Journal of Tropical Medicine The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Naturally Acquired Antibody Responses to a Synthetic Malaria Antigen AS202.11 Tue, 12 Sep 2017 07:56:00 +0000 Background. A major challenge to malaria vaccine development is identification of protective epitopes and respective protective immune responses. Objective. To characterize naturally acquired Immunoglobulin G (IgG) responses to the synthetic peptide AS202.11, a malaria vaccine candidate. Methodology. This community based cross-sectional study enrolled 320 participants aged 1 year and above. Demographic information was recorded through interviews. Detection of P. falciparum infection was done by microscopy, malaria rapid diagnostic test, and polymerase chain reaction. ELISA was used to detect IgG antibody. Data was analyzed using STATA. Results. The overall AS202.11 IgG seropositivity was 78.8% (73.9–82.9). Seropositivity by age categories was ≤12 years [74.3% (67.4–80.2)], 13–40 years [85.3% (76.5–91.1)], and >40 years [82.6% (68.7–91.1)]. Compared to the ≤ 12-year-old group, aORs for the other groups were 2.22 (1.14–4.32), , and 1.87 (0.81–4.35), , for the 13–40-year-old and >40-year-old groups, respectively. The 13–40-year-old group had more seropositive individuals compared to the ≤ 12-year-old group. Conclusion. We report a high degree of recognition of AS202.11 by IgG elicited by field P. falciparum strains, suggesting its close similarity to native P. falciparum antigens and possible suitability of the peptide as a future malaria vaccine candidate. Rebeka Nazareth, Pius Horumpende, Tolbert Sonda, Arnold Ndaro, Edson Mollel, Eliakim Paul, Emmanuel Athanase, and Jaffu Chilongola Copyright © 2017 Rebeka Nazareth et al. All rights reserved. Observation of Blood Donor-Recipient Malaria Parasitaemia Patterns in a Malaria Endemic Region Thu, 24 Aug 2017 00:00:00 +0000 Background. Asymptomatic malaria parasitaemia has been documented in donor blood in West Africa. However, donated blood is not routinely screened for malaria parasites (MPs). The present study therefore aimed to document the frequency of blood transfusion-induced donor-recipient malaria parasitaemia patterns, in children receiving blood transfusion in a tertiary health-centre. Methodology. A cross-sectional, observational study involving 140 children receiving blood transfusion was carried out. Blood donor units and patients’ blood samples were obtained, for the determination of malaria parasites (MPs). Giemsa staining technique was used to determine the presence of malaria parasitaemia. Results. Malaria parasites were detected in 7% of donor blood and in 8.3% of the recipients’ pretransfusion blood. The incidence of posttransfusion MPs was 3%, but none of these were consistent with blood transfusion-induced malaria, as no child with posttransfusion parasitaemia was transfused with parasitized donor blood. Majority of the blood transfusions (89.4%) had no MPs in either donors or recipients, while 6.8% had MPs in both donors and recipients, with the remaining 3.8% showing MPs in recipients alone. Conclusion. In conclusion, the incidence of posttransfusion malaria parasitaemia appears low under the prevailing circumstances. Jamilu Abdullahi Faruk, Gboye Olufemi Ogunrinde, and Aisha Indo Mamman Copyright © 2017 Jamilu Abdullahi Faruk et al. All rights reserved. Prevalence of Soil-Transmitted Helminthiases and Schistosomiasis in Preschool Age Children in Mwea Division, Kirinyaga South District, Kirinyaga County, and Their Potential Effect on Physical Growth Wed, 23 Aug 2017 07:04:49 +0000 Intestinal parasitic infections can significantly contribute to the burden of disease, may cause nutritional and energetic stress, and negatively impact the quality of life in low income countries of the world. This cross-sectional study done in Mwea irrigation scheme, in Kirinyaga, central Kenya, assessed the public health significance of soil-transmitted helminthiases (STH), schistosomiasis, and other intestinal parasitic infections, among 361 preschool age children (PSAC) through fecal examination, by measuring anthropometric indices, and through their parents/guardians, by obtaining sociodemographic information. Both intestinal helminth and protozoan infections were detected, and, among the soil-transmitted helminth parasites, there were Ascaris lumbricoides (prevalence, 3%), Ancylostoma duodenale (<1%), and Trichuris trichiura (<1%). Other intestinal helminths were Hymenolepis nana (prevalence, 3.6%) and Enterobius vermicularis (<1%). Schistosoma mansoni occurred at a prevalence of 5.5%. Interestingly, the protozoan, Giardia lamblia (prevalence, 14.7%), was the most common among the PSAC. Other protozoans were Entamoeba coli (3.9%) and Entamoeba histolytica (<1). Anthropometric indices showed evidence of malnutrition. Intestinal parasites were associated with hand washing behavior, family size, water purification, and home location. These findings suggest that G. lamblia infection and malnutrition may be significant causes of ill health among the PSAC in Mwea, and, therefore, an intervention plan is needed. Stephen Sifuna Wefwafwa Sakari, Amos K. Mbugua, and Gerald M. Mkoji Copyright © 2017 Stephen Sifuna Wefwafwa Sakari et al. All rights reserved. Liver Fibrosis and Hepatitis B Coinfection among ART Naïve HIV-Infected Patients at a Tertiary Level Hospital in Northwestern Tanzania: A Cross-Sectional Study Sun, 30 Jul 2017 06:51:18 +0000 Background. Liver fibrosis which is a common complication of chronic hepatitis B infection is rarely diagnosed in low-resource countries due to limited capacity to perform biopsy studies. Data on the utilization of noninvasive techniques which are feasible for diagnosis of liver fibrosis in these settings among HIV-infected patients is scarce. The objective of this study was to establish the magnitude of liver fibrosis by using both aspartate-aminotransferase-to-platelets ratio and fibrosis-4 scores with associated hepatitis B coinfection among antiretroviral therapy naïve HIV-infected patients. Methods. We reviewed data of 743 adult patients attending HIV clinic with available hepatitis B surface antigen test results. Baseline clinical information was recorded and aspartate-aminotransferase-to-platelet ratio and fibrosis-4 scores were calculated. The cut-off values of 1.5 and 3.25 were used for diagnosis of significant fibrosis by aspartate-aminotransferase-to-platelets ratio and fibrosis-4 scores, respectively. Results. The prevalence of liver fibrosis was 3.5% when aspartate-aminotransferase-to-platelet score was used and 4.6% with fibrosis-4 score and they were both significantly higher among patients with hepatitis B coinfection. Younger patients with HIV advanced disease and elevated liver transaminases had increased risk of having hepatitis B coinfection. Conclusion. A remarkable number of HIV-infected patients present with liver fibrosis, predominantly those with hepatitis B infection. Semvua B. Kilonzo, Daniel W. Gunda, Flora Kashasha, and Bonaventura C. Mpondo Copyright © 2017 Semvua B. Kilonzo et al. All rights reserved. Predictors for Mortality among Multidrug-Resistant Tuberculosis Patients in Tanzania Thu, 20 Jul 2017 07:09:43 +0000 Problem. Factors related to MDRTB mortality in Tanzania have not been adequately explored and reported. Objectives. To determine demographic, clinical, radiographic, and laboratory factors associated with MDRTB mortality in a Tanzanian TB Referral Hospital. Methodology. This was a cross-sectional study with 193 participants. Demographic, clinical, laboratory, and radiological data were collected, and their associations with mortality among MDRTB patients were determined. Results and Conclusions. Cough was the commonest finding among these MDRTB patients, with 179 (92.75%) of them presenting with cough, followed by chest X-ray consolidation in 156 patients (80.83%) and history of previous TB treatment in 151 patients (78.24%). Cigarette smoking, HIV positivity, and low CD4 counts were significantly associated with MDRTB mortality, values of 0.034, 0.044, and 0.048, respectively. Fever on the other hand was at the borderline with value of 0.059. We conclude that cigarette smoking and HIV status are significant risk factors for mortality among MDRTB patients. HIV screening should continually be emphasized among patients and the general community for early ARTs initiation. Based on the results from our study, policy makers and public health personnel should consider addressing tobacco cessation as part of national TB control strategy. Edson W. Mollel and Jaffu O. Chilongola Copyright © 2017 Edson W. Mollel and Jaffu O. Chilongola. All rights reserved. Dengue Virus NS1 Protein as a Diagnostic Marker: Commercially Available ELISA and Comparison to qRT-PCR and Serological Diagnostic Assays Currently Used by the State of Florida Tue, 27 Jun 2017 00:00:00 +0000 Background. The proper management of patients infected with dengue virus requires early detection. Here, real-time molecular assays have proven useful but have limitations, whereas ELISAs that detect antibodies are still favored but results are obtained too late to be of clinical value. The production of DENV NS1 peaks early during infection and its detection can combine the advantages of both diagnostic approaches. Methods. This study compared assays currently used for detecting DENV infection at the Florida Department of Health including anti-DENV IgM and IgG ELISAs as well as qRT-PCR, against a commercially available DENV NS1 ELISA. These comparisons were made among a group of 21 human sera. Results. Nine of 14 (64.3%) DENV qRT-PCR+ samples were also DENV NS1+. Interestingly, the 5 NS1− samples that were qRT-PCR+ were additionally IgM− and IgG+ suggesting a nonprimary infection. Compared to qRT-PCR, the NS1 assay had a sensitivity of 64.3%, specificity 100%, PPV of 100%, and NPV of 58.3%. Conclusions. The NS1 ELISA performed as expected in known DENV qRT-PCR+ samples; however negative NS1 results for qRT-PCR+ and IgG+ sera seemingly reduced the usefulness of the NS1 ELISA for nonprimary cases. We therefore conclude that diagnosis obtained via DENV NS1 ELISA deserves further investigation. Jason H. Ambrose, Shamala Devi Sekaran, and Azliyati Azizan Copyright © 2017 Jason H. Ambrose et al. All rights reserved. Interrelationship between Climatic, Ecologic, Social, and Cultural Determinants Affecting Dengue Emergence and Transmission in Puerto Rico and Their Implications for Zika Response Thu, 22 Jun 2017 06:50:23 +0000 Objective. The global resurgence of dengue has been attributed to rapid population growth, urban expansion, increased air travel, globalization, and climate change. Dengue is now endemic in Puerto Rico. Puerto Rico is at risk for Zika, another emerging arbovirus. The interrelationship between climatic, ecological, social, and cultural factors that affect dengue and other arboviruses’ transmission is understudied. Design. The objective of this systematic review is to examine the interrelationship between climatic, ecological, social, and cultural factors on dengue transmission in Puerto Rico and to draw lessons for Zika response. Results. A comprehensive search of peer-reviewed journal articles was performed, producing 562 articles; 26 were selected for this review. Findings indicate that human activities and behaviors (urbanization, migration, and consumption) as well as climate have a significant impact on the abundance and the transmission potential of Ae. aegypti, the vector for dengue, Zika, and other viruses. Conclusion. Despite the public health burden of dengue limited investments have been made in research and surveillance. Future research is needed to develop models that integrate the multivariate effects of climatic, ecological, social, and cultural factors, which for Puerto Rico have mostly been examined independently. Such models have the potential to inform response to dengue, Zika, and other arboviruses. Angela Matysiak and Amira Roess Copyright © 2017 Angela Matysiak and Amira Roess. All rights reserved. Prevalence and Risk Factors of Delayed Sputum Conversion among Patients Treated for Smear Positive PTB in Northwestern Rural Tanzania: A Retrospective Cohort Study Sun, 11 Jun 2017 09:05:32 +0000 Introduction. Smear positive TB carries high morbidity and mortality. The TB treatment aims at sputum conversion by two months of antituberculous. Patients who delay sputum conversion remain potentially infectious, with risk of treatment failure, drug resistance, and mortality. Little is known about the magnitude of this problem in our setting. This study was designed to determine the prevalence and risk factors of delayed sputum conversion in northwestern rural part of Tanzania. Methods. This was a retrospective cohort study involving smear positive TB patients at Sengerema DDH in 2015. Demographic data, HIV status, and sputum results at TB diagnosis and on TB treatment were collected and analyzed using STATA 11. Results. In total, 156 patients were studied. Males were 97 (62%); the median age was 39 [30–51] years. Fifty-five (35.3%) patients were HIV coinfected and 13 (8.3%) patients had delayed sputum conversion which was strongly associated with male gender (, ), age >50 years (, ), and AFB 3+ (, ). Conclusions. Delayed sputum conversion is prevalent in this study. These patients can potentially fail on treatment, develop drug resistance, and continue spreading TB. Strategies to reduce the rate of delayed sputum conversion could also reduce these potential unfavorable outcomes. Daniel W. Gunda, Igembe Nkandala, Godfrey A. Kavishe, Semvua B. Kilonzo, Rodrick Kabangila, and Bonaventura C. Mpondo Copyright © 2017 Daniel W. Gunda et al. All rights reserved. Antiviral Activity of Fridericia formosa (Bureau) L. G. Lohmann (Bignoniaceae) Extracts and Constituents Mon, 29 May 2017 00:00:00 +0000 A phytochemical study of Fridericia formosa (Bignoniaceae) ethanol extracts of leaves, stems, and fruits was guided by in vitro assays against vaccinia virus Western Reserve (VACV-WR), human herpes virus 1 (HSV-1), murine encephalomyocarditis virus (EMCV), and dengue virus type 2 (DENV-2) by the MTT method. All the ethanol extracts were active against DENV-2, HSV-1, and VACV-WR with best results for the fruits extract against DENV-2 (SI > 38.2). For VACV-WR and HSV-1, EC50 values > 200 μg mL−1 were determined, while no inhibition of the cytopathic effect was observed with EMCV. Five compounds were isolated and identified as the C-glucosylxanthones mangiferin (1), 2′-O-trans-caffeoylmangiferin (2), 2′-O-trans-coumaroylmangiferin (3), 2′-O-trans-cinnamoylmangiferin (5), and the flavonoid chrysin (4). The most active compound was 2′-O-trans-coumaroylmangiferin (3) with SI > 121.9 against DENV-2 and 108.7 for HSV-1. These results indicate that mangiferin cinnamoyl esters might be potential antiviral drugs. Geraldo Célio Brandão, Erna G. Kroon, José D. Souza Filho, and Alaíde Braga Oliveira Copyright © 2017 Geraldo Célio Brandão et al. All rights reserved. Urinalysis and Clinical Correlations in Patients with P. vivax or P. falciparum Malaria from Colombia Wed, 24 May 2017 06:53:57 +0000 Background. Urinalysis is a poorly reviewed diagnostic tool in malaria patients; its application can show the presence of severe malaria. Methods. Urinalysis was performed in a total of 620 patients diagnosed with malaria by thick blood smear; complications were classified according to WHO major criteria for severity and minor criteria according to the Colombian malaria guideline. Results. Severe or moderate clinical complications were diagnosed in 31.1% of patients, hepatic dysfunctions were diagnosed in 25.8%, anemia was diagnosed in 9.8%, thrombocytopenia was diagnosed in 7.7%, renal dysfunction was diagnosed in 4.8%, neurological and pulmonary complications were diagnosed in 2.1% and 2.4%, hypoglycemia was diagnosed in 1.1% of patients with blood glucose analysis, and acidosis was diagnosed in 10 of 25. Bilirubinuria was found in 24.3%, associated with urobilinuria, proteinuria, and increased specific gravity; urobilinuria was found in 30.6% associated with elevated serum bilirubin and alanine aminotransferase; 39.2% had proteinuria, associated with higher blood urea nitrogen, serum bilirubin, aspartate, alanine-transaminase, hematuria, and increased specific gravity. Severe or moderate liver and renal complications were associated with proteinuria and bilirubinuria. Urobilinuria was associated with thrombocytopenia and neurological and hepatic dysfunction. Ketonuria was associated with neurological dysfunctions. Conclusions. The most frequent alterations in the urinalysis were bilirubinuria, proteinuria, urobilinuria, and increased specific gravity, related to thrombocytopenia and liver, kidney, and neurological alterations. Alberto Tobón-Castaño, Sebastián Barrera Escobar, and Cecilia Giraldo Castro Copyright © 2017 Alberto Tobón-Castaño et al. All rights reserved. Distribution of Parasites Detected in Stool Samples of Patients in Le Dantec University Hospital of Dakar, Senegal, from 2011 to 2015 Mon, 15 May 2017 07:08:01 +0000 To identify the parasites responsible for intestinal parasitic infections diagnosed at Le Dantec University Hospital of Dakar, distribution of parasites detected in stool samples of patients was studied. From 2011 to 2015, 2578 patients were included in the study. A direct examination and Ritchie technique were performed as parasite search techniques. In total, 408 samples were positive showing 440 intestinal parasites; this corresponds to prevalence of 15.8%. Parasites were detected in monoparasitism (85.7%) and multiparasitism (14.3%). The most common species found in monoparasitism were Entamoeba coli (38.9%), E. histolytica/dispar (12.7%), Giardia intestinalis (8%), and Ascaris lumbricoides (7.3%). The most common associations were A. lumbricoides-Trichuris trichiura (3.6%) and E. coli-G. intestinalis (2.7%). Nonhospitalized patients were significantly more affected with 65.4% compared to hospitalized counterparts; and also there were more men (50.7%) than women. With 67.4%, adults were the most affected age group, while the elderly were less affected with only 7% (). This study shows increasing prevalence of intestinal parasitic infections over the years. So health education should be promoted in addition to the already begun mass treatment program. This would help to limit or even halt the spread of these diseases. Khadim Diongue, Mouhamadou Ndiaye, Mame Cheikh Seck, Mamadou Alpha Diallo, Yaye Dié Ndiaye, Aïda Sadikh Badiane, and Daouda Ndiaye Copyright © 2017 Khadim Diongue et al. All rights reserved. Analysing the Influence of Health Insurance Status on Peoples’ Health Seeking Behaviour in Rural Ghana Mon, 08 May 2017 09:41:15 +0000 This paper examines the influence of health insurance status on healthcare use in rural Ghana using 286 sampled respondents from four rural communities in the Bekwai Municipality. Data were obtained using structured interview and Pearson’s Chi square and bivariate regressions were used to analyse data. The results show low healthcare utilization among study participants, with most respondents having irregular use (43.5%) or rare use (43.3%). Respondents with health insurance utilized healthcare more than those without health insurance, the results being statistically significant (df = 4; = 283, = 0.000). The bivariate analysis revealed that health insurance status has a positive and significant influence on utilization ( = 1.284; value = 0.000). The study recommends promotion and improvement of services of the National Health Insurance Scheme as effective strategy to improve healthcare consumption by the rural people. The expansion of health insurance services to all sections of the population is also recommended. Benedict Osei Asibey and Seth Agyemang Copyright © 2017 Benedict Osei Asibey and Seth Agyemang. All rights reserved. Submicroscopic and Asymptomatic Congenital Infection by Plasmodium vivax or P. falciparum in Colombia: 37 Cases with Placental Histopathology and Cytokine Profile in Maternal and Placental Blood Tue, 28 Mar 2017 09:33:07 +0000 Problem. Congenital plasmodial infection (CPI) is a rare event, which has been little studied in Colombia. Objective. To measure the frequency of CPI and to describe the immune and histological characteristics in maternal blood and placentas when CPI occurs. Methodology. A cross-sectional study was carried out in northwest Colombia. A sample size of 39 unit analysis (a unit of analysis corresponds to the cord, placenta, and peripheral blood of a pregnant woman) was calculated using epidemiological and statistical parameters. Thick blood smear (TBS) and quantitative real-time polymerase chain reaction (qPCR) were used as diagnostic tests. Results and Conclusions. A total of 137 parturient women were studied. All cases of CPI were submicroscopic (TBS negative and qPCR positive) and asymptomatic infections. If the definition of CPI considers only detection of parasites in umbilical cord blood, regardless of what was found in peripheral or placental blood, the frequency of CPI was 27%. However, if that definition is stricter and includes simultaneous detection of parasites in maternal or placental blood with the same species, the frequency of CPI in this study was 13%. Olga María Agudelo-García, Eliana María Arango-Flórez, and Jaime Carmona-Fonseca Copyright © 2017 Olga María Agudelo-García et al. All rights reserved. Epidemiological Characteristics of Dengue Disease in Latin America and in the Caribbean: A Systematic Review of the Literature Tue, 14 Mar 2017 00:00:00 +0000 Dengue, an important mosquito-borne virus transmitted mainly by Aedes aegypti, is a major public health issue in Latin America and the Caribbean. National epidemiological surveillance systems, usually based on passive detection of symptomatic cases, while underestimating the true burden of dengue disease, can provide valuable insight into disease trends and excess reporting and potential outbreaks. We carried out a systematic review of the literature to characterize the recent epidemiology of dengue disease in Latin America and the English-speaking and Hispanic Caribbean Islands. We identified 530 articles, 60 of which met criteria for inclusion. In general, dengue seropositivity across the region was high and increased with age. All four virus serotypes were reported to circulate in the region. These observations varied considerably between and within countries and over time, potentially due to climatic factors (temperature, rainfall, and relative humidity) and their effect on mosquito densities and differences in socioeconomic factors. This review provides important insight into the major epidemiological characteristics of dengue in distinct regions of Latin America and the Caribbean, allowing gaps in current knowledge and future research needs to be identified. Jaime Rafael Torres, Tomás Agustín Orduna, Maricela Piña-Pozas, Daniela Vázquez-Vega, and Elsa Sarti Copyright © 2017 Jaime Rafael Torres et al. All rights reserved. A Thermostabilized, One-Step PCR Assay for Simultaneous Detection of Klebsiella pneumoniae and Haemophilus influenzae Sun, 12 Mar 2017 06:52:31 +0000 Klebsiella pneumoniae and Haemophilus influenzae are two common pathogens associated with respiratory tract infections. The identification of these pathogens using conventional molecular diagnostic tests requires trained personnel, cold-chain transportation, and storage-dependance, which does not render them user-friendly. The aim of this study was to develop a thermostabilized, cold-chain-free, one-step multiplex PCR for simultaneous detection of K. pneumoniae and H. influenzae. The multiplex PCR assay was designed to amplify the php gene of K. pneumoniae (202 bp) and p6 gene of H. influenzae (582 bp). In addition, the specific primer to amplify glm gene of Helicobacter pylori (105 bp) was included as an internal amplification control. Subsequently, the designed primers and all PCR reagents were thermostabilized by lyophilization. The stability of the thermostabilized PCR was evaluated using the Q10 method. The sensitivity and specificity of performances for thermostabilized PCR were evaluated using 127 clinical isolates and were found to be 100% sensitive and specific. The thermostabilized PCR mix was found to be stable for 30 days and the Q10 accelerated stability was found to be 3.02 months. A cold-chain-free, PCR assay for easy, rapid, and simultaneous detection of K. pneumoniae and H. influenzae was successfully developed in this study. Nur Amalina Khazani, Nik Zuraina Nik Mohd Noor, Chan Yean Yean, Habsah Hasan, Siti Suraiya, and Suharni Mohamad Copyright © 2017 Nur Amalina Khazani et al. All rights reserved. Diversity of Leptospira spp. in Rats and Environment from Urban Areas of Sarawak, Malaysia Tue, 28 Feb 2017 00:00:00 +0000 Various prevalence studies on Leptospira in animals and humans, as well as environmental samples, had been conducted worldwide, including Malaysia. However, limited studies have been documented on the presence of pathogenic, intermediate, and saprophytic Leptospira in selected animals and environments. This study was therefore conducted to detect Leptospira spp. in rats, soil, and water from urban areas of Sarawak using the polymerase chain reaction (PCR) method. A total of 107 rats, 292 soil samples, and 324 water samples were collected from April 2014 to February 2015. Pathogenic Leptospira was present in 5.6% (6/107) of rats, 11.6% (34/292) of soil samples, and 1.9% (6/324) of water samples. Intermediate Leptospira was present in 2.7% (8/292) of soil samples and 1.9% (6/324) of water samples. Saprophytic Leptospira was present in 10.3% (11/107) of rats, 1.4% (4/292) of soil samples, and 0.3% (1/324) of water samples. From this study, 76 Leptospira spp. were isolated. Based on DNA sequencing, the dominant Leptospira spp. circulating in urban areas of Sarawak are pathogenic Leptospira noguchii, intermediate Leptospira wolffii serovar Khorat, and saprophytic Leptospira meyeri, respectively. Overall, this study provided important surveillance data on the prevalence of Leptospira spp. from rats and the environment, with dominant local serovars in urban areas of Sarawak. Chai Fung Pui, Lesley Maurice Bilung, Kasing Apun, and Lela Su’ut Copyright © 2017 Chai Fung Pui et al. All rights reserved. Incidence and Predictors of Antiretroviral Treatment Modification in HIV-Infected Adults: A Brazilian Historical Cohort from 2001 to 2010 Mon, 27 Feb 2017 12:20:22 +0000 This study estimated the incidence of and time to first antiretroviral therapy (ART) modification. This longitudinal analysis comprised a sample of 236 patients from three HIV/AIDS referral centers in Belo Horizonte, Brazil—part of a major historical cohort. Inclusion criteria were as follows: having been treatment-naive patient ≥18 years old who initiated ART between 2001 and 2005 in these three referral centers. The main endpoint was time to first ART modification. Patients were followed up for five years, covering the period 2001–2010, during which time Pearson’s chi-square test was performed to compare ART modification between groups. Kaplan-Meier inverse survival curves were employed to describe the probability of ART modification and Cox proportional hazard regression was used to estimate the adjusted hazard ratio (aHR) of ART modification. Among 247 patients from the major cohort, 236 were eligible. Median follow-up time was 37.2 months and the contribution in person-months was 7,615.4 months. A total of 108 (45.8%) patients had their ART regimen modified at least once (incidence rate: 1.42 per 100 person-months). Adverse drug reactions were the main reason for ART modification. Women (aHR = 1.62; ) and patients on protease inhibitor- (PI-) based regimens (aHR = 2.70; ) were at higher risk of ART modification. Letícia Penna Braga, Cássia Cristina Pinto Mendicino, Edna Afonso Reis, Ricardo Andrade Carmo, and Cristiane Menezes de Pádua Copyright © 2017 Letícia Penna Braga et al. All rights reserved. Nitazoxanide in Acute Rotavirus Diarrhea: A Randomized Control Trial from a Developing Country Sun, 26 Feb 2017 07:47:53 +0000 Background. Acute diarrhea is one of the leading causes of childhood mortality, with rotavirus being an important pathogen. Nitazoxanide, an antiparasitic agent, has been shown to inhibit rotavirus. Objective. This double-blind, randomized trial was designed to study the role of nitazoxanide in acute rotavirus diarrhea. Methods. Of 174 children (12 months to 5 years) with acute diarrhea, 50 rotavirus positive cases were randomized. The intervention group received syrup nitazoxanide twice daily (100 mg in 12–47 months, 200 mg in ≥4 yr) for 3 days along with standard treatment of diarrhea. Duration of diarrhea was the primary outcome measure. Results. The median duration (hrs) of diarrhea (54 versus 80; 95% CI: –26 [–13.2 to –38.8]) and hospitalization (68 versus 90; 95% CI: –22 [–12.98 to –31.02]) was significantly shorter in the nitazoxanide group. No significant difference was seen in the median duration (hrs) of fever or vomiting or the proportion of children requiring parenteral rehydration. There was no report of any adverse events. Conclusions. Oral nitazoxanide is effective and safe in the management of acute rotavirus diarrhea in Indian children (CTRI REF/2016/10/012507). Samarendra Mahapatro, Nijwm Mahilary, Amit Kumar Satapathy, and Rashmi Ranjan Das Copyright © 2017 Samarendra Mahapatro et al. All rights reserved. Loop-Mediated Isothermal Amplification Test for Trypanosoma gambiense Group 1 with Stem Primers: A Molecular Xenomonitoring Test for Sleeping Sickness Tue, 21 Feb 2017 07:04:17 +0000 The World Health Organization has targeted Human African Trypanosomiasis (HAT) for elimination by 2020 with zero incidence by 2030. To achieve and sustain this goal, accurate and easy-to-deploy diagnostic tests for Gambian trypanosomiasis which accounts for over 98% of reported cases will play a crucial role. Most needed will be tools for surveillance of pathogen in vectors (xenomonitoring) since population screening tests are readily available. The development of new tests is expensive and takes a long time while incremental improvement of existing technologies that have potential for xenomonitoring may offer a shorter pathway to tools for HAT surveillance. We have investigated the effect of including a second set of reaction accelerating primers (stem primers) to the standard T. brucei gambiense LAMP test format. The new test format was analyzed with and without outer primers. Amplification was carried out using Rotorgene 6000 and the portable ESE Quant amplification unit capable of real-time data output. The stem LAMP formats indicated shorter time to results (~8 min), were 10–100-fold more sensitive, and indicated higher diagnostic sensitivity and accuracy compared to the standard LAMP test. It was possible to confirm the predicted product using ESE melt curves demonstrating the potential of combining LAMP and real-time technologies as possible tool for HAT molecular xenomonitoring. Zablon K. Njiru, Cecilia K. Mbae, and Gitonga N. Mburugu Copyright © 2017 Zablon K. Njiru et al. All rights reserved. Ending Preventable Child Deaths from Pneumonia and Diarrhoea in Afghanistan: An Analysis of Intervention Coverage Scenarios Using the Lives Saved Tool Sun, 19 Feb 2017 00:00:00 +0000 Background. Despite improvements in child health, Afghanistan still has a heavy burden of deaths due to preventable causes: 17% of under-5 deaths are due to pneumonia and 12% are due to diarrhoea. Objective. This article describes the situation of childhood pneumonia and diarrhoea in Afghanistan, including efforts to prevent, protect, and treat the two diseases. It estimates lives saved by scaling up interventions. Methods. A secondary analysis of data was conducted and future scenarios were modelled to estimate lives saved by scaling up a package of interventions. Results. The analysis reveals that 10,795 additional child deaths could be averted with a moderate scale-up of interventions, decreasing the under-five mortality rate in Afghanistan from 55 per 1,000 live births in 2015 to 40 per 1,000 in 2020. In an ambitious scale-up scenario, an additional 15,096 lives could be saved. There would be a 71% reduction in child deaths due to these two causes between 2016 and 2020 in the ambitious scenario compared to 47% reduction in the moderate scenario. Conclusion. Significant reductions in child mortality can be achieved through scale-up of essential interventions to prevent and treat pneumonia and diarrhoea. Strengthened primary health care functions and multisector collaboration on child health are suggested. Ariel Higgins-Steele, Khaksar Yousufi, Sharmina Sultana, Alawi Sayed Ali, and Sherin Varkey Copyright © 2017 Ariel Higgins-Steele et al. All rights reserved. Parasitological Indices of Malaria Transmission in Children under Fifteen Years in Two Ecoepidemiological Zones in Southwestern Burkina Faso Mon, 13 Feb 2017 00:00:00 +0000 Twenty years after the latest publications performed on the parasitological indices of malaria transmission in northwest of the second city of Burkina Faso, it was important to update the epidemiological profile of malaria in children under the age of 15 years. The objective of this study was to determine and compare the parasitological parameters of malaria transmission by season, area, and age in the two zones (rice and savanna) in the northwest of Bobo-Dioulasso, Burkina Faso. Overall, the results showed that there was no significant difference in the parasitological indices of malaria transmission within children under fifteen years between the rice site and the savannah site and whatever the season (). The profound environmental modifications that occurred in the rice zone would have led to changes in vector behavior and consequently to changes in the epidemiological profile of malaria, contrary to the results obtained since the last publications. An entomological study correlated with this study is therefore necessary for effective decision-making for the malaria control in both areas. Future research must now focus on the impact that these profound environmental modifications of rice area are having on malaria control in Burkina Faso. Aristide S. Hien, Ibrahim Sangaré, Sanata Coulibaly, Moussa Namountougou, Léa Paré-Toé, Anicet Georges Ouédraogo, Abdoulaye Diabaté, Brian D. Foy, and Roch K. Dabiré Copyright © 2017 Aristide S. Hien et al. All rights reserved. Clinical Profile and Visual Outcome of Ocular Bartonellosis in Malaysia Tue, 07 Feb 2017 08:22:17 +0000 Background. Ocular bartonellosis can present in various ways, with variable visual outcome. There is limited data on ocular bartonellosis in Malaysia. Objective. We aim to describe the clinical presentation and visual outcome of ocular bartonellosis in Malaysia. Materials and Methods. This was a retrospective review of patients treated for ocular bartonellosis in two ophthalmology centers in Malaysia between January 2013 and December 2015. The diagnosis was based on clinical features, supported by a positive Bartonella spp. serology. Results. Of the 19 patients in our series, females were predominant (63.2%). The mean age was 29.3 years. The majority (63.2%) had unilateral involvement. Five patients (26.3%) had a history of contact with cats. Neuroretinitis was the most common presentation (62.5%). Azithromycin was the antibiotic of choice (42.1%). Concurrent systemic corticosteroids were used in approximately 60% of cases. The presenting visual acuity was worse than 6/18 in approximately 60% of eyes; on final review, 76.9% of eyes had a visual acuity better than 6/18. Conclusion. Ocular bartonellosis tends to present with neuroretinitis. Azithromycin is a viable option for treatment. Systemic corticosteroids may be considered in those with poor visual acuity on presentation. Chai Lee Tan, Lai Chan Fhun, Evelyn Li Min Tai, Nor Hasnida Abdul Gani, Julieana Muhammed, Tengku Norina Tuan Jaafar, Liza Sharmini Ahmad Tajudin, and Wan-Hazabbah Wan Hitam Copyright © 2017 Chai Lee Tan et al. All rights reserved. Assessment of Antiretroviral Treatment Adherence among Children Attending Care at a Tertiary Hospital in Southeastern Nigeria Sun, 05 Feb 2017 12:24:05 +0000 Background. Adherence is the strongest predictor of successful treatment outcome among children infected with HIV. Our aim was to assess the antiretroviral drugs adherence status of HIV-infected children attending care at a tertiary hospital in Southeastern Nigeria. Method. The study involved a cross-sectional survey of 210 HIV-infected children attending care at a tertiary hospital in Southeastern Nigeria using self-report method of assessment. Optimal ART adherence is defined as patient taking not missing more than 1 dose of combined antiretroviral therapy medication in the preceding 2 weeks prior to the study. Result. A majority of the subjects 191 (91%) had good adherence. There was a significant relationship between adherence and patient educational level (), duration of treatment (), drug administrator (), and orphan status (). The motivating factor for adherence was “not falling sick as before” while stigma was the most discouraging factor. Conclusion. The adherence level in this study was good. Stigma was an important reason given by patient/caregivers for nonadherence. There is need for concerted effort in addressing this barrier to improve adherence and prevent the emergence of drug resistance and treatment failure. Cletus Akahara, Emeka Nwolisa, Kelechi Odinaka, and Seline Okolo Copyright © 2017 Cletus Akahara et al. All rights reserved. Use of Molecular Methods for the Rapid Mass Detection of Schistosoma mansoni (Platyhelminthes: Trematoda) in Biomphalaria spp. (Gastropoda: Planorbidae) Thu, 26 Jan 2017 00:00:00 +0000 The low stringency-polymerase chain reaction (LS-PCR) and loop-mediated isothermal amplification (LAMP) assays were used to detect the presence of S. mansoni DNA in (1) Brazilian intermediate hosts (Biomphalaria glabrata, B. straminea, and B. tenagophila) with patent S. mansoni infections, (2) B. glabrata snails with prepatent S. mansoni infections, (3) various mixtures of infected and noninfected snails; and (4) snails infected with other trematode species. The assays showed high sensitivity and specificity and could detect S. mansoni DNA when one positive snail was included in a pool of 1,000 negative specimens of Biomphalaria. These molecular approaches can provide a low-cost, effective, and rapid method for detecting the presence of S. mansoni in pooled samples of field-collected Biomphalaria. These assays should aid mapping of transmission sites in endemic areas, especially in low prevalence regions and improve schistosomiasis surveillance. It will be a useful tool to monitor low infection rates of snails in areas where control interventions are leading towards the elimination of schistosomiasis. Roberta Lima Caldeira, Liana Konovaloffi Jannotti-Passos, and Omar Dos Santos Carvalho Copyright © 2017 Roberta Lima Caldeira et al. All rights reserved. Development and Validation of a PCR-ELISA for the Diagnosis of Symptomatic and Asymptomatic Infection by Leishmania (Leishmania) infantum Mon, 09 Jan 2017 07:23:38 +0000 A kDNA PCR enzyme-linked immunosorbent assay (kDNA PCR-ELISA) for the diagnosis of human visceral leishmaniasis (HVL) was developed. The detection limit of the reaction, precision measurements, and cut-off of the kDNA PCR-ELISA were defined in a proof-of-concept phase. A reference strain of Leishmania (Leishmania) infantum and a bank of 14 peripheral blood samples from immunocompetent patients with VL were characterized using techniques considered gold standards, and 11 blood samples obtained from healthy individuals of an endemic area were also assessed. Phase II evaluation determined the performance of the assay in peripheral blood samples from 105 patients with VL (adults and children), 25 patients with Leishmania/HIV coinfection, 40 healthy individuals, and 33 asymptomatic individuals living in endemic areas. The kDNA PCR-ELISA exhibited satisfactory precision, with a detection limit of 0.07 fg of DNA from L. (L.) infantum and 1 parasite/mL blood. The overall sensitivity of the assay for all groups studied was 100% (95% confidence interval [CI]: 97.1–100%), and the specificity was 95% (95% CI: 83.5–98.6%). The kDNA PCR-ELISA was shown to be a useful tool for VL symptomatic and asymptomatic individuals diagnosis and its use in endemic countries may help monitor control interventions. Fernanda Alvarenga Cardoso Medeiros, Luciana Inácia Gomes, Edward Oliveira, Carolina Senra Alves de Souza, Maria Vitória Mourão, Gláucia Fernandes Cota, Letícia Helena dos Santos Marques, Mariângela Carneiro, and Ana Rabello Copyright © 2017 Fernanda Alvarenga Cardoso Medeiros et al. All rights reserved. Potential Distribution of Chagas Disease Vectors (Hemiptera, Reduviidae, Triatominae) in Colombia, Based on Ecological Niche Modeling Wed, 28 Dec 2016 12:52:59 +0000 Ecological niche modeling of Triatominae bugs allow us to establish the local risk of transmission of the parasite Trypanosoma cruzi, which causes Chagas disease. This information could help to guide health authority recommendations on infection monitoring, prevention, and control. In this study, we estimated the geographic distribution of triatomine species in Colombia and identified the relationship between landscape structure and climatic factors influencing their occurrence. A total of 2451 records of 4 triatomine species (Panstrongylus geniculatus, Rhodnius pallescens, R. prolixus, and Triatoma maculata) were analyzed. The variables that provided more information to explain the ecologic niche of these vectors were related to precipitation, altitude, and temperature. We found that the species with the broadest potential geographic distribution were P. geniculatus, R. pallescens, and R. prolixus. In general, the models predicted the highest occurrence probability of these vectors in the eastern slope of the Eastern Cordillera, the southern region of the Magdalena valley, and the Sierra Nevada of Santa Marta. Gabriel Parra-Henao, Laura C. Suárez-Escudero, and Sebastián González-Caro Copyright © 2016 Gabriel Parra-Henao et al. All rights reserved. Molecular Epidemiology and Genetic Diversity of Norovirus in Young Children in Phnom Penh, Cambodia Tue, 27 Dec 2016 11:02:00 +0000 This study investigated the genetic diversity of noroviruses identified from a previous surveillance study conducted at the National Pediatric Hospital in Phnom Penh, Cambodia, from 2004 to 2006. In the previous study, 926 stool samples were collected from children aged 3–60 months with acute diarrhea (cases) and without diarrhea (controls) with reported 6.7% of cases and 3.2% of controls being positive for norovirus. The initial norovirus diagnostic assay was performed with real-time reverse transcription-polymerase chain reaction (real-time RT PCR) which also distinguished between genogroups I and II (GI and GII). Norovirus infection was most commonly detected in children aged 12–23 months in both cases and controls. Norovirus Genotyping Tool and phylogenetic analysis of partial sequences of the 3′ end of the RNA-dependent RNA Polymerase (RdRp) and the capsid domain region were employed to assign genotypes of the norovirus strains. GII.4 was the most predominant capsid genotype detected at 39.5% followed by GII.6 at 14.9%. The GII.4 Hunter 2004 variant was the predominant strain detected. Six RdRP/capsid recombinants including GII.P7/GII.6, GII.P7/GII.14, GII.P7/GII.20, GII.P12/GII.13, GII.P17/GII.16, and GII.P21/GII.3 were also identified. This study of norovirus infection in young children in Cambodia suggests genetic diversity of norovirus as reported worldwide. Kaewkanya Nakjarung, Ladaporn Bodhidatta, Pimmnapar Neesanant, Paphavee Lertsethtakarn, Orntipa Sethabutr, Ket Vansith, Chhour Y. Meng, Brett E. Swierczewski, and Carl J. Mason Copyright © 2016 Kaewkanya Nakjarung et al. All rights reserved. Associated Factors to Seroprevalence of Ehrlichia spp. in Dogs of Quintana Roo, Mexico Wed, 21 Dec 2016 07:48:26 +0000 The objective of this study was to determine the seroprevalence to Ehrlichia spp. in dogs from Xcalak, Quintana Roo, Mexico, and the associated factors. Serum samples were obtained from 118 dogs and used in an indirect immunofluorescent assay test for the detection of antibodies against Ehrlichia spp. A questionnaire was used to obtain information about possible variables associated with seroprevalence. These variables were analyzed through Chi2 test and logistic regression. Dog seroprevalence of antibodies against Ehrlichia spp. was 64% (75/118). Fifty-two percent (61/118) of dogs had tick infestation which was identified as Rhipicephalus sanguineus sensu lato. Anemia was observed in 36% of dogs. Leucopenia (2.5%), thrombocytopenia (70%), and hemorrhage (14%) were also observed. Thirty-one percent (23/75) of dogs with anemia, 4% (3/75) of dogs with leucopenia, 80% (60/75) of dogs with thrombocytopenia, 17% (13/75) of dogs with hemorrhages, and 59% (44/75) of dogs with ticks were positive for Ehrlichia spp. antibodies. The factors associated with seroprevalence were age (1–3 and >3 years old, OR = 7.77 and OR = 15.39, resp.), tick infestation (OR = 3.13), and thrombocytopenia (OR = 3.36). In conclusion, seroprevalence of Ehrlichia spp. was high in the community of Xcalak and its associated factors were age, tick infestation, and thrombocytopenia. Pedro Pablo Martínez-Vega, Manuel Emilio Bolio-Gonzalez, Roger Iván Rodríguez-Vivas, Eduardo Gutierrez-Blanco, Carlos Pérez-Osorio, Sandra Luz Villegas-Perez, and Carlos Humberto Sauri-Arceo Copyright © 2016 Pedro Pablo Martínez-Vega et al. All rights reserved. Urinary Schistosomiasis among Children in Murbai and Surbai Communities of Ardo-Kola Local Government Area, Taraba State, Nigeria Wed, 14 Dec 2016 12:57:39 +0000 Background. This cross-sectional study was conducted to determine the prevalence, intensity of infection, and risk factors associated with urinary schistosomiasis among children in Murbai and Surbai communities of Ardo-Kola Local Government Area (LGA), Taraba State, Nigeria. Methods. Urine samples were analysed by the standard filtration technique using 10 ml syringe, Swinnex polypropylene filter holder (13 mm diameter), and polycarbonate membrane filters (12 μm porosity). Sociodemographic data and water contact activities were collated from children using structured questionnaires. Results. A point prevalence of 58.54% was reported out of the urine samples examined. Males were significantly more infected than their female counterparts (71.15% versus 43.66%, = 89.12, ). The age-related prevalence showed 6–10 and 11–15 years significantly infected with 78.70% and 73.02%, respectively ( = 89.12, ). Light intensity of infection, 62.51%, was significantly higher than heavy intensity, 37.48%, among the infected children ( = 365.8, ). Water contact activities such as fishing (OR = 4.01, CI = 3.04–5.61, ), rice farming (OR = 4.01, CI = 2.96–5.36, ), and dry season farming (OR = 4.78, CI = 3.68–6.22, ) were the risk factors exposing children to infection in the area. Conclusion. There is an urgent need to undertake a large scale deworming control programme using praziquantel in the area. R. S. Houmsou, H. Agere, B. E. Wama, J. B. Bingbeng, E. U. Amuta, and S. L. Kela Copyright © 2016 R. S. Houmsou et al. All rights reserved. Current Epidemiological Assessment of Bancroftian Filariasis in Tanga Region, Northeastern Tanzania Tue, 06 Dec 2016 11:49:01 +0000 Background. Tanzania started a countrywide lymphatic filariasis elimination programme in 2000 adopting the mass drug administration (MDA) strategy. The drug used for the programme was the combination of ivermectin and albendazole. However, there is limited information on the current epidemiological trend of the infections, where MDA implementation is ongoing. The present study aimed at assessing the current status of Bancroftian filariasis infection rate and morbidity where MDA has been distributed and administered for over eight rounds. Methodology. The study was a cross-sectional descriptive study involving 272 individuals (>18 years) from endemic communities in Tanga region where MDA has been implemented. Clinical, sociodemographic, and circulating filarial antigen (CFA) test was undertaken using immune chromatographic card test according to the manufacturer’s instructions. Results. A total of 472 individuals were screened: 307/472 (65.1%) were males while 165/472 (34.9%) were females. The overall prevalence of CFA was 5.51%, that of hydrocoele was 73.2%, and that of lymphoedema was 16.0%. The prevalence of hydrocoele combined with lymphoedema was 5.5%. Conclusion. Our findings demonstrate a considerable reduction in filarial infection. However, there is clear evidence of ongoing transmission despite the 8 rounds of MDA. It is unlikely that the annual MDA would interrupt filarial transmission; therefore, additional strategies are needed to accelerate lymphatic filariasis control and elimination. Happyness J. Mshana, Vito Baraka, Gerald Misinzo, and Williams H. Makunde Copyright © 2016 Happyness J. Mshana et al. All rights reserved.