morteza Izadi, Nematollah Jonaidi-Jafari, Amin Saburi, Hossein Eyni, Mohammad-Reza Rezaiemanesh, and Reza Ranjbar Copyright © 2014 Morteza Izadi et al. All rights reserved. Occult Hepatitis B Virus Infection among HIV Positive Patients in Nigeria Thu, 24 Apr 2014 09:24:56 +0000 http://www.hindawi.com/journals/jtm/2014/796121/ HIV has been known to interfere with the natural history of hepatitis B virus (HBV) infection. In this study we investigate the prevalence of occult hepatitis B virus infection (OBI) among HIV-infected individuals in Nigeria. Overall, 1200 archived HIV positive samples were screened for detectable HBsAg using rapid technique, in Ikole Ekiti Specialist Hospital. The HBsAg negative samples were tested for HBsAg, anti-HBc, and anti-HCV by ELISA. Polymerase chain reaction was used for HBV DNA amplification and CD4 counts were analyzed by cytometry. Nine hundred and eighty of the HIV samples were HBsAg negative. HBV DNA was detected in 21/188 (11.2%) of patients without detectable HBsAg. CD4 count for the patients ranged from 2 to 2,140 cells/μL of blood (mean = 490 cells/μL of blood). HCV coinfection was detected only in 3/188 (1.6%) of the HIV-infected patients (). Twenty-eight (29.2%) of the 96 HIV samples screened were positive for anti-HBc. Averagely the HBV viral load was <50 copies/mL in the OBI samples examined by quantitative PCR. The prevalence of OBI was significantly high among HIV-infected patients. These findings highlight the significance of nucleic acid testing in HBV diagnosis in HIV patients. Oluyinka Oladele Opaleye, Adeolu Sunday Oluremi, Adetona Babatunde Atiba, Moses Olubusuyi Adewumi, Olatunji Victor Mabayoje, Emmanuel Donbraye, Olusola Ojurongbe, and O. Adekunle Olowe Copyright © 2014 Oluyinka Oladele Opaleye et al. All rights reserved. Evidence of HLA-DQB1 Contribution to Susceptibility of Dengue Serotype 3 in Dengue Patients in Southern Brazil Thu, 10 Apr 2014 12:54:55 +0000 http://www.hindawi.com/journals/jtm/2014/968262/ Dengue infection (DI) transmitted by arthropod vectors is the viral disease with the highest incidence throughout the world, an estimated 300 million cases per year. In addition to environmental factors, genetic factors may also influence the manifestation of the disease; as even in endemic areas, only a small proportion of people develop the most serious form. Immune-response gene polymorphisms may be associated with the development of cases of DI. The aim of this study was to determine allele frequencies in the HLA-A, B, C, DRB1, DQA1, and DQB1 loci in a Southern Brazil population with dengue virus serotype 3, confirmed by the ELISA serological method, and a control group. The identification of the HLA alleles was carried out using the SSO genotyping PCR program (One Lambda), based on Luminex technology. In conclusion, this study suggests that DQB106:11 allele could act as susceptible factors to dengue virus serotype 3, while HLA-DRB111 and DQA105:01 could act as resistance factors. Daniela Maria Cardozo, Ricardo Alberto Moliterno, Ana Maria Sell, Gláucia Andréia Soares Guelsin, Leticia Maria Beltrame, Samaia Laface Clementino, Pamela Guimarães Reis, Hugo Vicentin Alves, Priscila Saamara Mazini, and Jeane Eliete Laguila Visentainer Copyright © 2014 Daniela Maria Cardozo et al. All rights reserved. Effect of Environmental Disturbance on the Population of Sandflies and Leishmania Transmission in an Endemic Area of Venezuela Mon, 07 Apr 2014 14:03:22 +0000 http://www.hindawi.com/journals/jtm/2014/280629/ The exploitation of new wilderness areas with crops is increasing and traditional crop substitution has been modified by new more productive crops. The results show the anthropogenic disturbance effect on the sandflies population and Leishmania transmission in endemic areas of Venezuela. Three agroecosystems with variable degrees of ecological disturbance, forest (conserved), cacao (fragmented), and orangery (disturbed), were selected. Four methods to sandfly capture were used; the specimens were identified and infected with Leishmania. Diversity, population structure, ANOVA, Tukey test, and simple correlation analysis were carried out. Shannon traps were able to capture 94.7% of the total sandflies, while CDC light traps, Sticky traps, and direct suction just captured 2.2%, 1.2%, and 0.9%, respectively. The results showed the effect of ecological disturbance degree on the composition of sandflies and population structure, revealing a dominance level increased but decreased on the diversity and richness of sandflies species in the greatest ecological disturbance area in relation to areas with less organic disturbance. Environments more disturbed cause adaptability of certain species such as Lutzomyia gomezi and Lutzomyia walkeri. These changes on the composition of sandflies population and structure emerging species could cause increasing of leishmaniasis transmission. Elsa Nieves, Luzmary Oraá, Yorfer Rondón, Mireya Sánchez, Yetsenia Sánchez, Masyelly Rojas, Maritza Rondón, Maria Rujano, Nestor González, and Dalmiro Cazorla Copyright © 2014 Elsa Nieves et al. All rights reserved. Role of Clinical Presentations and Routine CSF Analysis in the Rapid Diagnosis of Acute Bacterial Meningitis in Cases of Negative Gram Stained Smears Thu, 03 Apr 2014 09:30:25 +0000 http://www.hindawi.com/journals/jtm/2014/213762/ Background and Aim. Bacterial meningitis is a lethal, disabling endemic disease needing prompt antibiotic management. Gram stained smears is rapid accurate method for diagnosis of bacterial meningitis. In cases of negative gram stained smears diagnosis is delayed till culture results. We aim to assess the role of clinical presentations and routine CSF analysis in the cost-effective rapid diagnosis of negative gram stained smears bacterial meningitis. Methods. Cross sectional study including 623 acute meningitis patients divided into two groups: bacterial meningitis and nonbacterial meningitis groups. The clinical presentations, systemic inflammatory parameters, and CSF analysis were evaluated and compared in both groups. Results. Altered conscious level, localizing neurological signs, Kernig’s and Brudzinski’s signs together with peripheral leucocytosis (>10.000/mm3), high CRP (>6) together with high CSF protein (>50 gl/dL), CSF neutrophilic count (≥50% of total CSF leucocytic count), and low CSF glucose level (<45 gm/dL) and CSF/serum glucose ≤0.6 were significantly diagnostic in bacterial meningitis patients. From the significant CSF analysis variables CSF protein carried the higher accuracy of diagnosis 78% with sensitivity 88% and specificity 72%. Conclusions. High CSF protein (>50 mg/dL) together with plasma inflammatory markers and CSF cytochemical parameters can diagnose bacterial meningitis in gram stain negative smear till culture results. Rabab Fouad, Marwa Khairy, Waleed Fathalah, Taha Gad, Badawy El-Kholy, and Ayman Yosry Copyright © 2014 Rabab Fouad et al. All rights reserved. Incidence of Tuberculosis and Amyloidosis among Sudanese Patients Presented with Enlarged Nodes Sun, 30 Mar 2014 11:40:47 +0000 http://www.hindawi.com/journals/jtm/2014/832029/ Objectives. To determine the incidence of tuberculous lymphadenitis and amyloidosis in enlarged lymph nodes (LN). Methodology. A retrospective study was carried out in the department of pathology at the Faculty of Medicine, University of Kordofan, during one-year period. The study included a group of 103 patients with lymphadenopathy. Results. Of the 103 cases with enlarged neck nodes, 35 (34%) had tuberculous lymphadenitis. Sixteen (46%) cases were males and 19 (54%) cases were females. Out of the 103 patients, amyloidosis was diagnosed in 9/103 (8.7%). Out of the 9 positive cases, 2/9 (22.2%) were males and 7/9 (77.8%) were females. Conclusion. There is high incidence of tuberculous lymphadenitis in patients with enlarged LN in developing countries like North Sudan. Amyloidosis should not be ignored when investigating enlarged LN. Ahmed Abdalla Agab Eldour, Entisar Najeeb Mohmed Salih, and Hussain Gadelkarim Ahmed Copyright © 2014 Ahmed Abdalla Agab Eldour et al. All rights reserved. Viral Aetiology of Acute Flaccid Paralysis Surveillance Cases, before and after Vaccine Policy Change from Oral Polio Vaccine to Inactivated Polio Vaccine Wed, 19 Mar 2014 09:53:16 +0000 http://www.hindawi.com/journals/jtm/2014/814908/ Since 1992, surveillance for acute flaccid paralysis (AFP) cases was introduced in Malaysia along with the establishment of the National Poliovirus Laboratory at the Institute for Medical Research. In 2008, the Ministry of Health, Malaysia, approved a vaccine policy change from oral polio vaccine to inactivated polio vaccine (IPV). Eight states started using IPV in the Expanded Immunization Programme, followed by the remaining states in January 2010. The objective of this study was to determine the viral aetiology of AFP cases below 15 years of age, before and after vaccine policy change from oral polio vaccine to inactivated polio vaccine. One hundred and seventy-nine enteroviruses were isolated from the 3394 stool specimens investigated between 1992 and December 2012. Fifty-six out of 107 virus isolates were polioviruses and the remaining were non-polio enteroviruses. Since 2009 after the sequential introduction of IPV in the childhood immunization programme, no Sabin polioviruses were isolated from AFP cases. In 2012, the laboratory AFP surveillance was supplemented with environmental surveillance with sewage sampling. Thirteen Sabin polioviruses were also isolated from sewage in the same year, but no vaccine-derived poliovirus was detected during this period. T. S. Saraswathy Subramaniam, Mohd Apandi Apandi, Rohani Jahis, Mohd Samsul Samsudin, and Zainah Saat Copyright © 2014 T. S. Saraswathy Subramaniam et al. All rights reserved. Concomitant Infection with Leishmania donovani and L. major in Single Ulcers of Cutaneous Leishmaniasis Patients from Sudan Wed, 12 Mar 2014 06:36:11 +0000 http://www.hindawi.com/journals/jtm/2014/170859/ In Sudan human leishmaniasis occurs in different clinical forms, that is, visceral (VL), cutaneous (CL), mucocutaneous (ML), and post-kala-azar dermal leishmaniasis (PKDL). Clinical samples from 69 Sudanese patients with different clinical manifestations were subjected to a PCR targeting the cytochrome oxidase II (COII) gene for Leishmania species identification. Mixed infections were suspected due to multiple overlapping peaks presented in some sequences of the COII amplicons. Cloning these amplicons and alignment of sequences from randomly selected clones confirmed the presence of two different Leishmania species, L. donovani and L. major, in three out of five CL patients. Findings were further confirmed by cloning the ITS gene. Regarding other samples no significant genetic variations were found in patients with VL (62 patients), PKDL (one patient), or ML (one patient). The sequences clustered in a single homogeneous group within L. donovani genetic group, with the exception of one sequence clustering with L. infantum genetic group. Findings of this study open discussion on the synergetic/antagonistic interaction between divergent Leishmania species both in mammalian and vector hosts, their clinical implications with respect to parasite fitness and response to treatment, and the route of transmission with respect to vector distribution and or adaptation. A. M. Babiker, S. Ravagnan, A. Fusaro, M. M. Hassan, S. M. Bakheit, M. M. Mukhtar, G. Cattoli, and G. Capelli Copyright © 2014 A. M. Babiker et al. All rights reserved. Prevalence of Plasmodium falciparum Parasitaemia and Its Correlation with Haematological Parameters among HIV-Positive Individuals in Nigeria Tue, 04 Mar 2014 12:54:36 +0000 http://www.hindawi.com/journals/jtm/2014/161284/ Malaria and HIV are the two most important health challenges of our time. Haematologic abnormalities are features in Plasmodium falciparum infection, and anaemia is a well-known outcome. The prevalence and haematological impact of P. falciparum parasitaemia were determined among HIV-infected individuals in Nigeria. Parasite detection was carried out using microscopy and Polymerase Chain Reaction (PCR). Haemoglobin concentration was determined using an automated machine while CD4+ T-cells count was analyzed using flow cytometer. Thirty-seven (18.5%) out of the 200 HIV individuals enrolled had malaria parasites detected in their blood. All the positive cases were detected by PCR while only 20 (10%) were detected by thick blood microscopy. The mean haemoglobin concentration and packed cell volume (PCV) of HIV individuals with malaria parasitaemia were lower compared to those without malaria parasitaemia but the difference was not statistically significant. Also no significant difference was observed in malaria positivity in respect to sex and mean CD4+ cell count. The study highlights the effects of P. falciparum parasitaemia on the haematologic and immune components of HIV individuals. Olusola Ojurongbe, Oluwatoyin Adeola Oyeniran, Oyebode Armstrong Terry Alli, Sunday Samuel Taiwo, Taiwo Adetola Ojurongbe, Adekunle Olugbenga Olowe, Oluyinka Oladele Opaleye, and Oluwaseyi Adegboyega Adeyeba Copyright © 2014 Olusola Ojurongbe et al. All rights reserved. Vaccination and Malaria Prevention among International Travelers Departing from Athens International Airport to African Destinations Sun, 02 Mar 2014 00:00:00 +0000 http://www.hindawi.com/journals/jtm/2014/563030/ Background. International travel to Africa has grown dramatically over the last decade along with an increasing need to understand the health issues for travelers. The current survey aimed to assess vaccination and malaria prevention of travelers visiting Africa. Methods. A questionnaire-based survey was conducted from of November 1, 2011 to of April 30, 2013 at Athens International Airport. Results. A total of 360 travelers were studied; 68% were men. Their mean age was 39.9 years. Previous travel to tropical countries was reported by 71.9% of them. Most frequent destination was sub-Saharan Africa (60%). Most of them traveled for ≥1 month (62%). The main reason for travel was work (39.7%). Only 47% sought pretravel consultation. Hepatitis A, typhoid, and meningococcal vaccines were administered to 49.8%, 28%, and 26.6%, respectively, and malaria chemoprophylaxis to 66.8% of those who visited sub-Saharan Africa. A history of previous travel to a tropical country, elementary level of education, and traveling for visiting friends and relatives, and for short duration were significant determinants for not pursuing pretravel consultation. Conclusions. The current survey revealed important inadequacies in vaccine and malaria prophylaxis of travelers departing to Africa. Educational tools should be developed in order to improve awareness of travelers to risk destinations. Androula Pavli, Athina Spilioti, Paraskevi Smeti, Stavros Patrinos, and Helena C. Maltezou Copyright © 2014 Androula Pavli et al. All rights reserved. Molecular and Microscopic-Based Characterization of Plasmodium spp. in Fars and Hormozgan Provinces, South of Iran Thu, 06 Feb 2014 13:36:21 +0000 http://www.hindawi.com/journals/jtm/2014/935469/ Despite malaria control programs in recent years, malaria transmission has not been eliminated in Iran. Molecular techniques including PCR, which has proved more sensitive and specific than microscopic examination methods, help to detect infection in low levels of parasitemia and mixed infections. Main our objectives were setting up nested PCR for detection of malaria and evaluating PCR based on plasmodia DNA from blood smears in Fars province, the comparison of this method with traditional microscopy and also evaluate the data in comparison with its neighboring province, Hormozgan. A total of 149 malaria positive samples including 116, 19, and 14 samples from Shiraz, Jask, and Lengeh ports were utilized in this study, respectively. Blood slides were prepared for microscopic observation. DNA from thin smears was extracted and nested PCR was analyzed using rPLU5 and rPLU6 for genus specification, rFAL1, rFAL2, and rVIV1, rVIV2 for P. falciparum and P. vivax detection, respectively. The results showed that 126 (84.6%), 16 (10.7%), and 7 (4.7%) out of 149 cases were positive for P. vivax, P. falciparum, and mixed infections, respectively, by microscopy. The PCR indicated that 95 (63.7%), 15 (10.1%), and 22 (14.8%) cases were infected with P. vivax, P. falciparum, and mixed mentioned species, respectively, and 17 (11.4%) cases were uninfected. Our results confirmed the considerable sensitivity of nested PCR for detection of the mixed infections. Simultaneous application of PCR even based on microscopy slides can facilitate access to the highest level of confidence in malaria researches. Tahereh Mohammadzadeh, Gholamreza Hatam, Mohsen Kalantari, Bahador Sarkari, Mohammad Hosein Motazedian, Seyed Mahmoud Sadjjadi, and Reza Safari Copyright © 2014 Tahereh Mohammadzadeh et al. All rights reserved. Effectiveness and Safety of Concurrent Use of First-Line Antiretroviral and Antituberculous Drugs in Rwanda Thu, 30 Jan 2014 06:53:25 +0000 http://www.hindawi.com/journals/jtm/2014/904957/ Background. Overlapping toxicity between drugs used for HIV and TB could complicate the management of HIV/TB coinfected patients, particularly those carrying multiple opportunistic infections. This study aimed to evaluate the clinical outcomes and adverse drug events in HIV patients managed with first-line antiretroviral and first-line anti-TB drugs. Methods. This is a retrospective study utilizing medical dossiers from single-HIV infected and HIV/TB coinfected patients already initiated on ART. Predictors of outcomes included changes in CD4 cells/mm3, body weight, physical improvement, death rate, and adverse drug reactions. Results. Records from 60 HIV patients and 60 HIV/TB patients aged between 20 and 58 years showed that all clinical indicators of effectiveness were better in single-HIV infected than in HIV/TB coinfected patients: higher CD4 cell counts, better physical improvement, and low prevalence of adverse drug events. The most frequently prescribed regimen was TDF/3TC/EFV+RHZE. The mortality rate was 20% in HIV/TB patients compared to 8.3% in the single-HIV group. Conclusion. Treatment regimens applied are efficient in controlling the progression of the infection. However, attention should be paid to adjust dosing when combining nonnucleoside antiretrovirals (EFV and NVR) with anti-TB drugs to minimize the risk of death by drug intoxication. Justin Ntokamunda Kadima, Marie Françoise Mukanyangezi, and Claude Bernard Uwizeye Copyright © 2014 Justin Ntokamunda Kadima et al. All rights reserved. Introducing Single Dose Liposomal Amphotericin B for the Treatment of Visceral Leishmaniasis in Rural Bangladesh: Feasibility and Acceptance to Patients and Health Staff Mon, 20 Jan 2014 17:10:08 +0000 http://www.hindawi.com/journals/jtm/2014/676817/ Background. For the treatment of visceral leishmaniasis in Bangladesh, single dose liposomal amphotericin B (ambisome) is supposed to be the safest and most effective treatment. Specific needs for application and storage raise questions about feasibility of its implementation and acceptance by patients and health staff. Methods. The study was carried out in the most endemic district of Bangladesh. Study population includes patients treated with ambisome or miltefosine, hospital staff, and a director of the national visceral leishmaniasis program. Study methods include direct observation (subdistrict hospitals), open interviews (heath staff and program personnel), structured questionnaires, and focus group discussions (patients). Results. Politicalcommitment for ambisome is strong; the general hospital infrastructure favours implementation but further strengthening is required, particularly for drug storage below 25°C (refrigerators), back-up energy (fuel for generators), and supplies for ambisome administration (like 5% dextrose solution). Ambisome created high satisfaction in patients and hospital staff, less adverse events, and less income loss for patients compared to miltefosine. Conclusions. High political commitment, general capacities of subdistrict hospitals, and high acceptability favour the implementation of ambisome treatment in Bangladesh. However, strengthening of the infrastructure and uninterrupted supplies of essential accessories is mandatory before introducing sLAB in Bangladesh. Eva-Maria Maintz, Mahbub Hassan, M. Mamun Huda, Debashis Ghosh, Md. Shakhawat Hossain, Abdul Alim, Axel Kroeger, Byron Arana, and Dinesh Mondal Copyright © 2014 Eva-Maria Maintz et al. All rights reserved. Mitochondrial PCR-RFLP Assay to Distinguish Triatoma brasiliensis macromelasoma from Triatoma brasiliensis brasiliensis Subspecies (Hemiptera: Reduviidae) Tue, 17 Dec 2013 10:35:27 +0000 http://www.hindawi.com/journals/jtm/2013/305198/ Triatoma brasiliensis sensu lato (s.l.), the main vector of Chagas disease in northeastern Brazil, is a species complex comprising four species, one with two subspecies (T. brasiliensis brasiliensis, T. brasiliensis macromelasoma, T. juazeirensis, T. sherlocki, and T. melanica), and each taxon displaying distinct ecological requirements. In order to evaluate the genetic relationships among nine T. brasiliensis s.l. populations from northeastern Brazil, we analyzed their mitochondrial cytochrome c oxidase subunit 1 sequences and suggested a PCR-RFLP assay to distinguish between T. b. macromelasoma and T. b. brasiliensis subspecies. All the specimens were morphologically identified as T. b. brasiliensis. The resulting phylogenies identified two major clades that are congruent with the geographical populations studied. Based on collection sites and in accordance with type-location, one clade was identified as the subspecies T. b. macromelasoma. The second clade grouped T. b. brasiliensis populations. Restriction endonuclease sites were observed in the sequences and used in PCR-RFLP assays, producing distinct fingerprints for T. b. macromelasoma and T. b. brasiliensis populations. The results suggest that these are different species and that gene flow occurs only among T. b. brasiliensis populations, possibly associated with human activity in the area. Daniel Pagotto Vendrami, Walter Ceretti-Junior, Marcos Takashi Obara, and Mauro Toledo Marrelli Copyright © 2013 Daniel Pagotto Vendrami et al. All rights reserved. Children with Kaposi Sarcoma in Two Southern African Hospitals: Clinical Presentation, Management, and Outcome Wed, 11 Dec 2013 08:38:52 +0000 http://www.hindawi.com/journals/jtm/2013/213490/ Introduction. In 2010 more than 3 million children with human immunodeficiency virus (HIV) were living in Sub-Saharan Africa. The AIDS epidemic has contributed to an abrupt increase of the frequency of Kaposi sarcoma (KS), especially in Southern Africa. There is a need to describe the clinical features of this disease, its management, and its outcome in HIV positive children in Southern Africa. The aim of the study is to describe two different populations with HIV and KS from two African hospitals in Namibia and South Africa. Material and Methods. A retrospective descriptive study of patients with KS who presented to Tygerberg Hospital (TH) and Windhoek Central Hospital (WCH) from 1998 to 2010. Demographic data, HIV profile, clinical picture of KS, and survival were documented. Results. The frequency of KS declined from 2006 to 2010 in TH but showed an increase in the same period in WCH. Children in TH were diagnosed at a much younger age than those in WCH (44.2 months versus 90 months). Cutaneous lesions were the most common clinical presenting feature, followed by lymphadenopathy, intrathoracic and oral lesions. Conclusions. The clinical characteristics of KS in South Africa and Namibia differ in many aspects between the 2 countries. G. P. De Bruin and D. C. Stefan Copyright © 2013 G. P. De Bruin and D. C. Stefan. All rights reserved. Challenges in the Therapy of Visceral Leishmaniasis in Brazil: A Public Health Perspective Thu, 05 Dec 2013 13:29:37 +0000 http://www.hindawi.com/journals/jtm/2013/319234/ Over 3,000 yearly cases of Visceral Leishmaniasis (VL) are reported in Brazil. Brazilian Public Health System provides universal free access to antileishmania therapeutic options: Meglumine Antimoniate, Amphotericin B deoxycholate, and Liposomal Amphotericin B. Even though Amphotericin formulations have been advised for severe disease, this recommendation is mostly based on the opinion of experts and on analogy with studies conducted in other countries. Presently, there are two ongoing multicenter clinical trials comparing the efficacy and safety of the available therapeutic options. Some other issues require further clarification, such as severity markers and the approach to VL/AIDS coinfection. Brazil is facing the challenge of providing access to diagnosis and adequate treatment, in order to avoid VL-related deaths. Edson Carvalho de Melo and Carlos Magno Castelo Branco Fortaleza Copyright © 2013 Edson Carvalho de Melo and Carlos Magno Castelo Branco Fortaleza. All rights reserved. Detecting and Responding to a Dengue Outbreak: Evaluation of Existing Strategies in Country Outbreak Response Planning Wed, 09 Oct 2013 13:55:11 +0000 http://www.hindawi.com/journals/jtm/2013/756832/ Background. Dengue outbreaks are occurring with increasing frequency and intensity. Evidence-based epidemic preparedness and effective response are now a matter of urgency. Therefore, we have analysed national and municipal dengue outbreak response plans. Methods. Thirteen country plans from Asia, Latin America and Australia, and one international plan were obtained from the World Health Organization. The information was transferred to a data analysis matrix where information was extracted according to predefined and emerging themes and analysed for scope, inconsistencies, omissions, and usefulness. Findings. Outbreak response planning currently has a considerable number of flaws. Outbreak governance was weak with a lack of clarity of stakeholder roles. Late timing of responses due to poor surveillance, a lack of combining routine data with additional alerts, and lack of triggers for initiating the response weakened the functionality of plans. Frequently an outbreak was not defined, and early response mechanisms based on alert signals were neglected. There was a distinct lack of consideration of contextual influences which can affect how an outbreak detection and response is managed. Conclusion. A model contingency plan for dengue outbreak prediction, detection, and response may help national disease control authorities to develop their own more detailed and functional context specific plans. Julia Harrington, Axel Kroeger, Silvia Runge-Ranzinger, and Tim O'Dempsey Copyright © 2013 Julia Harrington et al. All rights reserved. Is the Dog a Possible Reservoir for Cutaneous Leishmaniasis in Suriname? Tue, 01 Oct 2013 16:09:57 +0000 http://www.hindawi.com/journals/jtm/2013/324140/ Cutaneous leishmaniasis (CL) is an emerging disease in Suriname, with at least 200 cases per year. Little is known about the biology of CL in the country. The most important parasite species is Leishmania Viannia guyanensis, but possible vectors and reservoirs are hardly incriminated. In the present study, it was investigated whether the dog could possibly be a zoonotic reservoir for the disease in Suriname. Forty-seven dogs were examined for overt clinical signs of leishmaniasis, and blood samples were collected on filter paper for serology (direct agglutination test) and molecular biology (by polymerase chain reaction). Three dogs had clinical signs that could be compatible with canine cutaneous leishmaniosis: dermatitis (two) or nasal lesion (one). Two dogs were seropositive with DAT (titre > 1 : 1600), and three animals had a borderline titre (1 : 800). All other animals () were DAT negative. PCR analysis found Leishmania DNA equivalent to 1 parasite per mL in only one dog at a first round of analysis, but this animal was negative after retesting. The clinical, serological, and molecular data show some preliminary lines of evidence that canine leishmaniosis is present in Suriname, but further studies are needed to incriminate the reservoir, including a possible sylvatic cycle. Alida Kent, Prakash Ramkalup, Dennis Mans, and Henk Schallig Copyright © 2013 Alida Kent et al. All rights reserved. Evaluation of Polyethylene-Based Long Lasting Treated Bed Net Netprotect on Anopheles Mosquitoes, Malaria Incidence, and Net Longivity in Western Kenya Tue, 01 Oct 2013 10:08:45 +0000 http://www.hindawi.com/journals/jtm/2013/563957/ We studied the effect on malaria incidence, mosquito abundance, net efficacy, net use rate, chemical analysis, and holes of a long lasting insecticide treated bed net (Netprotect) in western Kenya, 2007–2010. Nets were hung in 150 households 6 months before they were hung in a second, 2 km away. Indoor resting densities were monitored by pyrethrum spray catch and malaria cases by passive detection using clinical manifestations and rapid diagnostic test. The probability of finding An. arabiensis in the control area was 2.6 times higher than that in intervention area during the first 6 months. Human blood feeding index of Anopheles funestus declined 17%. After bed nets were hung in the second area, malaria incidence declined 25% down to the level in the first area. Incidence remained at this low level for 2 years. 90% of collected nets were efficacious after 3-year use. Deltamethrin dosage declined from 1.9 to 0.5 g/kg over 3 years. Attrition rate after 3 years was 21%. WHO hole index changed from 333 to 114 to 381 over the three years. This index summarizes the numbers of holes in size categories and multiplies with the mean hole area per category. It is very sensitive to the impact of big holes in a few nets. M. T. O. Odhiambo, O. Skovmand, J. M. Vulule, and E. D. Kokwaro Copyright © 2013 M. T. O. Odhiambo et al. All rights reserved. Factors Associated with Migration in Individuals Affected by Leprosy, Maranhão, Brazil: An Exploratory Cross-Sectional Study Mon, 30 Sep 2013 15:24:05 +0000 http://www.hindawi.com/journals/jtm/2013/495076/ In Brazil, leprosy is endemic and concentrated in high-risk clusters. Internal migration is common in the country and may influence leprosy transmission and hamper control efforts. We performed a cross-sectional study with two separate analyses evaluating factors associated with migration in Brazil’s Northeast: one among individuals newly diagnosed with leprosy and the other among a clinically unapparent population with no symptoms of leprosy for comparison. We included 394 individuals newly diagnosed with leprosy and 391 from the clinically unapparent population. Of those with leprosy, 258 (65.5%) were birth migrants, 105 (26.6%) were past five-year migrants, and 43 (10.9%) were circular migrants. In multivariate logistic regression, three independent factors were found to be significantly associated with migration among those with leprosy: (1) alcohol consumption, (2) separation from family/friends, and (3) difficulty reaching the healthcare facility. Separation from family/friends was also associated with migration in the clinically unapparent population. The health sector may consider adapting services to meet the needs of migrating populations. Future research is needed to explore risks associated with leprosy susceptibility from life stressors, such as separation from family and friends, access to healthcare facilities, and alcohol consumption to establish causal relationships. C. Murto, C. Kaplan, L. Ariza, K. Schwarz, C. H. Alencar, L. M. M. da Costa, and J. Heukelbach Copyright © 2013 C. Murto et al. All rights reserved. Visceral Leishmaniasis with Associated Common, Uncommon, and Atypical Morphological Features on Bone Marrow Aspirate Cytology in Nonendemic Region Sun, 08 Sep 2013 17:44:58 +0000 http://www.hindawi.com/journals/jtm/2013/861032/ Objectives. The present study was conducted to categorise the morphological features on bone marrow aspirate cytology into common, uncommon, and atypical features in a nonendemic region which would be helpful in clinching an early and correct diagnosis especially in clinically unsuspected cases. Methods. The morphological features on bone marrow were categorized into common, uncommon, and atypical in cases of leishmaniasis from non endemic region. Results. Out of total 27 cases, 77.7% were residents of places at the height of 500 m or above and fever was the most common presentation followed by hepatosplenomegaly. Plasmacytosis, hemophagocytosis were the common cytological features while dysmyelopoiesis, presence of leishmania bodies in nonhistiocytic cells, and granuloma with necrosis were uncommon features. Aggregates of LD bodies in form of ring, floret, or strap shapes along with giant cells constitute the atypical morphological features. Conclusion. The knowledge of common, uncommon, and atypical features on bone marrow aspirate cytology is helpful in clinching an early and correct diagnosis of leishmaniasis especially in non endemic areas where clinical suspicion is low. These features will guide the pathologist for vigilant search of LD bodies in the marrow for definite diagnosis and thus will also be helpful in preventing unnecessary workups. Harish Chandra, Smita Chandra, and Rajeev Mohan Kaushik Copyright © 2013 Harish Chandra et al. All rights reserved.