http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2013 , Hindawi Publishing Corporation . All rights reserved. Thu, 18 Apr 2013 17:40:50 +0000 http://www.hindawi.com/journals/jtm/2013/493834/ Immunity against malaria develops slowly and only after repeated exposure to the parasite. Many of those that die of the disease are children under five years of age. Antibodies are an important part of immunity, but which antibodies that are protective and how these should be measured are still unclear. We discuss the pros and cons of ELISA, invasion inhibition assays/ADCI, and measurement of affinity of antibodies and what can be done to improve these assays, thereby increasing the knowledge about the immune status of an individual, and to perform better evaluation of vaccine trials. Sriwipa Chuangchaiya and Kristina E. M. Persson Copyright © 2013 Sriwipa Chuangchaiya and Kristina E. M. Persson. All rights reserved. Mon, 15 Apr 2013 17:35:18 +0000 http://www.hindawi.com/journals/jtm/2013/708391/ Post-kala-azar dermal leishmaniasis (PKDL) is a dermatosis that affects more than 50% of successfully treated visceral leishmaniasis (VL) patients in Sudan. PKDL is considered an important reservoir for the parasite and its treatment may help in the control of VL. Currently, treatment is mainly with sodium stibogluconate (SSG), an expensive and fairly toxic drug and without universally in treatment protocols used. A literature review, a consensus of a panel of experts, and unpublished data formed the basis for the development of guidelines for the treatment of PKDL in the Sudan. Six treatment modalities were evaluated. Experts were asked to justify their choices based on their experience regarding of drug safety, efficacy, availability, and cost. The consensus was defined by assigning a categorical rank (first line, second line, third line) to each option. Regarding the use of AmBisome the presence of the drug in the skin was confirmed in smears from PKDL lesions. Recommendations: AmBisome at 2.5 mg/kg/day/20 days or SSG at 20 mg/kg/day/40 days plus four/weekly intradermal injection of alum-precipitated autoclave L. major vaccine are suggested as first- and second-treatment options for PKDL in the Sudan, respectively. SSG at 20 mg/Kg/day/60 or more days can be used if other options are not available. A. M. Musa, E. A. G. Khalil, B. M. Younis, M. E. E. Elfaki, M. Y. Elamin, A. O. A. Adam, H. A. A. Mohamed, M. M. M. Dafalla, A. A. Abuzaid, and A. M. El-Hassan Copyright © 2013 A. M. Musa et al. All rights reserved. Mon, 15 Apr 2013 09:44:39 +0000 http://www.hindawi.com/journals/jtm/2013/538629/ Cutaneous leishmaniasis (CL) and mucocutaneous leishmaniasis (MCL) due to Leishmania (V.) braziliensis are endemic in Paraguay. We performed a series of knowledge, attitudes, and practice (KAP) surveys simultaneously with individuals in endemic communities in San Pedro department (), health professionals (), and patients (). Results showed that communities were exposed to high risk factors for transmission of L. braziliensis. In logistic regression analysis, age was the only factor independently associated with having seen a CL/MCL lesion (). The pervasive attitude in communities was that CL was not a problem. Treatment seeking was often delayed, partly due to secondary costs, and inappropriate remedies were applied. Several important cost-effective measures are indicated that may improve control of CL. Community awareness could be enhanced through existing community structures. Free supply of specific drugs should continue but ancillary support could be considered. Health professionals require routine and standardised provision of diagnosis and treatment algorithms for CL and MCL. During treatment, all patients could be given simple information to increase awareness in the community. Mónica Ruoti, Rolando Oddone, Nathalie Lampert, Elizabeth Orué, Michael A. Miles, Neal Alexander, Andrea M. Rehman, Rebecca Njord, Stephanie Shu, Susannah Brice, Bryony Sinclair, and Alison Krentel Copyright © 2013 Mónica Ruoti et al. All rights reserved. Wed, 10 Apr 2013 10:32:44 +0000 http://www.hindawi.com/journals/jtm/2013/596316/ A broad variety of factors have been associated with leprosy among contacts, including socioeconomic, epidemiological, and genetic characteristics. Data from 7,174 contacts of leprosy patients from a leprosy outpatient clinic in Rio de Janeiro, Brazil, 1987–2010, were analyzed to investigate the effects of kinship, individual, and contextual factors on leprosy. Multivariate analyses were performed using a robust estimation method. In the prevalence analysis, close kinship (sibling OR = 2.75, offspring OR = 2.00, and other relatives OR = 1.70), socioeconomic factors, and the duration of exposure to the bacillus were associated to leprosy. In the incidence analysis, significant risks were found for all categories of kinship (parents RR = 10.93, spouse, boyfriend/girlfriend, and bride/groom RR = 7.53, sibling RR = 7.03, offspring RR = 5.34, and other relatives RR = 3.71). Once the treatment of the index case was initiated, other factors lost their significance, and the index case bacteriological index and BCG (Bacillus Calmette-Guérin vaccine) protection had a greater impact. Our findings suggested that both genetic susceptibility and physical exposure play an important role in the epidemiology of leprosy, but it was not possible establishing the role of genetic factor. Analyses of other factors related to the genotype of individuals, such as genetic polymorphisms, are needed. Daiane Santos dos Santos, Nadia Cristina Duppre, Anna Maria Sales, José Augusto da Costa Nery, Euzenir Nunes Sarno, and Mariana Andréa Hacker Copyright © 2013 Daiane Santos dos Santos et al. All rights reserved. Sun, 07 Apr 2013 11:54:51 +0000 http://www.hindawi.com/journals/jtm/2013/390986/ Maria Aparecida Shikanai Yasuda and Pedro Albajar Viñas Copyright © 2013 Maria Aparecida Shikanai Yasuda and Pedro Albajar Viñas. All rights reserved. Wed, 03 Apr 2013 15:52:23 +0000 http://www.hindawi.com/journals/jtm/2013/158462/ Objectives. The number of countries reporting dengue cases is increasing worldwide. Nepal saw its first dengue outbreak in 2010, with 96% of cases reported in three districts. There are numerous policy challenges to providing an effective public health response system in a fragile state. This paper evaluates the dengue case notification, surveillance, laboratory facilities, intersectoral collaboration, and how government and community services responded to the outbreak. Methods. Qualitative data were collected through 20 in-depth interviews, with key stakeholders, and two focus-group discussions, with seven participants. Results. Limitations of case recognition included weak diagnostic facilities and private hospitals not incorporated into the case reporting system. Research on vectors was weak, with no virological surveillance. Limitations of outbreak response included poor coordination and an inadequate budget. There was good community mobilization and emergency response but no routine vector control. Conclusions. A weak state has limited response capabilities. Disease surveillance and response plans need to be country-specific and consider state response capacity and the level of endemicity. Two feasible solutions for Nepal are (1) go upwards to regional collaboration for disease and vector surveillance, laboratory assistance, and staff training; (2) go downwards to expand upon community mobilisation, ensuring that vector control is anticipatory to outbreaks. Karolina Griffiths, Megha Raj Banjara, T. O'Dempsey, B. Munslow, and Axel Kroeger Copyright © 2013 Karolina Griffiths et al. All rights reserved. Sat, 30 Mar 2013 15:07:47 +0000 http://www.hindawi.com/journals/jtm/2013/789758/ Human Chagas disease originated in Latin America, being spread around the world in relation with multiple bioecological, sociocultural, and political factors. The process of the disease production and dispersion is discussed, emphasizing the human migration and correlated aspects, in the context of globalization. Positive and negative consequences concern the future of this trypanosomiasis, mainly in terms of the ecologic and sociopolitical characteristics of the endemic and nonendemic countries. João Carlos Pinto Dias Copyright © 2013 João Carlos Pinto Dias. All rights reserved. Sun, 24 Mar 2013 11:17:12 +0000 http://www.hindawi.com/journals/jtm/2013/275253/ Visceral leishmaniasis (VL) is a parasitic disease characterized by immune suppression. Successful treatment is usually followed by immune reconstitution and a dermatosis called post-Kala-azar dermal leishmaniasis (PKDL). Recently, PKDL was described as one of the immune reconstitution syndromes (IRISs) in HIV/VL patients on HAART. This study aimed to present PKDL as a typical example of paradoxical IRIS in non-HIV/AIDS individuals. Published and new data on the pathogenesis and healing of PKDL was reviewed and presented. The data suggested that PKDL is a typical example of paradoxical IRIS, being a new disease entity that follows VL successful treatment and immune recovery. PKDL lesions are immune inflammatory in nature with granuloma, adequate response to immunochemotherapy, and an ensuing hypersensitivity reaction, the leishmanin skin test (LST). The data also suggested that the cytokine patterns of PKDL pathogenesis and healing are probably as follows: an active disease state dominated by IL-10 followed by spontaneous/treatment-induced IL-12 priming, IL-2 stimulation, and INF-γ production. INF-γ-activated macrophages eliminate the Leishmania parasites/antigen to be followed by LST conversion and healing. In conclusion, PKDL is a typical example of paradoxical IRIS in non-HIV/AIDS individuals with anti-inflammatory cytokine patterns that are superseded by treatment-induced proinflammatory cytokines and lesions healing. Eltahir Awad Gasim Khalil, Selma Abdelmoneim Khidir, Ahmed Mudawi Musa, Brema Younis Musa, Mona Elfaki Eltahir Elfaki, Abdelgadir Mohamed Yousif Elkadaru, Edward Zijlstra, and Ahmed Mohamed El-Hassan Copyright © 2013 Eltahir Awad Gasim Khalil et al. All rights reserved. Wed, 20 Mar 2013 10:41:48 +0000 http://www.hindawi.com/journals/jtm/2013/507034/ It is imperative to consider the meaning of leprosy and everyday experiences of people affected by leprosy and key persons in the community if one aims to make leprosy services more effective, which appears necessary in Indonesia given the large numbers of new cases detected annually. However, little is written in the international literature about the experiences of people currently being treated for leprosy, those cured, or other key informants. This paper analyses the narratives of the people by drawing upon in-depth interviews with 53 participants and 20 focus groups discussions. The participants were purposively selected. We provide insights into the experiences of people and the meaning they give to leprosy and highlight aspect of aetiology, spirituality, religion, darkening of the skin, and sorcery. We also examine experiences of seeking care and focused on the impact of the disease in particular on the elderly and children. In conclusion, the continued need for implementation of leprosy services in Indonesia is very evident. The diversities in people’s experiences with leprosy indicate a demand for responsive leprosy services to serve the diverse needs, including services for those formally declared to be “cured.” Ruth M. H. Peters, Dadun, Mimi Lusli, Beatriz Miranda-Galarza, Wim H. van Brakel, Marjolein B. M. Zweekhorst, Rita Damayanti, Francisia S. S. E. Seda, Joske F. G. Bunders, and Irwanto Copyright © 2013 Ruth M. H. Peters et al. All rights reserved. Tue, 19 Mar 2013 11:42:05 +0000 http://www.hindawi.com/journals/jtm/2013/812793/ The present study aims at analysing the degree of deformity in leprosy cases diagnosed in children under 15 years old and its relationship with operational and epidemiological factors. This epidemiological cross-sectional study was carried out at municipalities of three microregions in a Brazilian hyperendemic area. Data between 1998 and 2010 was collected from the Information System for Notifiable Diseases database. The average coefficient of detection was 32.96/100.000 inhabitants; 7.61% of new cases were diagnosed in children under 15 years old; 5% in this age group were grade 2 deformity at diagnosis. Prevalence of leprosy cases in children under 15 years old with deformity was higher in males ( CI 95%: 1.09–6.45) and in multibacillary patients ( CI 95%: 3.54–60.87) and lower when the detection mode was passive ( CI 95%: 0.31–1.73). Such context suggests high transmissibility and early exposure to Mycobacterium leprae since a lot of cases were diagnosed in children under fifteen years old and the incubation period of the leprosy bacillus varies from 02 to 07 years. This situation contributes to maintaining the chain of disease transmission in the area and indicates that health care services should intensify leprosy control. Francisco Carlos Félix Lana, Angélica da Conceição Oliveira Coelho Fabri, Fabiana Nascimento Lopes, Ana Paula Mendes Carvalho, and Fernanda Moura Lanza Copyright © 2013 Francisco Carlos Félix Lana et al. All rights reserved. Thu, 07 Mar 2013 11:57:15 +0000 http://www.hindawi.com/journals/jtm/2013/360540/ Background. Plasmodium falciparum malaria, as well as certain antimalarial drugs, is associated with hearing impairment in adults. There is little information, however, on the extent, if any, of this effect in children, and the evidence linking artemisinin combination therapies (ACTs) with hearing is inconclusive. Methods. Audiometry was conducted in children with uncomplicated malaria treated with artesunate-amodiaquine (), artemether-lumefantrine (), or amodiaquine () in Accra, Ghana. Audiometry was repeated 3, 7, and 28 days later and after 9 months. Audiometric thresholds were compared with those of a control group of children () from the same area. Findings. During the acute stage, hearing threshold levels of treated children were significantly elevated compared with controls (). The threshold elevations persisted up to 28 days, but no differences in hearing thresholds were evident between treated children and controls after 9 months. The hearing thresholds of children treated with the two ACT regimens were comparable but lower than those of amodiaquine-treated children during acute illness. Interpretation. Malaria is the likely cause of the elevated hearing threshold levels during the acute illness, a finding that has implications for learning and development in areas of intense transmission, as well as for evaluating potential ototoxicity of new antimalarial drugs. George O. Adjei, Bamenla Q. Goka, Emmanuel Kitcher, Onike P. Rodrigues, Ebenezer Badoe, and Jorgen A. L. Kurtzhals Copyright © 2013 George O. Adjei et al. All rights reserved. Tue, 05 Mar 2013 09:02:31 +0000 http://www.hindawi.com/journals/jtm/2013/961051/ Hyperreactive Malarial Splenomegaly (HMS) is defined as a massive enlargement of the spleen resulting from abnormal immune responses after repeated exposure to the malaria parasites. This study was carried out in Khartoum, Sudan. Sudan is considered to be one of the countries where HMS is quite prevalent. The objective of the study was to determine the incidence of HMS in patients who reported to the Omdurman Tropical Diseases Hospital (OMTDH) in Sudan and to investigate the basic laboratory and immunological characteristics of this condition in these patients. A cross-sectional study was carried out in OMTDH, and all patients with enlarged spleens were included in the study. Thirty-one out of 335 (9.3%) patients were diagnosed as having the HMS condition using international criteria for HMS diagnosis. The mean serum immunoglobulin M (IgM) levels in HMS patient groups were  g/L, and this was significantly higher compared with geographically matched controls (). Immunoglobulin G (IgG) C anticircumsporozoite (CSP) antibody levels were higher in the HMS patients although the difference was not statistically significant, when compared with a group of patients with mild malaria. In comparison with naïve European controls, both the HMS and the mild malaria groups had significantly higher antimalarial antibody levels and , respectively. Plasma levels of interleukin 10 (IL10) and interferon gamma (IFNγ) were significantly increased in the HMS patients compared with the healthy control donors ( and ) for IL10 and IFNγ, respectively. The findings of this study suggest that HMS is one of the significant causes of tropical splenomegaly in Sudan. HMS is associated with significant elevations of circulating IgM and antimalarial IgG antibodies as well as IL10 and IFNγ. Tayseer Alkadarou, Ahmed Musa, Abedelgader Alkadarou, Mohamed S. Mahfouz, Marita Troye-Blomberg, Ahmed M. Elhassan, and Ibrahim M. Elhassan Copyright © 2013 Tayseer Alkadarou et al. All rights reserved. Tue, 26 Feb 2013 08:46:35 +0000 http://www.hindawi.com/journals/jtm/2013/734562/ Background. The intestinal parasitic infections (IPIs) are globally endemic, and they constitute the greatest cause of illness and disease worldwide. Transmission of IPIs occurs as a result of inadequate sanitation, inaccessibility to potable water, and poor living conditions. Objectives. To determine a baseline prevalence of IPIs among children of five years and below at Webuye Health and Demographic Surveillance (HDSS) area in western Kenya. Methods. Cross-sectional survey was used to collect data. Direct saline and formal-ether-sedimentation techniques were used to process the specimens. Descriptive and inferential statistics such as Chi-square statistics were used to analyze the data. Results. A prevalence of 52.3% (417/797) was obtained with the male child slightly more infected than the female (53.5% versus 51%), but this was not significant (, ). Giardia lamblia and Entamoeba histolytica were the most common pathogenic IPIs with a prevalence of 26.1% (208/797) and 11.2% (89/797), respectively. Soil-transmitted helminths (STHs) were less common with a prevalence of 4.8% (38/797), 3.8% (30/797), and 0.13% (1/797) for Ascaris lumbricoides, hookworms, and Trichuris trichiura, respectively. Conclusions. Giardia lamblia and E. histolytica were the most prevalent pathogenic intestinal protozoa, while STHs were less common. Community-based health promotion techniques are recommended for controlling these parasites. A. A. Obala, C. J. Simiyu, D. O. Odhiambo, V. Nanyu, P. Chege, R. Downing, E. Mwaliko, A. W. Mwangi, D. Menya, D. Chelagat, H. D. N. Nyamogoba, P. O. Ayuo, W. P. O'Meara, M. Twagirumukiza, D. Vandenbroek, B. B. O. Otsyula, and J. de Maeseneer Copyright © 2013 A. A. Obala et al. All rights reserved. Thu, 07 Feb 2013 14:40:32 +0000 http://www.hindawi.com/journals/jtm/2013/890603/ The standard reference for pathogenic and nonpathogenic amoebae is the human parasite Entamoeba histolytica; a direct correlation between virulence and protease expression has been demonstrated for this amoeba. Traditionally, proteases are considered virulence factors, including those that produce cytopathic effects in the host or that have been implicated in manipulating the immune response. Here, we expand the scope to other amoebae, including less-pathogenic Entamoeba species and highly pathogenic free-living amoebae. In this paper, proteases that affect mucin, extracellular matrix, immune system components, and diverse tissues and cells are included, based on studies in amoebic cultures and animal models. We also include proteases used by amoebae to degrade iron-containing proteins because iron scavenger capacity is currently considered a virulence factor for pathogens. In addition, proteases that have a role in adhesion and encystation, which are essential for establishing and transmitting infection, are discussed. The study of proteases and their specific inhibitors is relevant to the search for new therapeutic targets and to increase the power of drugs used to treat the diseases caused by these complex microorganisms. Jesús Serrano-Luna, Carolina Piña-Vázquez, Magda Reyes-López, Guillermo Ortiz-Estrada, and Mireya de la Garza Copyright © 2013 Jesús Serrano-Luna et al. All rights reserved. Tue, 05 Feb 2013 15:46:27 +0000 http://www.hindawi.com/journals/jtm/2013/907375/ Malaria transmission pattern was studied in 3 villages (Toubanding, Daga Ndoup, and Keur Samba Guèye) situated within an area selected for clinical trials. The study was conducted in the rainy season from July to December 2011. The main objective of this work was to gather baseline data on malaria transmission intensity and other entomological parameters before the advent of clinical trials. Mosquitoes were collected by Human-Landing Collections (HLCs) and by pyrethrum spray catches (PSCs). Five anopheline species were collected, namely, An. arabiensis, An. gambiae, An. funestus, An. pharoensis, and An. rufipes, giving a heterogeneous distribution within the study area. The populations dynamics of the vectors varied temporarily in each village depending on the pattern of the rainy season. Transmission intensity estimated by the entomological inoculation rate (EIR) was measured in each of the three villages with the variations linked to the microecological differences between the villages. Measurements were calculated for August, September, and October and were found to vary between 4 and 30 infected bites per person over the study period with a peak intensity observed in September. These results indicate that epidemiological field trials on malaria could be conducted in this area on the basis of the differences observed with transmission intensity, micro-ecological variations, and the objectives of the trials. El Hadji Amadou Niang, Aissatou Touré, El Hadji Malick Ngom, Lassana Konaté, Ousmane Faye, Mawlouth Diallo, and Ibrahima Dia Copyright © 2013 El Hadji Amadou Niang et al. All rights reserved. Sun, 03 Feb 2013 08:57:11 +0000 http://www.hindawi.com/journals/jtm/2013/956234/ Setting. A nationwide study in Fiji. Objective. To describe the incidence of congenital rubella syndrome (CRS) and its relationship to the incidence of notified cases of rubella in Fiji from 1995 to 2010. Design. Descriptive, retrospective review of all recorded congenital abnormalities associated with live births in Fiji over 16 years. Results. There were 294 infants who met the criteria for CRS. Of these, 95% were classified as “suspected” cases, 5% were “clinically confirmed,” and none were “laboratory confirmed cases”. There was a significant linear increase over the study period in the incidence of CRS (odds ratio 1.045 per year, 95% CI 1.019 to 1.071, ). There was no significant association between the incidence of CRS and the reported incidence of rubella (). Conclusion. There is a rising trend in reports of suspected CRS cases in Fiji. This highlights the need to strengthen surveillance for CRS through improvements in clinical and laboratory diagnosis to confirm or exclude suspected cases. It is also important to ensure high coverage of rubella vaccination in Fiji. Sheetalpreet Singh, Frances Bingwor, Katherine Tayler-Smith, Marcel Manzi, and Guy B. Marks Copyright © 2013 Sheetalpreet Singh et al. All rights reserved. Mon, 28 Jan 2013 08:46:35 +0000 http://www.hindawi.com/journals/jtm/2013/352689/ Leprosy is a disabling chronic infection, with insidious onset that often evades early detection. In order to detect new leprosy cases in a timely manner, we conducted surveillance visits in some difficult-to-reach mountain areas in South West China where the disease is still prevalent. Our data confirm that Chinese multibacillary (MB) leprosy patients have strong antibody responses against Mycobacterium leprae antigens ND-O-BSA and LID-1. Contacts of clinically diagnosed patients were then monitored at regular intervals by both physical examinations and the laboratory determination of antibody responses in sera collected during these examinations. Elevations in antibody titers indicated the onset of MB leprosy in one of the contacts, and diagnosis was subsequently confirmed on physical examination. Our data indicate that rising antibody titers can be used as a trigger for physical examination or increased monitoring of particular individuals in order to provide early leprosy diagnosis. Pan Qiong-Hua, Zheng Zhong-Yi, Yang Jun, Wen Yan, Yuan Lian-Chao, Li Huan-Ying, Steven G. Reed, and Malcolm S. Duthie Copyright © 2013 Pan Qiong-Hua et al. All rights reserved. Mon, 24 Dec 2012 10:22:10 +0000 http://www.hindawi.com/journals/jtm/2012/590463/ The primary objective was to evaluate the safety and tolerability of the new chewable formulation of mebendazole to treat soil-transmitted helminth (STH) infections in children ≤10 years old with the goal of using this formulation in preventive chemotherapy programs and expand treatment to young children who are unable to swallow solid tablets. In this open-label, single-arm, phase 3 study conducted at Pemba Island, Zanzibar, Tanzania, children aged 2 to 10 years (median age: 4 years) were administered a single dose of the mebendazole 500 mg chewable tablet. Safety was assessed 30 minutes after dose and 3 days later. Of the 390 (98%) children who completed the study, 195 (55%) had ≥1 STH infection and 157 (45%) had no infection at baseline. The most common STH infections were Trichuris trichiura (51%), hookworm (16%), and Ascaris lumbricoides (7%). Treatment-emergent adverse events (TEAEs) were experienced by 11% of children. There was no difference in the percentage of children experiencing TEAEs between the age strata of 2–5 years and 6–10 years. Diarrhea was reported only in children aged 2–5 years. No correlation was observed between the type or percentage of AEs and presence or severity of infection. A single dose of mebendazole 500 mg chewable tablet was safe and well tolerated in children aged 2 to 10 years. Andrew J. Friedman, Said M. Ali, and Marco Albonico Copyright © 2012 Andrew J. Friedman et al. All rights reserved. Thu, 13 Dec 2012 15:13:09 +0000 http://www.hindawi.com/journals/jtm/2012/940616/ Populations exposed to Plasmodium infection develop genetic mechanisms of protection against severe disease. The clinical manifestation of malaria results primarily from the lysis of infected erythrocytes and subsequent immune and inflammatory responses. Herein, we review the genetic alterations associated with erythrocytes or mediators of the immune system, which might influence malaria outcome. Moreover, polymorphisms in genes related to molecules involved in mechanisms of cytoadherence and their influence on malaria pathology are also discussed. The results of some studies have suggested that the combinatorial effects of a set of genetic factors in the erythrocyte-immunology pathway might be relevant to host resistance or susceptibility against Plasmodium infection. However, these results must be interpreted with caution because of the differences observed in the functionality and frequency of polymorphisms within different populations. With the recent advances in molecular biology techniques, more robust studies with reliable data have been reported, and the results of these studies have identified individual genetic factors for consideration in preventing severe disease and the individual response to treatment. Vitor R. R. de Mendonça, Marilda Souza Goncalves, and Manoel Barral-Netto Copyright © 2012 Vitor R. R. de Mendonça et al. All rights reserved. Thu, 13 Dec 2012 11:24:45 +0000 http://www.hindawi.com/journals/jtm/2012/120496/ To determine the incidence of dengue infection, we established active surveillance of febrile episodes in a cohort of schoolchildren from three schools in Medellin, Colombia. We followed a cohort of 2,379 schoolchildren in 2010 and followed 1,840 of these children the following year. During the follow-up time, 264 schoolchildren displayed 297 febrile episodes; of these, 23 episodes (7.7%) were caused by acute dengue infection. All four dengue serotypes were found, and all of the cases were mild. The most common symptoms in the dengue cases compared with those in other febrile illness were asthenia (96% versus 87%), anorexia (78% versus 57%), rhinorrhea (65.2% versus 58%), abdominal pain (56.5% versus 47.8%), arthralgia (43% versus 33%), and positive tourniquet test (13% versus 3%). This difference was not statistically significant. Pulse was elevated, and systolic arterial pressure was lower in dengue cases compared with other febrile illness (). Mosquito indexes were determined in 8 children’s houses and in the schools. Aedes aegypti adults were found in both households and in schools, whereas Aedes aegypti larvae were found only in schools. These results showed an elevated dengue frequency in children, with symptoms similar to those of other febrile illness and transmission risk in households and schools. Berta Nelly Restrepo, Leidy Diana Piedrahita, Ivony Yireth Agudelo, Gabriel Parra-Henao, and Jorge E. Osorio Copyright © 2012 Berta Nelly Restrepo et al. All rights reserved. Tue, 11 Dec 2012 15:26:44 +0000 http://www.hindawi.com/journals/jtm/2012/808132/ The aim of this study was to investigate genetic polymorphism in Leishmania braziliensis population previously typed through isoenzyme electrophoresis, isolated from the same patient in two different moments: (A) before the beginning of treatment and (B) after treatment failure to meglumine antimoniate or reactivation after successful initial treatment. Fifteen pairs of isolates were assessed using the polymorphic molecular marker LSSP-PCR and following the phenetic analysis. The genetic profiles of the 30 samples were grouped in four clusters. Only two patients presented total identity in the A and B isolates. Most isolates presented similarity coefficients varying from 0.63 to 0.91. In this group of patients genetic polymorphisms could be observed indicating low similarity between the pairs of isolates. The results demonstrate the existence of genetic polymorphism between the samples isolated before treatment and after reactivation or treatment failure, suggesting a possible differentiation of the structure of the original parasite population which could be involved in the mechanisms of resistance to treatment or reactivation of lesions in the ATL. This phenomenon is important, although other factors also could be involved in this context and are discussed in this paper. Cibele Baptista, Armando de Oliveira Schubach, Maria de Fatima Madeira, Luciana de Freitas Campos Miranda, Andressa Guimarães de Souza Pinto, Juliana Helena da Silva Barros, Fatima Conceição-Silva, Maria Ines Fernandes Pimentel, and Raquel da Silva Pacheco Copyright © 2012 Cibele Baptista et al. All rights reserved. Mon, 03 Dec 2012 14:02:27 +0000 http://www.hindawi.com/journals/jtm/2012/956875/ Dengue is one of the major public health concerns in the world. Since all the four serotypes are actively circulating in Mexico, there is a need to develop an efficient diagnosis system to improve case management of the patients. There exist few studies evaluating the use of the NS3 protein as a protective antigen against dengue virus (DENV). In this paper we show the expression of a recombinant NS3 protein from all serotypes of dengue virus (GST-DVNS3-1-4) and report a reliable “in-house detection system” for the diagnosis of dengue infection which was field-tested in a small village (Tezonapa) in the state of Veracruz, Mexico. The fusion proteins were immunogenic, inducing antibodies to be able to recognize to antigens up to a 1 : 3200 dilution. The purified proteins were used to develop an in-house detection system (ELISA) and were further tested with a panel of 239 serum samples. The in-house results were in excellent agreement with the commercial kits with (95%  CI = 0.808–1.061), and (95%  CI = 0.779–0.965) for IgM and IgG, respectively. The agreement between the NS1 antigen detection versus the rNS3 ELISA, (95%  CI = 0.708–0.966), was very good. Thus, these results demonstrate that recombinant NS3 proteins have potential in early diagnosis of dengue infections. Laura Mónica Álvarez-Rodríguez, Angel Ramos-Ligonio, José Luis Rosales-Encina, María Teresa Martínez-Cázares, Aurora Parissi-Crivelli, and Aracely López-Monteon Copyright © 2012 Laura Mónica Álvarez-Rodríguez et al. All rights reserved. Thu, 29 Nov 2012 15:50:15 +0000 http://www.hindawi.com/journals/jtm/2012/371915/ Aims. This retrospective study was to identify some challenges in the treatment of Buruli ulcer (BU) and present a proposed treatment regime. Materials and Methods. Information from patients medical records, hospital database, and follow-up findings on BU treatment procedures from 1994 to 1998 and from 2004 to 2007 at three research sites in Ghana were reviewed to determine the treatment challenges encountered. Data needed were recorded and analyzed, and results presented using SPSS version 17.0. Results. A total of 489 BU patients information was selected for the study. A majority (56.90%, ) of the patients were children (0–14 years), with a mean age of 12.8 years. Significant challenges in BU treatment in Ghana identified included sequelae ( ), delayed treatment ( ), and high treatment cost ( ). Duration of hospital stay was clearly correlated with the time spent at home prior to admission; spearman’s rank correlation coefficient was 0.72 (95% CI 0.42–0.87). Conclusion. Delays in seeking treatment among BU patients were the main factor which resulted in most of the other factors contributing to the challenges in treatment. A combination of psychosocial and biomedical approach was proposed as holistic method to alleviate the challenges in BU treatment. Pius Agbenorku, Isaac K. Donwi, Pawson Kuadzi, and Paul Saunderson Copyright © 2012 Pius Agbenorku et al. All rights reserved. Tue, 20 Nov 2012 18:45:39 +0000 http://www.hindawi.com/journals/jtm/2012/349312/ There is growing attention for chronic diseases in sub-Saharan Africa (SSA) and for bridges between the management of HIV/AIDS and other (noncommunicable) chronic diseases. This becomes more urgent with increasing numbers of people living with both HIV/AIDS and other chronic conditions. This paper discusses the commonalities between chronic diseases by reviewing models of care, focusing on the two most dominant ones, diabetes mellitus type 2 (DM2) and HIV/AIDS. We argue that in order to cope with care for HIV patients and diabetes patients, health systems in SSA need to adopt new strategies taking into account essential elements of chronic disease care. We developed a “chronic dimension framework,” which analyses the “disease dimension,” the “health provider dimension,” the patient or “person dimension,” and the “environment dimension” of chronic diseases. Applying this framework to HIV/AIDS and DM2 shows that it is useful to think about management of both in tandem, comparing care delivery platforms and self-management strategies. A literature review on care delivery models for diabetes and HIV/AIDS in SSA revealed potential elements for cross-fertilisation: rapid scale-up approaches through the public health approach by simplification and decentralisation; community involvement, peer support, and self-management strategies; and strengthening health services. Josefien van Olmen, François Schellevis, Wim Van Damme, Guy Kegels, and Freya Rasschaert Copyright © 2012 Josefien van Olmen et al. All rights reserved. Tue, 20 Nov 2012 11:05:31 +0000 http://www.hindawi.com/journals/jtm/2012/573965/ Maria Goreti Rosa-Freitas, Nildimar Alves Honório, Cláudia Torres Codeço, Guilherme Loureiro Werneck, and Nicolas Degallier Copyright © 2012 Maria Goreti Rosa-Freitas et al. All rights reserved. Wed, 07 Nov 2012 14:57:05 +0000 http://www.hindawi.com/journals/jtm/2012/235015/ Background. Malaria remains a major cause of mortality and morbidity in the world, and particularly in sub-Saharan Africa. Objectives. The aim of this study was to determine ownership and utilization of ITNs among households with children under five in the previous night. Methods. A community based cross-sectional study was conducted in Gursum district in Eastern Ethiopia. A total of 335 households were surveyed using a pretested structured questionnaire administered though house-to-house interviews. Results. Household ownership for at least one mosquito net and use of nets were 62.4% (95% CI 57.2–67.6%) and 21.5% (95% CI 17.1–25.9%), respectively. Households who received or were told about ITN in the last 6 months were three times more likely to have used it than those who were not (OR 3.25; 95% CI 1.5–7.10). Households whose heads were engaged as a farmer (adjusted OR 0.137; 95% CI: 0.04–0.50) and housewife (OR 0.26; 95% CI: 0.08–0.82) were less likely to use ITN than those of other occupations. Conclusion. The findings indicate low ITN ownership and utilization among the households. Intensive health education and community mobilization effort should be employed to increase the possession and proper utilization of insecticide treated bed nets. Sibhatu Biadgilign, Ayalu Reda, and Haji Kedir Copyright © 2012 Sibhatu Biadgilign et al. All rights reserved. Thu, 01 Nov 2012 15:30:07 +0000 http://www.hindawi.com/journals/jtm/2012/829139/ The acute phase of Chagas' disease in mice and human is marked by states of immunosuppression, in which Trypanosoma cruzi replicates extensively and releases immunomodulatory molecules that delay parasite-specific responses mediated by effector T cells. This mechanism of evasion allows the parasite to spread in the host. Parasite molecules that regulate the host immune response during Chagas’ disease have not been fully identified, particularly proteins of the amastigote stage. In this work, we evaluated the role of the GPI anchored SSP4 protein of T. cruzi as an immunomodulatory molecule in peripheral blood mononuclear cells (PBMCs). rMBP::SSP4 protein was able to stimulate nitric oxide (NO) production. Likewise, rMBP::SSP4 induced the expression of genes and production of molecules involved in the inflammatory process, such as, cytokines, chemokines, and adhesion molecules (CAMs) as determined by RT-PCR and ELISA. These results suggest that the amastigote SSP4 molecule could play a key role in the immunoregulatory and/or immunosuppressive process observed in the acute phase of infection with T. cruzi. Yadira Morán-Utrera, Aracely López-Monteon, José Luis Rosales-Encina, Enrique Méndez-Bolaina, and Angel Ramos-Ligonio Copyright © 2012 Yadira Morán-Utrera et al. All rights reserved. Thu, 01 Nov 2012 09:38:44 +0000 http://www.hindawi.com/journals/jtm/2012/853562/ Toxoplasma gondii primary infection/reactivation after solid organ transplantation is a serious complication, due to the high mortality rate following disseminated disease. We performed a retrospective study of all cases of T. gondii infections in 436 adult patients who had received an orthotopic cardiac transplant at our Institution from May 1968 to January 2011. Six patients (1.3%) developed T. gondii infection/reactivation in the post-operative period. All infections/reactivations occurred before 1996, when no standardized toxoplasmosis prophylactic regimen or co-trimoxazole prophylaxis was used. Starting with the 112th heart transplant, oral pyrimethamine 75 mg/day was used for seronegative transplant recipients whose donors were seropositive or unknown. Two patients (33.3%) presented with disseminated toxoplasmosis infection, and all patients (100%) had myocarditis. Five patients (83.3%) were seronegative before transplant and one patient did not have pre-transplant serology available. Median time for infection onset was 131 days following transplantation. Three patients (50%) died due to toxoplasmosis infection. After 1996, we did not observe any additional cases of T. gondii infection/reactivation. In conclusion, toxoplasmosis in heart allographs was more frequent among seronegative heart recipients, and oral pyrimethamine was highly effective for the prevention of T. gondii infection in this population. Tania Mara V. Strabelli, Rinaldo Focaccia Siciliano, Silvia Vidal Campos, Jussara Bianchi Castelli, Fernando Bacal, Edimar A. Bocchi, and David E. Uip Copyright © 2012 Tania Mara V. Strabelli et al. All rights reserved. Thu, 18 Oct 2012 10:52:55 +0000 http://www.hindawi.com/journals/jtm/2012/819563/ Sub-Saharan Africa suffers by far the greatest malaria burden worldwide and is currently undergoing a profound demographic change, with a growing proportion of its population moving to urban areas. Urbanisation is generally expected to reduce malaria transmission; however the disease still persists in African cities, in some cases at higher levels than in nearby rural areas. Objective. This paper aims to collate and analyse risk factors for urban malaria transmission throughout sub-Saharan Africa and to discuss their implications for control. Methods. A systematic search on malaria and urbanisation was carried out focusing on sub-Saharan Africa. Particular interest was taken in vector breeding sites in urban and periurban areas. Results. A variety of urban vector breeding sites were catalogued, the majority of which were artificial, including urban agriculture, tyre tracks, and ditches. Natural breeding sites varied according to location. Low socioeconomic status was a significant risk factor for malaria, often present in peri-urban areas. A worrying trend was seen in the adaptation of malaria vector species to the urban environment. Urban malaria is highly focused and control programs should reflect this. Conclusion. As urbanisation continues and vector species adapt, continued monitoring and control of urban malaria in sub-Saharan Africa is essential. Prathiba M. De Silva and John M. Marshall Copyright © 2012 Prathiba M. De Silva and John M. Marshall. All rights reserved. Wed, 17 Oct 2012 09:01:35 +0000 http://www.hindawi.com/journals/jtm/2012/173437/ Ricardo E. Fretes, Ulrike Kemmerling, and Demba Sarr Copyright © 2012 Ricardo E. Fretes et al. All rights reserved.