Journal of Tropical Medicine The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . 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. A Descriptive Study of Nosocomial Infections in an Adult Intensive Care Unit in Fiji: 2011-12 Wed, 17 Sep 2014 08:42:01 +0000 Nosocomial infections in an intensive care unit (ICU) are common and associated with a high mortality but there are no published data from the Oceania region. A retrospective study in Fiji’s largest ICU (2011-12) reported that 114 of a total 663 adult ICU admissions had bacteriological culture-confirmed nosocomial infection. The commonest sites of infection were respiratory and bloodstream. Gram negative bacteria were the commonest pathogens isolated, especially Klebsiella pneumoniae (extended-spectrum β-Lactamase-producing), Acinetobacter, and Pseudomonas species. Mortality for those with a known outcome was 33%. Improved surveillance and implementation of effective preventive interventions are needed. Keshni Naidu, Ilisapeci Nabose, Sharan Ram, Kerri Viney, Stephen M. Graham, and Karen Bissell Copyright © 2014 Keshni Naidu et al. 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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.