Journal of Tropical Medicine The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Genome-Wide Prediction of Vaccine Candidates for Leishmania major: An Integrated Approach Mon, 23 Nov 2015 09:26:03 +0000 Despite the wealth of information regarding genetics of the causative parasite and experimental immunology of the cutaneous leishmaniasis, there is currently no licensed vaccine against it. In the current study, a two-level data mining strategy was employed, to screen the Leishmania major genome for promising vaccine candidates. First, we screened a set of 25 potential antigens from 8312 protein coding sequences, based on presence of signal peptides, GPI anchors, and consensus antigenicity predictions. Second, we conducted a comprehensive immunogenic analysis of the 25 antigens based on epitopes predicted by NetCTL tool. Interestingly, results revealed that candidate antigen number 1 (LmjF.03.0550) had greater number of potential T cell epitopes, as compared to five well-characterized control antigens (CSP-Plasmodium falciparum, M1 and NP-Influenza A virus, core protein-Hepatitis B virus, and PSTA1-Mycobacterium tuberculosis). In order to determine an optimal set of epitopes among the highest scoring predicted epitopes, the OptiTope tool was employed for populations susceptible to cutaneous leishmaniasis. The epitope (127SLWSLLAGV) from antigen number 1, found to bind with the most prevalent allele HLA-A0201 (25% frequency in Southwest Asia), was predicted as most immunogenic for all the target populations. Thus, our study reasserts the potential of genome-wide screening of pathogen antigens and epitopes, for identification of promising vaccine candidates. Satarudra Prakash Singh, Kriti Roopendra, and Bhartendu Nath Mishra Copyright © 2015 Satarudra Prakash Singh et al. All rights reserved. Leukogram Profile and Clinical Status in vivax and falciparum Malaria Patients from Colombia Wed, 18 Nov 2015 06:44:03 +0000 Introduction. Hematological alterations are frequent in malaria patients; the relationship between alterations in white blood cell counts and clinical status in malaria is not well understood. In Colombia, with low endemicity and unstable transmission for malaria, with malaria vivax predominance, the hematologic profile in malaria patients is not well characterized. The aim of this study was to characterize the leukogram in malaria patients and to analyze its alterations in relation to the clinical status. Methods. 888 leukogram profiles of malaria patients from different Colombian regions were studied: 556 with P. falciparum infection (62.6%), 313 with P. vivax infection (35.2%), and 19 with mixed infection by these species (2.1%). Results. Leukocyte counts at diagnosis were within normal range in 79% of patients and 18% had leucopenia; the most frequent alteration was lymphopenia (54%) followed by monocytosis (11%); the differential granulocyte count in 298 patients revealed eosinophilia (15%) and high basophil counts (8%). Leukocytosis, eosinopenia, and neutrophilia were associated with clinical complications. The utility of changes in leukocyte counts as markers of severity should be explored in depth. A better understanding of these hematological parameters will allow their use in prompt diagnosis of malaria complications and monitoring treatment response. Alberto Tobón-Castaño, Esteban Mesa-Echeverry, and Andrés Felipe Miranda-Arboleda Copyright © 2015 Alberto Tobón-Castaño et al. All rights reserved. Significant Decline of Malaria Incidence in Southwest of Iran (2001–2014) Mon, 16 Nov 2015 09:33:53 +0000 Iran is considered as one of the malaria endemic countries of the Eastern Mediterranean Region (EMR) and is at risk due to neighboring Afghanistan, Pakistan in the east, and Iraq to the west. Therefore the aim of the present investigation is the evaluation of the trend of malaria distribution during the past decade (2001–2014) in Khuzestan province, southwestern Iran. In this retrospective cross-sectional investigation, blood samples were taken from all malaria suspicious cases who were referred to health centers across Khuzestan province. For each positive subject a questionnaire containing demographic information was filled out. Data analysis was performed using SPSS 18. From a total of 541 malaria confirmed cases, 498 (92.05%) were male and 43 (7.95%) were female. The highest number of infections was seen in 2001 with 161 (29.75%) cases and the lowest was in 2014 with 0 (0%). Also, Plasmodium vivax was identified as dominant species in 478 (88.35%) individuals and P. falciparum comprised 63 (11.65%). The highest infection rate was observed in non-Iranian populations with number 459 (84.85%) and imported cases 508 (93.90%). Also, the majority of subjects were over 15 years of age, 458 (84.65%). Due to proximity to endemic countries which has made the malaria campaign difficult, more effort is needed to control the infection in order to achieve malaria elimination. Shokrollah Salmanzadeh, Masoud Foroutan-Rad, Shahram Khademvatan, Sasan Moogahi, and Shahla Bigdeli Copyright © 2015 Shokrollah Salmanzadeh et al. All rights reserved. Current Status of Norovirus Infections in Children in Sub-Saharan Africa Mon, 16 Nov 2015 08:17:57 +0000 Noroviruses are a leading cause of acute sporadic gastroenteritis worldwide. In Sub-Saharan Africa, information regarding norovirus infections in children is scarce. A systematic review of studies performed between 1993 and June 2015 was conducted to establish the genotypic distribution and prevalence of norovirus infections in children (≤17) in Sub-Saharan Africa. Analysis of data from 19 studies involving 8,399 samples from children with symptomatic and nonsymptomatic gastroenteritis revealed prevalence of 12.6% (range 4.6% to 32.4%). The prevalence of norovirus infections was higher in symptomatic children (14.2%) than asymptomatic children (9.2%). Genogroup II (GII) was the most prevalent genogroup accounting for 76.4% of all the reported norovirus infections. The rest of the infections were GI (21.7%) and GI/GII (1.9%). The most common genotypes were GII.4 (65.2%), GI.7 (33.3%), and GI.3 (21.3%). These statistics were calculated from studies carried out in 12 out of 48 Sub-Saharan African countries. Therefore, more studies involving several countries are required to determine fully the epidemiology of noroviruses and their contribution to childhood diarrhoea in Sub-Saharan Africa. Samuel Munalula Munjita Copyright © 2015 Samuel Munalula Munjita. All rights reserved. Child Health in the Peruvian Amazon: Prevalence and Factors Associated with Referred Morbidity and Health Care Access in the City of Iñapari Tue, 10 Nov 2015 12:52:25 +0000 Introduction. Children under 5 years of age are more susceptible to developing morbidities such as diarrhea, respiratory infections, anemia, and malnutrition. The objective of the study is to evaluate the prevalence of reported morbidities in this age group in the city of Iñapari (Peru) and the access to health services in this municipality. Methods. Data collection using interviews that assessed socioeconomic and demographic conditions, child morbidity, and access to health services was performed in 2011. Statistical analysis was performed using SPSS 13.0. Results. Regarding morbidities that occurred during lifetime, 39.8% reported previous anemia and intestinal parasite infection. About 53.7% of the children reported any type of morbidities in the last 15 days before interview, being most frequent respiratory symptoms (38.9%), diarrhea (23,4%), and fever (23,1%). Only 63.1% of those reporting recent morbidities sought health care. These morbidities were associated with precarious sanitation and lack of infrastructure, the presence of other comorbidities, and poor access to health services. Conclusion. The main referred morbidities in Amazonian Peruvian children were diarrhea, respiratory symptoms, anemia, and vomiting. Incentives and improvements in the health and sanitation conditions would be important measures to improve the quality of life of the Amazonian child population. Maria Gabriela Silva Guimarães, Athos Muniz Braña, Humberto Oliart-Guzmán, Fernando Luiz Cunha Castelo Branco, Breno Matos Delfino, Thasciany Moraes Pereira, Saulo Augusto Silva Mantovani, Antonio Camargo Martins, Ana Paula Santos, José Alcântara Filgueira-Júnior, Alanderson Alves Ramalho, Andreia da Silva Guimarães, Cristieli Sérgio de Menezes Oliveira, Thiago Santos de Araújo, Carlos Hermógenes Manrique de Lara Estrada, Nancy Arróspide, and Mônica da Silva-Nunes Copyright © 2015 Maria Gabriela Silva Guimarães et al. All rights reserved. Association between Severe Dehydration in Rotavirus Diarrhea and Exclusive Breastfeeding among Infants at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia Tue, 03 Nov 2015 06:23:50 +0000 Background. Rotavirus is the leading cause of severe acute diarrhea in children. Infants who are exclusively breastfed develop fewer infections and have less severe illnesses. This study aimed to determine association between severe dehydration in rotavirus diarrhea and exclusive breastfeeding. Methods. This is a cross-sectional study in infants ≤ 6 months old with acute diarrhea in Dr. Hasan Sadikin Hospital, Bandung, Indonesia. Results. From 134 infants ≤ 6 months old with acute diarrhea enrolled from April 2009 to December 2012, there were 88 (65.6%) boys and 46 (34.4%) girls in this study. Rotavirus was detected in 60 (44.8 %), 32 (53.3%) of whom were exclusively breastfed. From rotavirus positive subjects, severe dehydration occurred in 4 (12.6%) exclusively breastfed infants and 6 (21.5%) not exclusively breastfed infants. No significant association was found between severe dehydration and exclusive breastfeeding (p = 0.491) in rotavirus diarrhea. Conclusions. In rotavirus diarrhea, there was no significant association between exclusive breastfeeding and severe dehydration. Dwi Prasetyo, Iesje Martiza Sabaroedin, Yudith Setiati Ermaya, and Yati Soenarto Copyright © 2015 Dwi Prasetyo et al. All rights reserved. Knowledge, Attitude, and Practice of Health Workers in a Tertiary Hospital in Ile-Ife, Nigeria, towards Ebola Viral Disease Tue, 20 Oct 2015 13:49:24 +0000 Background. Health workers are more prone to Ebola viral disease (EVD) than the general population. This study assessed the preparedness of health workers in the control and management of EVD. Methods. A descriptive cross-sectional study. Consenting 400 health workers completed a semistructured questionnaire that assessed participants’ general knowledge, emergency preparedness, and control and management of EVD. Data were analysed using descriptive and inferential statistics. Results. The mean age (SD) was 34.5 ± 8.62 years ranging from 20 to 59 years. Most participants were medical doctors (24.6%) and nurses (52.2%). The majority had practised <10 years (73.8%) and were aware of the EVD outbreak in the West African subregion (85.5%). Colleagues (40%) and radio (37.2%) were their major sources of information. Only 42% had good knowledge while 27% knew that there was no vaccine presently to prevent EVD. About one-quarter (24.2%) had low risk perception. The majority (89%) felt the hospital infection control policy was inadequate to protect against EVD. The only predictor of good knowledge was participants’ occupation. Conclusion. There is knowledge gap and poor infection control preparedness among respondents. Thus, knowledge and practices of health workers towards EVD need improvement. Samuel Anu Olowookere, Emmanuel Akintunde Abioye-Kuteyi, Olusegun Kayode Adepoju, Oluwaseun Taiwo Esan, Temitope Michael Adeolu, Tolulope Kola Adeoye, Adesola Adebayo Adepoju, and Adedayo Titilayo Aderogba Copyright © 2015 Samuel Anu Olowookere et al. All rights reserved. Antibiotic Resistance in Streptococcus pneumoniae after Azithromycin Distribution for Trachoma Sun, 18 Oct 2015 17:20:28 +0000 Trachoma is caused by Chlamydia trachomatis and is a leading cause of blindness worldwide. Mass distribution of azithromycin (AZM) is part of the strategy for the global elimination of blinding trachoma by 2020. Although resistance to AZM in C. trachomatis has not been reported, there have been concerns about resistance in other organisms when AZM is administered in community settings. We identified studies that measured pneumococcal prevalence and resistance to AZM following mass AZM provision reported up to 2013 in Medline and Web of Science databases. Potential sources of bias were assessed using the Cochrane Risk of Bias Tool. A total of 45 records were screened, of which 8 met the inclusion criteria. We identified two distinct trends of resistance prevalence, which are dependent on frequency of AZM provision and baseline prevalence of resistance. We also demonstrated strong correlation between the prevalence of resistance at baseline and at 2-3 months (). Although resistance to AZM in C. trachomatis has not been reported, resistance to this commonly used macrolide antibiotic in other diseases could compromise treatment. This should be considered when planning long-term trachoma control strategies. Derek K-H. Ho, Christian Sawicki, and Nicholas Grassly Copyright © 2015 Derek K-H. Ho et al. All rights reserved. Mycological Pattern of Dermatomycoses in a Tertiary Care Hospital Wed, 30 Sep 2015 13:14:54 +0000 Background. Dermatomycoses are not diseases requiring compulsory notifications; rather they cause cosmetic defacements. Indian subcontinent with a varied topography is favorable for various fungal infections. Objective. To look for the epidemiological and mycological profile of superficial mycoses in North India. Methods. Three hundred and fifty-one clinical samples of skin, hair, and nail were examined to find the fungal etiology of the dermatomycoses. Results. Dermatomycoses were seen in 215/351 (61.2%) of cases. Most common isolates obtained were nondermatophyte molds (NDMs) (36.1%), followed by dermatophytes (13.8%) and yeasts (8.6%). Aspergillus niger (9%) was the most common mold. Trichophyton rubrum (4.6%) was the most common dermatophyte isolated, while amongst the yeasts Non-albicans Candida (NAC) species were more common (6%). Many other NDMs like Syncephalastrum spp., Cunninghamella spp., Rhodotorula spp., A. terreus, Scytalidium spp. and Scopulariopsis spp. were also isolated. Conclusion. Our study reflects an increasing role of NDMs (thought to be normal laboratory or environmental contaminants) as a causative agent of dermatomycoses, replacing the dermatophytes. Clinician’s awareness of the demographic profile of the population involved along with more studies on dermatomycoses can help in understanding the etiological profile in area, leading to prevention of disease occurrence and cosmetic disfigurement. Ravinder Kaur, Pragyan Swagatika Panda, Kabir Sardana, and Sahanawaj Khan Copyright © 2015 Ravinder Kaur et al. All rights reserved. Clinical Presentation, Aetiology, and Outcomes of Meningitis in a Setting of High HIV and TB Prevalence Wed, 30 Sep 2015 09:26:18 +0000 Meningitis causes significant morbidity and mortality globally. The aim of this study was to study the clinical presentation, aetiology, and outcomes of meningitis among adult patients admitted to Queen Mamohato Memorial Hospital in Maseru, Lesotho, with a diagnosis of meningitis. A cross-sectional study was conducted between February and April 2014; data collected included presenting signs and symptoms, laboratory results, and clinical outcomes. Descriptive statistics were used to summarise data; association between variables was analysed using Fisher’s exact test. 56 patients were enrolled; the HIV coinfection rate was 79%. The most common presenting symptoms were altered mental status, neck stiffness, headache, and fever. TB meningitis was the most frequent diagnosis (39%), followed by bacterial (27%), viral (18%), and cryptococcal meningitis (16%). In-hospital mortality was 43% with case fatalities of 23%, 40%, 44%, and 90% for TB, bacterial, cryptococcal, and viral meningitis, respectively. Severe renal impairment was significantly associated with mortality. In conclusion, the causes of meningitis in this study reflect the high prevalence of HIV and TB in our setting. Strategies to reduce morbidity and mortality due to meningitis should include improving diagnostic services to facilitate early detection and treatment of meningitis and timely initiation of antiretroviral therapy in HIV-infected patients. Keneuoe Hycianth Thinyane, Keanole Mofona Motsemme, and Varsay Jim Lahai Cooper Copyright © 2015 Keneuoe Hycianth Thinyane et al. All rights reserved. Amodiaquine and Ciprofloxacin Combination in Plasmodiasis Therapy Tue, 29 Sep 2015 13:28:18 +0000 Objective. The study was designed to determine the efficacy of combined Amodiaquine and Ciprofloxacin in plasmodiasis therapy. Method. The in vivo antiplasmodial effect of different dosage levels of Amodiaquine, Ciprofloxacin, and their combinations against Plasmodium berghei berghei was evaluated using Swiss albino mice. Results. Amodiaquine (a known antiplasmodial agent) had a fairly significant antiplasmodial effect reducing the parasites for every 100 red blood cells (RBC) from 66 to 16 (75.75%) at the tolerable dosage level of 7.5 mg/kg body weight while Ciprofloxacin (an antibiotic known to have antimalarial effect) showed an insignificant antiplasmodial effect reducing the parasites for every 100 RBC from 65 to 64 (1.53%) at the tolerable dosage level of 10.7 mg/kg body weight. Conversely, the combination therapy of Amodiaquine and Ciprofloxacin had a significant antiplasmodial effect at all the doses administered. The combination of 7.5 mg/kg of Amodiaquine and 12.8 mg/kg of Ciprofloxacin, however, showed the most significant antiplasmodial effect of the doses used reducing the number of parasites per 100 RBC from 60 to 10 (83.33%). Conclusions. Appropriate Amodiaquine and Ciprofloxacin combination will be effective for the treatment of malaria and better than either Amodiaquine or Ciprofloxacin singly at their recommended dosage levels. Peace Mayen Edwin Ubulom, Chinweizu Ejikeme Udobi, and Mark Iheukwumere Madu Copyright © 2015 Peace Mayen Edwin Ubulom et al. All rights reserved. Prevalence of Intestinal Protozoa among Saudi Patients with Chronic Renal Failure: A Case-Control Study Mon, 28 Sep 2015 08:10:07 +0000 It has been hypothesized that chronic renal failure (CRF) predisposes patients to infection with intestinal protozoa. We tested this hypothesis with a matched case-control study to determine the prevalence of these protozoa and their diarrhea associated symptoms among 50 patients with CRF (cases) from Taif, western Saudi Arabia. Fifty diarrheal patients without CRF were recruited in the study as controls. Participants were interviewed by a structured questionnaire and stool samples were collected. Samples were thoroughly examined with microscopy and three coproantigens detection kits. Enteric protozoa were detected in 21 cases and 14 controls. Blastocystis spp. were the most predominant parasite (16% in cases versus 8% in controls), followed by Giardia duodenalis (10% in cases versus 12% in controls) and Cryptosporidium spp. (10% in cases versus 6% in controls). Cyclospora cayetanensis was identified in two cases, while Entamoeba histolytica was described in one case and one control. Intestinal parasitism was positively associated with the male gender, urban residence, and travel history. Clinical symptoms of nausea/vomiting and abdominal pain were significantly varied between the parasitized cases and controls (P value 0.05). Given the results, we recommend screening all diarrheal feces for intestinal protozoa in the study’s population, particularly those with CRF. Yousry A. Hawash, Laila Sh. Dorgham, El-Amir M. Amir, and Osama F. Sharaf Copyright © 2015 Yousry A. Hawash et al. All rights reserved. Newer Classification System for Fissured Tongue: An Epidemiological Approach Sun, 20 Sep 2015 12:37:09 +0000 Introduction. Fissured tongue is a commonly encountered tongue disorder in dental practice. But there is a lack of data on different pattern, severity, and association of fissuring with various systemic disorders and other tongue anomalies. This study attempts to establish a classification system for fissured tongue and to know the correlation with the systemic health and other disorders of the tongue. Materials and Methods. A total of 1000 subjects between the age groups of 10 and 80 years were included in the study. Pattern of fissuring, allied systemic diseases, and related tongue anomalies were tabulated. Results. Out of 1000 subjects, 387 subjects presented with fissured tongue. Out of 387 subjects, hypertension was present in 57 cases, 18 subjects had diabetes, and 3 subjects had both hypertension and diabetes. Central longitudinal type was found to be the most common type of tongue fissuring. Conclusion. Fissured tongue has been found to be associated with certain systemic disease and further researches are required to know positive correlation. If a correlation exists, such disorders could be diagnosed earlier by identifying fissured tongue at an earlier age. Ramachandran Sudarshan, G. Sree Vijayabala, Y. Samata, and A. Ravikiran Copyright © 2015 Ramachandran Sudarshan et al. All rights reserved. Cytokine Profiles and Cell Proliferation Responses to Truncated ORF2 Protein in Iranian Patients Recovered from Hepatitis E Infection Tue, 15 Sep 2015 14:09:58 +0000 Background. The aim of this study was to evaluate hepatitis E virus (HEV) specific cellular immune responses to truncated ORF2 protein in Iranian patients recovered from HEV infection. Information about HEV-specific immune responses could be useful in finding an effective way for development of HEV vaccine. Methods. A truncated form of HEV ORF2 protein containing amino acids 112-608 was used to stimulate peripheral blood mononuclear cells (PBMCs) separated from HEV-recovered and control groups. Finally, the levels of four cytokines, IFN-γ ELISPOT, and cell proliferative responses following stimulation with the truncated ORF2 protein were assessed in the both groups. Results. The truncated ORF2 protein was able to induce IFN-γ ELISPOT and cell proliferation responses and to produce significant amounts of IFN-γ and IL-12 cytokines, but low amounts of IL-10 and IL-4 cytokines in vitro. These responses were significantly higher in the recovered group compared to the control group. These results indicate the antigenic nature of the truncated ORF2 protein and production of T helper type 1 cytokines. Conclusion. The truncated ORF2 protein can effectively induce significant cellular immune responsesand can be introduced as a potential vaccine candidate. However, further studies are required to evaluate this protein in vivo. Reza Taherkhani, Fatemeh Farshadpour, Manoochehr Makvandi, Hamid Rajabi Memari, Ali Reza Samarbafzadeh, Nasrin Sharifi, Behrouz Naeimi, Saeed Tajbakhsh, and Samad Akbarzadeh Copyright © 2015 Reza Taherkhani et al. All rights reserved. Short-Course Induction Treatment with Intrathecal Amphotericin B Lipid Emulsion for HIV Infected Patients with Cryptococcal Meningitis Thu, 10 Sep 2015 08:57:08 +0000 Cryptococcal meningitis (CM) is a common cause of death among HIV infected patients in developing countries, especially in sub-Saharan Africa. In this observational HIV cohort study in a resource-limited setting in India, we compared the standard two-week intravenous amphotericin B deoxycholate (AmBd) (Regimen I) with one week of intravenous AmBd along with daily therapeutic lumbar punctures and intrathecal AmB lipid emulsion (Regimen II) during the intensive phase of CM treatment. 78 patients received Regimen I and 45 patients received Regimen II. After adjustment for baseline characteristics (gender, age, altered mental status or seizures at presentation, CD4 cell count, white blood cells, cerebrospinal fluid white cells, and haemoglobin), the use of Regimen II was associated with a significant relative risk reduction in mortality (adjusted hazard ratio 0.4, 95% confidence interval, 0.22–0.76) and 26.7% absolute risk reduction (95% confidence interval, 9.9–43.5) at 12 weeks. The use of Regimen II resulted in lower costs of drugs and hospital admission days. Since the study is observational in nature, we should be cautious about our results. However, the good tolerability of intrathecal administration of AmB lipid emulsion and the clinically important mortality reduction observed with the short-course induction treatment warrant further research, ideally through a randomized clinical trial. Gerardo Alvarez-Uria, Manoranjan Midde, Raghavakalyan Pakam, Pradeep Sukumar Yalla, Praveen Kumar Naik, and Raghuprakash Reddy Copyright © 2015 Gerardo Alvarez-Uria et al. All rights reserved. Prevalence and Pattern of Soil-Transmitted Helminthic Infection among Primary School Children in a Rural Community in Imo State, Nigeria Mon, 07 Sep 2015 12:17:31 +0000 Background. Soil-transmitted helminthic infection is a common public health challenge of primary school children in resource challenged and developing countries. Our aim was to determine the prevalence and pattern of soil-transmitted helminthic infection among primary school children in a rural community in Imo State, Nigeria. Method. The study involved a cross-sectional survey of 284 primary school children in a rural community. Results. The overall prevalence of soil-transmitted helminthic infection (STHI) was 30.3%. Of all STHIs, hookworm was the commonest geohelminth observed, 81 (94.2%). The prevalence of soil-transmitted helminthic infection was more in males, 58 (38.4%), than in females, 28 (21.1%). This difference was statistically significant (). Conclusion. The high prevalence rate of soil-transmitted helminthic infection amongst the study population is worrisome. There is need for organized and routine deworming among school children in the community. Kelechi Kenneth Odinaka, Emeka Charles Nwolisa, Francis Mbanefo, Alfreda Chinekwu Iheakaram, and Seline Okolo Copyright © 2015 Kelechi Kenneth Odinaka et al. All rights reserved. Clinicoradiological Profile of Lower Lung Field Tuberculosis Cases among Young Adult and Elderly People in a Teaching Hospital of Madhya Pradesh, India Tue, 25 Aug 2015 14:16:50 +0000 Aim. To study the clinical and radiological features of lower lung field tuberculosis (LLFTB) in relation to the patients of nonlower lung field tuberculosis (non-LLFTB). Material and Methods. All the patients of lower lung field tuberculosis defined by the lesions below an arbitrary line across the hila in their chest X-rays were included in the study. Their sputum for acid fast bacilli, HIV, blood sugar, and other relevant investigations were performed. Results. The total of 2136 cases of pulmonary tuberculosis was studied. Among them 215 (10%) cases of patients were diagnosed as the case of lower lung field tuberculosis. Females (62%) were more commonly affected. Most common clinical feature in non-LLFTB was cough (69%) followed by fever (65%), chest pain (54.7%), and weight loss (54.4%). Chest X-ray showed predominance of right side (60.9%) in cases of LLFTB. The relative risk of having the LLFTB in diabetes patients, HIV seropositive patients, end stage renal disease patients, and patients on corticosteroid therapy was high. Conclusion. Lower lung field tuberculosis is not an uncommon entity. It is more common in diabetes, HIV positive, end stage renal disease, and corticosteroid treated patients. Clinical and radiological features are different from upper lobe tuberculosis patients. Saurabh Kumar Singh and Kamlesh Kumar Tiwari Copyright © 2015 Saurabh Kumar Singh and Kamlesh Kumar Tiwari. All rights reserved. Protective Effect of Aqueous Crude Extract of Neem (Azadirachta indica) Leaves on Plasmodium berghei-Induced Renal Damage in Mice Tue, 25 Aug 2015 10:14:04 +0000 Malaria is a major public health problem in the world because it can cause of death in patients. Malaria-associated renal injury is associated with 45% of mortality in adult patients hospitalized with severe form of the disease. Therefore, new plant extracts to protect against renal injury induced by malaria infection are urgently needed. In this study, we investigated the protective effect of aqueous crude extract of Azadirachta indica (neem) leaves on renal injury induced by Plasmodium berghei ANKA infection in mice. ICR mice were injected intraperitoneally with 1 × 107 parasitized erythrocytes of PbANKA, and neem extracts (500, 1,000, and 2,000 mg/kg) were given orally for 4 consecutive days. Plasma blood urea nitrogen (BUN) and creatinine levels were subsequently measured. Malaria-induced renal injury was evidenced as marked increases of BUN and creatinine levels. However, the oral administration of neem leaf extract to PbANKA infected mice for 4 days brought back BUN and creatinine levels to near normalcy, and the highest activity was observed at doses of 1,000 and 2,000 mg/kg. Additionally, no toxic effects were found in normal mice treated with this extract. Hence, neem leaf extract can be considered a potential candidate for protection against renal injury induced by malaria. Voravuth Somsak, Sukanya Chachiyo, Ubonwan Jaihan, and Somrudee Nakinchat Copyright © 2015 Voravuth Somsak et al. All rights reserved. Determinants of Adherence with Malaria Chemoprophylactic Drugs Used in a Traveler’s Health Clinic Mon, 24 Aug 2015 12:24:32 +0000 Background. The WHO recommends mefloquine, atovaquone/proguanil, and doxycycline for malaria chemoprophylaxis. Adherence to a drug is determined by many factors. Objective. To detect the determinants of travelers’ adherence to malaria chemoprophylaxis. Methods. A prospective comparative study was conducted from January 2012 to July 2013 that included travelers (928 travelers) to malaria endemic countries who visited the THC. They were classified into 3 groups: the 1st is the mefloquine group (396 travelers), the 2nd is the doxycycline group (370 travelers), and finally those who did not receive any drugs (162 travelers). The participants from the 1st and 2nd groups enrolled in the study. Results. Univariate and multivariate analyses were performed. The predictors for adherence in the mefloquine group were travel to an African destination [OR = 51 (6.8–2385)], higher than a secondary school education [OR = 21 (4.1–144.2)], organized travel [OR = 4 (2.1–6.5)], traveling for leisure [OR = 2.1 (1.1–0.4)], and nationality [OR = 2 (1.11–4.00)]. In the doxycycline group, the predictors included higher than a secondary education [OR = 20.1 (4.5–125.1)], organized travel [OR = 11.4 (5.5–20.9)], travel for leisure [OR = 7 (2.3–22.9)], travel to an African destination [OR = 6.1 (0.41–417)], and nationality [OR = 4.5 (2.3–9.5)]. Conclusion. Adherence with malaria chemoprophylaxis could be affected by many factors such as nationality, education, and organized travel. Ibrahim Shady Copyright © 2015 Ibrahim Shady. All rights reserved. Voluntary Counseling and Testing for HIV in Rural Area of Democratic Republic of the Congo: Knowledge, Attitude, and Practice Survey among Service Users Sun, 09 Aug 2015 09:44:42 +0000 Aims. To determine the prevalence of HIV, the level of sexual risk for HIV, and determinants of VCT attendance among adult population living in a rural area. Methods. A cross-sectional study was conducted in Mbanza-Ngungu, Democratic Republic of the Congo. An anonymous questionnaire was designed to extract relevant data. Results. In our cohort, 69% were respondents of more than 24 years of age and the single marital status was most represented (64.1%). A high proportion of respondents (90.6%) visited VCT service for requiring information (good acceptability). Positive test for HIV was reported in 9.4% of respondents. In this cohort, 49.6% of respondents had declared themselves to never use condom. In binary analysis, there was association between positive HIV test and age () and religions (). In this cohort, it was observed that positive HIV test was significantly associated with confidentiality (). However, there was no association between positive HIV test and condom use (), knowledge of VCT (), service requested (), and previous HIV test (). Conclusions. Preventive information for AIDS should be recommended in the population living in rural zone. Mida Kautako-Kiambi, Mathilde B. Ekila, Smith Kama-Lemba, Roger Wumba, and Michel N. Aloni Copyright © 2015 Mida Kautako-Kiambi et al. All rights reserved. End Stage Renal Disease: Seroprevalence of Hepatitises B and C along with Associated Aetiology and Risk Factors in Children Wed, 05 Aug 2015 13:00:00 +0000 Background. End Stage Renal Disease (ESRD) normally requires dialysis or transplantation for survival. Since ESRD patients are on long term dialysis, infections such as Hepatitis B (HBV) and Hepatitis C (HCV) are commonly reported. Methods. This was a retrospective study carried out at a government hospital during a 12-month period from January 2013 to December 2013. The data was collected using a predesigned pro forma to note the etiology, gender, age, and HBsAg and anti-HCV test result of each patient. Results. 444 children suffering from ESRD were included in our analysis. The mean age of sample was 12.7 ± 4.1 years. Sixty percent () of the children were boys. The most common etiology of ESRD was kidney stones (, 29.3%). HBV was positive in 11 children (2.5%) while HCV was positive in 13 (2.9%). Conclusion. This study asserts the need for carrying out further work to confirm these findings and expand our recommendations. It is imperative to reliably determine the burden of HBV and HCV disease and to determine the aetiology of their spread especially in children with ESRD. Syed Raza Shah, Muhammad Shahzeb Khan, Muhammad Tanveer Alam, Adnan Salim, Mehwish Hussain, and Areeba Altaf Copyright © 2015 Syed Raza Shah et al. All rights reserved. Physiological Age Structure and Leishmania spp. Detection in Phlebotomus (Larroussius) orientalis (Parrot, 1936) (Diptera: Psychodidae) at an Endemic Focus of Visceral Leishmaniasis in Northern Ethiopia Wed, 29 Jul 2015 09:51:48 +0000 Visceral leishmaniasis (VL) caused by Leishmania donovani is endemic in northern Ethiopia, where P. orientalis is the most important presumed vector. This study was designed to determine the physiological age structure and the occurrence of Leishmania infection in the vector of VL in Tahtay Adiyabo district, northern Ethiopia. Sand flies were collected using CDC light traps from peridomestic and agricultural fields between May 2011 and April 2012 and P. orientalis females were dissected for age determination and detection of Leishmania promastigotes. Sand flies were also analyzed for L. donovani detection using molecular methods. Of 1,282 P. orientalis examined for abdominal stages and age characterization, 66.2%, 28.2%, 4.1%, and 1.6% were unfed, freshly fed, half-gravid, and gravid. Parous rate in unfed females was 34.1% and 35.4% in peridomestic and agricultural fields, respectively. Out of 921 P. orientalis females dissected, one specimen (0.1%) was found naturally infected with promastigotes. Five pools (25 females) of unfed P. orientalis were also found with DNA of Leishmania spp. In particular, a single P. orientalis was positive for L. donovani (0.5%). Based on this and other evidences (abundance, human blood feeding, and xenodiagnostic studies), P. orientalis is the principal vector of VL in this endemic focus. Araya Gebresilassie, Ibrahim Abbasi, Oscar David Kirstein, Essayas Aklilu, Solomon Yared, Habte Tekie, Meshesha Balkew, Alon Warburg, Asrat Hailu, and Teshome Gebre-Michael Copyright © 2015 Araya Gebresilassie et al. All rights reserved. Perceptions about Eclampsia, Birth Preparedness, and Complications Readiness among Antenatal Clients Attending a Specialist Hospital in Kano, Nigeria Tue, 14 Jul 2015 11:10:10 +0000 Background. Eclampsia is a reliable indicator of poor birth preparedness and complications readiness. We determined perceptions about eclampsia, birth preparedness, and complications readiness among antenatal clients in Kano, Nigeria. Materials and Method. A cross-sectional design was used to study 250 randomly selected antenatal clients. Data was analyzed using SPSS 16.0. Result. The mean age of the respondents was 26.1 ± 6.4 years. The majority perceived that eclampsia is preventable through good ANC (76.4%) and hospital delivery (70.8%). Overall, 66.8% had good perception about eclampsia. Having at least secondary school education and multigravidity were associated with good perception about eclampsia on multivariate analysis. About a third (39.6%) of the mothers was less prepared. On binary logistic regression, good perception about eclampsia and multigravidity were associated with being very prepared for birth. Up to 37.6% were not ready for complications. Half (50.4%) knew at least three danger signs of pregnancy, and 30.0% donated blood or identified suitable blood donor. On multivariate analysis, having at least secondary school education, being very prepared for birth, and multigravidity emerged as the only predictors of the respondents’ readiness for complications. Conclusion and Recommendations. Health workers should emphasize the practicability of birth preparedness and complications readiness during ANC and in the communities, routinely review plans, and support clients meet-up challenging areas. The importance of girl-child education to at least secondary school should be buttressed. Umar Muhammad Lawan, Idris Usman Takai, and Hamza Ishaq Copyright © 2015 Umar Muhammad Lawan et al. All rights reserved. Adherence to Artemisinin-Based Combination Therapy for the Treatment of Uncomplicated Malaria: A Systematic Review and Meta-Analysis Thu, 28 May 2015 13:47:37 +0000 Adherence to artemisinin-based combination therapy (ACT) is not clearly defined. This meta-analysis determines the prevalence and predictors of adherence to ACT. Twenty-five studies and six substudies met the inclusion criteria. The prevalence of ACT adherence in the public sector was significantly higher compared to retail sector (76% and 45%, resp., ). However, ACT adherence was similar across different ACT dosing regimens and formulations. In metaregression analysis prevalence estimates of adherence significantly decrease with increasing year of study publication . Factors found to be significant predictors of ACT adherence were years of education ≥ 7 odds ratio (OR) (95% CI) = 1.63 (1.05–2.53), higher income 2.0 (1.35–2.98), fatty food 4.6 (2.49–8.50), exact number of pills dispensed 4.09 (1.60–10.7), and belief in traditional medication for malaria 0.09 (0.01–0.78). The accuracy of pooled estimates could be limited by publication bias, and differing methods and thresholds of assessing adherence. To improve ACT adherence, educational programs to increase awareness and understanding of ACT dosing regimen are interventions urgently needed. Patients and caregivers should be provided with an adequate explanation at the time of prescribing and/or dispensing ACT. Ahmad M. Yakasai, Muhammad Hamza, Mahmood M. Dalhat, Musa Bello, Muktar A. Gadanya, Zuwaira M. Yaqub, Daiyabu A. Ibrahim, and Fatimah Hassan-Hanga Copyright © 2015 Ahmad M. Yakasai et al. All rights reserved. A Prospective Study of Tuberculosis Drug Susceptibility in Sabah, Malaysia, and an Algorithm for Management of Isoniazid Resistance Mon, 09 Mar 2015 09:27:27 +0000 Introduction. The burden of tuberculosis is high in eastern Malaysia, and rates of Mycobacterium tuberculosis drug resistance are poorly defined. Our objectives were to determine M. tuberculosis susceptibility and document management after receipt of susceptibility results. Methods. Prospective study of adult outpatients with smear-positive pulmonary tuberculosis (PTB) in Sabah, Malaysia. Additionally, hospital clinicians accessed the reference laboratory for clinical purposes during the study. Results. 176 outpatients were enrolled; 173 provided sputum samples. Mycobacterial culture yielded M. tuberculosis in 159 (91.9%) and nontuberculous Mycobacterium (NTM) in three (1.7%). Among outpatients there were no instances of multidrug resistant M. tuberculosis (MDR-TB). Seven people (4.5%) had isoniazid resistance (INH-R); all were switched to an appropriate second-line regimen for varying durations (4.5–9 months). Median delay to commencement of the second-line regimen was 13 weeks. Among 15 inpatients with suspected TB, 2 had multidrug resistant TB (one extensively drug resistant), 2 had INH-R, and 4 had NTM. Conclusions. Current community rates of MDR-TB in Sabah are low. However, INH-resistance poses challenges, and NTM is an important differential diagnosis in this setting, where smear microscopy is the usual diagnostic modality. To address INH-R management issues in our setting, we propose an algorithm for the treatment of isoniazid-resistant PTB. Muhammad Redzwan S. Rashid Ali, Uma Parameswaran, Timothy William, Elspeth Bird, Christopher S. Wilkes, Wai Khew Lee, Tsin Wen Yeo, Nicholas M. Anstey, and Anna P. Ralph Copyright © 2015 Muhammad Redzwan S. Rashid Ali et al. All rights reserved. Health-Seeking Behaviors and Self-Care Practices of People with Filarial Lymphoedema in Nepal: A Qualitative Study Wed, 28 Jan 2015 17:33:46 +0000 Background. Lymphatic filariasis is endemic in Nepal. This study aimed to investigate health-seeking behaviors and self-care practices of people with filarial Lymphoedema in Nepal. Methods. A cross-sectional study was conducted using qualitative methods in three endemic districts. Twenty-three patients with current Lymphoedema were recruited in the study. Results. Hydrocele was found to be a well-known condition and a major health problem in the studied communities. People with Lymphoedema primarily sought health care from traditional healers, whereas sometimes home-based care was their first treatment. Later Ayurvedic and allopathic hospital-based care were sought. Respondents reported various psychological problems such as difficulty in engaging in sexual intercourse, anxiety, worry and stress, depression, low self-esteem, feeling weak, fear of being abandoned, and fear of transmitting disease to the children. Standard foot care practices except washing were largely absent. Conclusions. Lymphoedema in the limbs and hydrocele were found to be major health problems. The traditional health care providers were the first contact of care for the majority of respondents. Only a few patients had been practicing standard foot care practices. Ram Kumar Adhikari, Jeevan Bahadur Sherchand, Shiva Raj Mishra, Kamal Ranabhat, Amrit Pokharel, Pramila Devkota, Durga Mishra, Yadu Chandra Ghimire, Khageshwor Gelal, Rajan Paudel, and Rajendra Raj Wagle Copyright © 2015 Ram Kumar Adhikari et al. All rights reserved. Patterns of Brucellosis Infection Symptoms in Azerbaijan: A Latent Class Cluster Analysis Sun, 14 Dec 2014 09:11:49 +0000 Brucellosis infection is a multisystem disease, with a broad spectrum of symptoms. We investigated the existence of clusters of infected patients according to their clinical presentation. Using national surveillance data from the Electronic-Integrated Disease Surveillance System, we applied a latent class cluster (LCC) analysis on symptoms to determine clusters of brucellosis cases. A total of 454 cases reported between July 2011 and July 2013 were analyzed. LCC identified a two-cluster model and the Vuong-Lo-Mendell-Rubin likelihood ratio supported the cluster model. Brucellosis cases in the second cluster (19%) reported higher percentages of poly-lymphadenopathy, hepatomegaly, arthritis, myositis, and neuritis and changes in liver function tests compared to cases of the first cluster. Patients in the second cluster had a severe brucellosis disease course and were associated with longer delay in seeking medical attention. Moreover, most of them were from Beylagan, a region focused on sheep and goat livestock production in south-central Azerbaijan. Patients in cluster 2 accounted for one-quarter of brucellosis cases and had a more severe clinical presentation. Delay in seeking medical care may explain severe illness. Future work needs to determine the factors that influence brucellosis case seeking and identify brucellosis species, particularly among cases from Beylagan. Rita Ismayilova, Emilya Nasirova, Colleen Hanou, Robert G. Rivard, and Christian T. Bautista Copyright © 2014 Rita Ismayilova et al. All rights reserved. Elevated Dengue Virus Nonstructural Protein 1 Serum Levels and Altered Toll-Like Receptor 4 Expression, Nitric Oxide, and Tumor Necrosis Factor Alpha Production in Dengue Hemorrhagic Fever Patients Thu, 11 Dec 2014 09:02:03 +0000 Background. During dengue virus (DV) infection, monocytes produce tumor necrosis factor alpha (TNF-α) and nitric oxide (NO) which might be critical to immunopathogenesis. Since intensity of DV replication may determine clinical outcomes, it is important to know the effects of viral nonstructural protein 1 (NS1) on innate immune parameters of infected patients. The present study investigates the relationships between dengue virus nonstructural protein 1 (NS1) serum levels and innate immune response (TLR4 expression and TNF-α/NO production) of DV infected patients presenting different clinical outcomes. Methodology/Principal Findings. We evaluated NO, NS1 serum levels (ELISA), TNF-α production by peripheral blood mononuclear cells (PBMCs), and TLR4 expression on CD14+ cells from 37 dengue patients and 20 healthy controls. Early in infection, increased expression of TLR4 in monocytes of patients with dengue fever (DF) was detected compared to patients with dengue hemorrhagic fever (DHF). Moreover, PBMCs of DHF patients showed higher NS1 and lower NO serum levels during the acute febrile phase and a reduced response to TLR4 stimulation by LPS (with a reduced TNF-α production) when compared to DF patients. Conclusions/Significance. During DV infection in humans, some innate immune parameters change, depending on the NS1 serum levels, and phase and severity of the disease which may contribute to development of different clinical outcomes. Denise Maciel Carvalho, Fernanda Gonçalves Garcia, Ana Paula Sarreta Terra, Ana Cristina Lopes Tosta, Luciana de Almeida Silva, Lúcio Roberto Castellano, and David Nascimento Silva Teixeira Copyright © 2014 Denise Maciel Carvalho et al. All rights reserved. Seroepidemiology of Toxoplasma gondii amongst Pregnant Women in Jazan Province, Saudi Arabia Thu, 13 Nov 2014 11:49:18 +0000 Background. Toxoplasma gondii (T. gondii) is an obligate intracellular protozoan parasite of worldwide distribution. There is limited information about the seroprevalence of toxoplasmosis in the southern area of Saudi Arabia. The current study was carried out to determine the prevalence of T. gondii in pregnant women in Jazan province. Materials and Methods. The study was conducted between January and June 2013 and included 195 pregnant women, data on sociodemographic and predisposing factors were collected from each participant. Venous blood samples were collected following standard operating procedures. Serological analysis for latent toxoplasmosis (levels of IgG) and active toxoplasmosis (IgM) was done using Enzyme Linked Immunosorbent Assay (ELISA). Results. The overall seroprevalence of T. gondii in the study area was 24.1%. The seroprevalence of anti-Toxoplasma IgG was 20% (39 out of 195), whereas IgM seropositivity was 6.2% (12 out of 195). Only 4 pregnant women tested positive for both IgG and IgM. The highest IgG and IgM seroprevalence was among the study participants aged 35 to 39 years (13.5% and 35.1%, resp.). The seropositivity rate of T. gondii-specific antibodies was higher among pregnant women from the urban areas than those from rural communities (7.4% versus 0% and 21% versus 15.4% for IgM and IgG, resp.). Conclusions. The seroprevalence of T. gondii was high in pregnant woman in Jazan. The prevalence of toxoplasmosis increases with increase of age. Awareness health education program in Jazan needs to be maintained and developed to targeted pregnant women. Hussein Aqeely, Eman K. El-Gayar, Darakhshan Perveen Khan, Abdullah Najmi, Ayesha Alvi, Ibrahim Bani, Mohamed Salih Mahfouz, Saif Elden Abdalla, and Ibrahim M. Elhassan Copyright © 2014 Hussein Aqeely et al. All rights reserved. Absolute Lymphocyte Count Is Not a Suitable Alternative to CD4 Count for Determining Initiation of Antiretroviral Therapy in Fiji Mon, 27 Oct 2014 00:00:00 +0000 Introduction. An absolute lymphocyte count is commonly used as an alternative to a CD4 count to determine initiation of antiretroviral therapy for HIV-infected individuals in Fiji when a CD4 count is unavailable. Methods. We conducted a retrospective analysis of laboratory results of HIV-infected individuals registered at all HIV clinics in Fiji. Results. Paired absolute lymphocyte and CD4 counts were available for 101 HIV-infected individuals, and 96% had a CD4 count of ≤500 cells/mm3. Correlation between the counts in individuals was poor (Spearman rank correlation ). No absolute lymphocyte count could be determined in this population as a suitable surrogate for a CD4 count of either 350 cells/mm3 or 500 cells/mm3. The currently used absolute lymphocyte count of ≤2300 cells/μL had a positive predictive value of 87% but a negative predictive value of only 17% for a CD4 of ≤350 cells/mm3 and if used as a surrogate for a CD4 of ≤500 cells/mm3 it would result in all HIV-infected individuals receiving ART including those not yet eligible. Weight, CD4 count, and absolute lymphocyte count increased significantly at 3 months following ART initiation. Conclusions. Our findings do not support the use of absolute lymphocyte count to determine antiretroviral therapy initiation in Fiji. Dashika A. Balak, Karen Bissell, Christine Roseveare, Sharan Ram, Rachel R. Devi, and Stephen M. Graham Copyright © 2014 Dashika A. Balak et al. All rights reserved.