Journal Description
Tropical Medicine and Infectious Disease
Tropical Medicine and Infectious Disease
is an international, scientific, peer-reviewed, open access journal of tropical medicine and infectious disease published monthly online by MDPI. It is the official journal of the Australasian College of Tropical Medicine (ACTM) and its Joint Faculties of Travel Medicine and Expedition and Wilderness Medicine.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within Scopus, SCIE (Web of Science), PubMed, PMC, Embase, Informit, and other databases.
- Journal Rank: JCR - Q1 (Tropical Medicine) / CiteScore - Q2 (Public Health, Environmental and Occupational Health)
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 20.9 days after submission; acceptance to publication is undertaken in 4.8 days (median values for papers published in this journal in the first half of 2024).
- Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
Impact Factor:
2.8 (2023);
5-Year Impact Factor:
3.0 (2023)
Latest Articles
Molecular Testing of Environmental Samples as a Potential Source to Estimate Parasite Infection
Trop. Med. Infect. Dis. 2024, 9(10), 226; https://doi.org/10.3390/tropicalmed9100226 - 26 Sep 2024
Abstract
We discuss the potential usefulness of molecular testing of soil, dust, and water samples to detect medically important parasites, and where such testing could be used to supplement stool sampling in humans. A wide variety of parasites including protozoa and helminths, many of
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We discuss the potential usefulness of molecular testing of soil, dust, and water samples to detect medically important parasites, and where such testing could be used to supplement stool sampling in humans. A wide variety of parasites including protozoa and helminths, many of which are zoonotic, have an important infection reservoir in the environment. In some cases, this environmental period is essential for further parasite development. We describe the progress in implementing methods for the molecular detection of these parasites in soil across eight collaborating centers in Latin America and represent a variety of potential applications in improving our understanding of parasite epidemiology and mapping, surveillance, and control of these parasites. This methodology offers new opportunities for improving our understanding of a wide variety of parasites of public health importance and novel tools for their control.
Full article
(This article belongs to the Special Issue Molecular Diagnosis and Risk Assessment of Helminth Infections)
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Geospatial Analysis of Abiotic and Biotic Conditions Associated with Leptospirosis in the Klaten Regency, Central Java, Indonesia
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Dwi Sutiningsih, Dewi Puspito Sari, Cintya Dipta Permatasari, Nur Azizah Azzahra, Alfonso J. Rodriguez-Morales, Sri Yuliawati and Nine Elissa Maharani
Trop. Med. Infect. Dis. 2024, 9(10), 225; https://doi.org/10.3390/tropicalmed9100225 - 24 Sep 2024
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The Klaten Regency, Central Java Province, Indonesia, is a leptospirosis endemic area. The purpose of this study is to spatially describe the abiotic and biotic environmental factors that contributed to the incidence of leptospirosis in the Klaten Regency in 2018. This was a
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The Klaten Regency, Central Java Province, Indonesia, is a leptospirosis endemic area. The purpose of this study is to spatially describe the abiotic and biotic environmental factors that contributed to the incidence of leptospirosis in the Klaten Regency in 2018. This was a descriptive observational with a cross-sectional approach conducted in the Klaten Regency, Central Java, in 2019 with 59 respondents. The results revealed that the percentage of abiotic environmental factors such as poor waste disposal facilities, poor gutter conditions, rivers < 200 m, and flooding history, namely 35.6%, 41.2%, 54.2%, and 6.8%, respectively. The highest leptospirosis cases occurred in April 2018, with 325 mm of rainfall, an average temperature of 27 °C, an average humidity of 82.3%, and an altitude of 100–200 MASL (79.7%). Meanwhile, biotic factors included rat nest existence (100%), having pets at risk (32.2%), and ≥three types of vegetation (79.7%). The main result confirmed that all leptospirosis cases had rat nests throughout the respondent’s house. This finding emphasizes the importance of rat pest control programs by establishing cross-sectoral collaboration with the Department of Agriculture and educating the public to also play a role in environmental cleanliness in controlling rats.
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Open AccessCase Report
Think Vibrio, Think Rare: Non-O1-Non-O139- Vibrio cholerae Bacteremia in Advanced Lung Cancer—A Case Report
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Andrea Marino, Bruno Cacopardo, Laura Villa, Adriana D’Emilio, Salvatore Piro and Giuseppe Nunnari
Trop. Med. Infect. Dis. 2024, 9(9), 224; https://doi.org/10.3390/tropicalmed9090224 - 21 Sep 2024
Abstract
Vibrio cholerae, a Gram-negative bacterium, is widely known as the cause of cholera, an acute diarrheal disease. While only certain strains are capable of causing cholera, non-O1/non-O139 V. cholerae strains (NOVC) can lead to non-pathogenic colonization or mild illnesses such as gastroenteritis.
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Vibrio cholerae, a Gram-negative bacterium, is widely known as the cause of cholera, an acute diarrheal disease. While only certain strains are capable of causing cholera, non-O1/non-O139 V. cholerae strains (NOVC) can lead to non-pathogenic colonization or mild illnesses such as gastroenteritis. In immunocompromised patients, however, NOVC can cause severe infections, including rare cases of bacteremia, especially in those with underlying conditions like liver disease, hematologic disorders, and malignancies. This case report presents a rare instance of NOVC bacteremia in a 71-year-old patient with advanced lung cancer, illustrating the clinical presentation, diagnostic challenges, and treatment interventions required. The patient presented with fever, asthenia, and confusion, and was found to have bacteremia caused by NOVC, confirmed through blood cultures and molecular analysis. Treatment with intravenous ceftriaxone and ciprofloxacin led to a rapid clinical improvement and resolution of the infection. This case, along with an overview of similar incidents, underscores the importance of considering NOVC in differential diagnoses for immunocompromised patients presenting with fever, and highlights the necessity of timely diagnosis and targeted antimicrobial therapy to achieve favorable outcomes.
Full article
(This article belongs to the Special Issue Foodborne Zoonotic Bacterial Infections)
Open AccessReview
Antimalarial Mechanisms and Resistance Status of Artemisinin and Its Derivatives
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Dan Zheng, Tingting Liu, Shasha Yu, Zhilong Liu, Jing Wang and Ying Wang
Trop. Med. Infect. Dis. 2024, 9(9), 223; https://doi.org/10.3390/tropicalmed9090223 - 20 Sep 2024
Abstract
Artemisinin is an endoperoxide sesquiterpene lactone isolated from Artemisia annua and is often used to treat malaria. Artemisinin’s peroxide bridge is the key structure behind its antimalarial action. Scientists have created dihydroartemisinin, artemether, artesunate, and other derivatives preserving artemisinin’s peroxide bridge to increase
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Artemisinin is an endoperoxide sesquiterpene lactone isolated from Artemisia annua and is often used to treat malaria. Artemisinin’s peroxide bridge is the key structure behind its antimalarial action. Scientists have created dihydroartemisinin, artemether, artesunate, and other derivatives preserving artemisinin’s peroxide bridge to increase its clinical utility value. Artemisinin compounds exhibit excellent efficacy, quick action, and minimal toxicity in malaria treatment and have greatly contributed to malaria control. With the wide and unreasonable application of artemisinin-based medicines, malaria parasites have developed artemisinin resistance, making malaria prevention and control increasingly challenging. Artemisinin-resistant Plasmodium strains have been found in many countries and regions. The mechanisms of antimalarials and artemisinin resistance are not well understood, making malaria prevention and control a serious challenge. Understanding the antimalarial and resistance mechanisms of artemisinin drugs helps develop novel antimalarials and guides the rational application of antimalarials to avoid the spread of resistance, which is conducive to malaria control and elimination efforts. This review will discuss the antimalarial mechanisms and resistance status of artemisinin and its derivatives, which will provide a reference for avoiding drug resistance and the research and development of new antimalarial drugs.
Full article
(This article belongs to the Special Issue Epidemiology, Detection and Treatment of Malaria)
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Open AccessReview
Chemical Control of Snail Vectors as an Integrated Part of a Strategy for the Elimination of Schistosomiasis—A Review of the State of Knowledge and Future Needs
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Amadou Garba Djirmay, Rajpal Singh Yadav, Jiagang Guo, David Rollinson and Henry Madsen
Trop. Med. Infect. Dis. 2024, 9(9), 222; https://doi.org/10.3390/tropicalmed9090222 - 20 Sep 2024
Abstract
WHO promotes the implementation of a comprehensive strategy to control and eliminate schistosomiasis through preventive chemotherapy, snail control, clean water supply, improved sanitation, behaviour change interventions, and environmental management. The transmission of schistosomiasis involves infected definitive hosts (humans or animals) excreting eggs that
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WHO promotes the implementation of a comprehensive strategy to control and eliminate schistosomiasis through preventive chemotherapy, snail control, clean water supply, improved sanitation, behaviour change interventions, and environmental management. The transmission of schistosomiasis involves infected definitive hosts (humans or animals) excreting eggs that hatch (miracidia), which infect freshwater snail vectors (also referred to as intermediate snail hosts) living in marshlands, ponds, lakes, rivers, or irrigation canals. Infective larvae (cercariae) develop within the snail, which, when released, may infect humans and/or animals in contact with the water. Snail control aims to interrupt the transmission cycle of the disease by removing the vector snails and, by so doing, indirectly improves the impact of the preventive chemotherapy by reducing reinfection. Snail control was, for many years, the only strategy for the prevention of schistosomiasis before preventive chemotherapy became the primary intervention. Snails can be controlled through various methods: environmental control, biological control, and chemical control. The chemical control of snails has proven to be the most effective method to interrupt the transmission of schistosomiasis. The current review aims to describe the vector snails of human schistosomiasis, present the chemicals and strategies for the control of snails, the challenges with the implementation, and the future needs. Snail control can play a key role in reducing schistosomiasis transmission and, thus, complements other interventions for disease control. There is a need to develop new molluscicide products or new formulations and methods of applications for existing molluscicides that would target snail vectors more specifically.
Full article
(This article belongs to the Section Vector-Borne Diseases)
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Open AccessReview
Schistosomiasis in the Military—A Narrative Review
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Diana Isabela Costescu Strachinaru, Jemima Nyaboke Nyandwaro, Anke Stoefs, Eric Dooms, Peter Vanbrabant, Pierre-Michel François, Mihai Strachinaru, Marjan Van Esbroeck, Emmanuel Bottieau and Patrick Soentjens
Trop. Med. Infect. Dis. 2024, 9(9), 221; https://doi.org/10.3390/tropicalmed9090221 - 19 Sep 2024
Abstract
Schistosomiasis is a parasitosis caused by trematodes of the genus Schistosoma. Humans are infected when coming into contact with freshwater containing the parasites’ infective stages, which are amplified through freshwater-dwelling snails acting as intermediate hosts. Schistosomiasis has posed significant problems for troops
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Schistosomiasis is a parasitosis caused by trematodes of the genus Schistosoma. Humans are infected when coming into contact with freshwater containing the parasites’ infective stages, which are amplified through freshwater-dwelling snails acting as intermediate hosts. Schistosomiasis has posed significant problems for troops exposed to freshwater in endemic regions ever since the Napoleonic wars. Schistosomiasis has substantial differences in clinical presentation, depending on the type of parasite, intensity of infection and reinfection, clinical form, and disease stage. It can remain undiagnosed for long periods of time, with well-known long-term morbidity and mortality risks. The diagnosis of schistosomiasis depends on its stage and relays on several tests, all with limitations in sensitivity and specificity. The diagnostic gold standard is the detection of eggs in urine, feces, or tissue biopsies, but this can raise problems in patients such as military personnel, in which the worm burden is usually low. Praziquantel is the drug of choice for schistosomiasis. Currently, there is no available commercial vaccine against any Schistosoma parasite. Avoiding freshwater exposure is the best prevention. Herein, we review the clinical presentation, diagnosis, treatment, and prevention of schistosomiasis in the military. This information may decrease the impact of schistosomiasis on this particular professional group.
Full article
(This article belongs to the Special Issue Military Medicine: An Everlasting War against Tropical and Infectious Diseases)
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Open AccessArticle
People Who Self-Reported Testing HIV-Positive but Tested HIV-Negative: A Multi-Country Puzzle of Data, Serology, and Ethics, 2015–2021
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Melissa Metz, Vivian Hope Among, Tafadzwa Dzinamarira, Faith Ussery, Peter Nkurunziza, Janet Bahizi, Samuel Biraro, Francis M. Ogollah, Joshua Musinguzi, Wilford Kirungi, Mary Naluguza, Christina Mwangi, Sehin Birhanu, Lisa J. Nelson, Herbert Longwe, Frieda Sara Winterhalter, Andrew C. Voetsch, Bharat S. Parekh, Hetal K. Patel, Yen T. Duong, Rachel Bray and Shannon M. Farleyadd
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Trop. Med. Infect. Dis. 2024, 9(9), 220; https://doi.org/10.3390/tropicalmed9090220 - 19 Sep 2024
Abstract
During population-based HIV impact assessments (PHIAs), some participants who self-reported testing HIV-positive (PSRP) tested negative in one or more subsequent survey HIV tests. These unexpected discrepancies between their self-reported results and the survey results draw into question the validity of either the self-reported
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During population-based HIV impact assessments (PHIAs), some participants who self-reported testing HIV-positive (PSRP) tested negative in one or more subsequent survey HIV tests. These unexpected discrepancies between their self-reported results and the survey results draw into question the validity of either the self-reported status or the test results. We analyzed PSRP with negative test results aged 15–59 years old using data collected from 2015 to 2021 in 13 countries, assessing prevalence, self-report status, survey HIV status, viral load, rapid tests and confirmatory tests, and answers to follow-up questions (such as years on treatment). Across these surveys, 19,026 participants were PSRP, and 256 (1.3%) of these were concluded to be HIV-negative after additional survey-based testing and review. PSRP determined to be HIV-negative trended higher in countries with a higher HIV prevalence, but their number was small enough that accepting self-reported HIV-positive status without testing would not have significantly affected the prevalence estimates for HIV or viral load suppression. Additionally, using more detailed information for Uganda, we examined 107 PSRP with any negative test results and found no significant correlation with years on treatment or age. Using these details, we examined support for the possible reasons for these discrepancies beyond misdiagnosis and false reporting. These findings suggest that those conducting surveys would benefit from a nuanced understanding of HIV testing among PSRP to conduct surveys ethically and produce high-quality results.
Full article
(This article belongs to the Section Infectious Diseases)
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Open AccessSystematic Review
Evaluation of Chemokines MIG and IP-10 as Immunological Biomarkers of Human Visceral Leishmaniasis: A Systematic Review
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Bruna Eduarda Freitas Monteiro, Elis Dionísio da Silva, Walter Lins Barbosa Júnior, Amanda Virginia Batista Vieira, Roberta dos Santos Souza, Maria Karollyne dos Santos Paiva, Pablo Cantalice Santos Farias, Diego Lins Guedes, Gilberto Silva Nunes Bezerra and Zulma Maria de Medeiros
Trop. Med. Infect. Dis. 2024, 9(9), 219; https://doi.org/10.3390/tropicalmed9090219 - 19 Sep 2024
Abstract
Visceral leishmaniasis (VL) is a neglected tropical disease that is potentially fatal when untreated. Current diagnostic methods have limitations that contribute to ongoing transmission and poor prognosis. Thus, new tests are needed to provide quick, accurate diagnoses and evaluate clinical progression and treatment
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Visceral leishmaniasis (VL) is a neglected tropical disease that is potentially fatal when untreated. Current diagnostic methods have limitations that contribute to ongoing transmission and poor prognosis. Thus, new tests are needed to provide quick, accurate diagnoses and evaluate clinical progression and treatment efficacy. The monokine induced by interferon-gamma (MIG) and interferon-gamma-inducible protein 10 (IP-10) has been associated with the host susceptibility to VL with potential diagnostic and prognostic purposes. We performed a systematic review using four search databases (Scopus, PubMed, Web of Science, and MEDLINE) to identify studies assessing MIG and IP-10 as potential biomarkers in patients with VL across various clinical conditions. A total of 13 studies were potentially eligible and included in this review. The articles, in general, reveal that the chemokines MIG and IP-10 are elevated in response to infection by Leishmania spp., acting on the host’s resistance to the development of the disease. They are associated with asymptomatic conditions and after VL treatment, and this relationship can be observed in both immunocompetent and immunocompromised individuals. Consequently, these chemokines hold relevance in the diagnoses and appropriate management of individuals with VL.
Full article
(This article belongs to the Special Issue Advances in Parasitic Neglected Tropical Diseases)
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Tolerability and Safety of Miltefosine for the Treatment of Cutaneous Leishmaniasis
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Nadav Astman, Chen Arbel, Oren Katz, Aviv Barzilai, Michal Solomon and Eli Schwartz
Trop. Med. Infect. Dis. 2024, 9(9), 218; https://doi.org/10.3390/tropicalmed9090218 - 19 Sep 2024
Abstract
Miltefosine, an orally administered drug, is an important component of the therapeutic arsenal against visceral and mucosal forms of leishmaniasis. However, data regarding the safety and tolerability of miltefosine treatment for cutaneous leishmaniasis (CL) are relatively limited. The aim of this study was
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Miltefosine, an orally administered drug, is an important component of the therapeutic arsenal against visceral and mucosal forms of leishmaniasis. However, data regarding the safety and tolerability of miltefosine treatment for cutaneous leishmaniasis (CL) are relatively limited. The aim of this study was to evaluate the tolerability, safety, and adverse events (AEs) of miltefosine treatment in patients with CL. In this cohort study, we reviewed the medical records of all miltefosine-treated patients between 1 January 2016 and 31 December 2022, at Israel Defense Forces military dermatology clinics and the dermatology and Tropical Medicine Clinics at Chaim Sheba Medical Center, Ramat-Gan, Israel. A total of 68 patients (54 males, 79%) with a median age of 30.3 ± 15.6 years (range: 18–88) were included in this study. Leishmania species were identified as L. major (n = 37, 54.4%), L. tropica (n = 12, 17.6%), L. braziliensis (n = 18, 26.5%), and L. infantum (n = 1, 1.5%) using polymerase chain reaction (PCR). Miltefosine tablets were administered orally at a dose of 50 mg, three times daily, for 28 days. Overall, 44 patients (65%) completed the 28-day treatment, and the remaining patients required dose reduction or early discontinuation of treatment. AEs (of any degree) were common, reported in 91% of patients. Both previously reported and previously unreported AEs were documented. Gastrointestinal symptoms (66.1%) and malaise (23.5%) typically occurred during the first two weeks of treatment and tended to subside. Other AEs, including acute renal failure (20.6%), sudden and severe pleuritic chest pain (7.6%), acne exacerbation (11.8%), suppuration of CL lesions (17.8%), and AEs related to the male genitourinary system (39.6% of males), typically occurred towards the end of treatment. The latter included testicular pain, epididymitis, diminution or complete absence of ejaculate, inability to orgasm, and impotence. Severe AEs necessitated treatment discontinuation (29.4%) or hospitalization (10.3%). URTI-like symptoms, arthritis, cutaneous eruption, pruritus, and laboratory abnormalities were also observed. Overall, the cure rate (for all patients combined) evaluated 3 months after the completion of treatment was 60%. The tolerability of miltefosine treatment for CL is low. Close clinical and laboratory monitoring is required during treatment, as severe AEs are not uncommon. As new insights regarding its toxicities emerge, further studies are required to define the role of miltefosine in the treatment of CL.
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Open AccessArticle
Multidrug-Resistant Proteus mirabilis and Other Gram-Negative Species Isolated from Native Egyptian Chicken Carcasses
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Bassant Ashraf El-Saeed, Hend Ali Elshebrawy, Amira Ibrahim Zakaria, Adel Abdelkhalek, Kálmán Imre, Adriana Morar, Viorel Herman and Khalid Ibrahim Sallam
Trop. Med. Infect. Dis. 2024, 9(9), 217; https://doi.org/10.3390/tropicalmed9090217 - 18 Sep 2024
Abstract
Poultry carcasses may be reservoirs for the zoonotic transmission of antimicrobial-resistant bacteria to humans and pose a major public health hazard. During the isolation of Salmonella from poultry and other foods, many of the presumptive typical Salmonella colonies on xylose lysine deoxycholate (XLD)
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Poultry carcasses may be reservoirs for the zoonotic transmission of antimicrobial-resistant bacteria to humans and pose a major public health hazard. During the isolation of Salmonella from poultry and other foods, many of the presumptive typical Salmonella colonies on xylose lysine deoxycholate (XLD) agar were found to lack the invA gene, which is the specific target gene for Salmonella spp. Therefore, the current study aimed to estimate the prevalence and antimicrobial resistance profiles of extensively drug-resistant invA-negative non-Salmonella isolates recovered from native Egyptian chicken carcasses as presumptive Salmonella colonies on XLD agar. The non-Salmonella isolates were detected in 84% (126/150) of the examined native Egyptian chicken carcasses and classified into five genera, with prevalence rates of 64% (96/150), 14% (21/150), 6.7% (10/150), 3.3% (5/150), and 1.3% (2/150) for Proteus, Citrobacter, Shigella, Pseudomonas, and Edwardsiella, respectively. One hundred and ninety-five invA-negative, non-verified presumptive Salmonella isolates were recovered and classified at the species level into Proteus mirabilis (132/195; 67.7%), Proteus vulgaris (11/195; 5.6%), Citrobacter freundii (26/195; 13.3%), Shigella flexneri (8/195; 4.1%), Shigella sonnei (6/195; 3.1%), Shigella dysenteriae (3/195; 1.5%), Pseudomonas fluorescens (6/195; 3.1%), and Edwardsiella tarda (3/195; 1.5%). All (195/195; 100%) of these isolates showed resistance against cefaclor and fosfomycin. Additionally, these isolates showed high resistance rates of 98%, 92.8%, 89.7%, 89.2%, 89.2%, 86.7%, 80%, 78.5%, 74.4%, and 73.9% against cephalothin, azithromycin, vancomycin, nalidixic acid, tetracycline, sulfamethoxazole/trimethoprim, cefepime, gentamicin, cefotaxime, and ciprofloxacin, respectively. Interestingly, all (195/195; 100%) of the identified isolates were resistant to at least five antibiotics and exhibited an average MAR (multiple antibiotic resistance) index of 0.783. Furthermore, 73.9% of the examined isolates were classified as extensively drug-resistant, with an MAR index equal to 0.830. The high prevalence of extensively drug-resistant foodborne Proteus, Citrobacter, Shigella, Pseudomonas, and Edwardsiella isolated from native chicken carcasses poses a great hazard to public health and necessitates more monitoring and concern about the overuse and misuse of antibiotics in humans and animals. This study also recommends the strict implementation of GHP (good hygienic practices) and GMP (good manufacturing practices) in the chicken meat supply chain to protect consumer health.
Full article
(This article belongs to the Special Issue Pathogen-Host-Environment Interactions: One-Health Perspectives and Solutions in Antimicrobial Resistance and Disease)
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Enhancing the Interpretability of Malaria and Typhoid Diagnosis with Explainable AI and Large Language Models
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Kingsley Attai, Moses Ekpenyong, Constance Amannah, Daniel Asuquo, Peterben Ajuga, Okure Obot, Ekemini Johnson, Anietie John, Omosivie Maduka, Christie Akwaowo and Faith-Michael Uzoka
Trop. Med. Infect. Dis. 2024, 9(9), 216; https://doi.org/10.3390/tropicalmed9090216 - 16 Sep 2024
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Malaria and Typhoid fever are prevalent diseases in tropical regions, and both are exacerbated by unclear protocols, drug resistance, and environmental factors. Prompt and accurate diagnosis is crucial to improve accessibility and reduce mortality rates. Traditional diagnosis methods cannot effectively capture the complexities
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Malaria and Typhoid fever are prevalent diseases in tropical regions, and both are exacerbated by unclear protocols, drug resistance, and environmental factors. Prompt and accurate diagnosis is crucial to improve accessibility and reduce mortality rates. Traditional diagnosis methods cannot effectively capture the complexities of these diseases due to the presence of similar symptoms. Although machine learning (ML) models offer accurate predictions, they operate as “black boxes” with non-interpretable decision-making processes, making it challenging for healthcare providers to comprehend how the conclusions are reached. This study employs explainable AI (XAI) models such as Local Interpretable Model-agnostic Explanations (LIME), and Large Language Models (LLMs) like GPT to clarify diagnostic results for healthcare workers, building trust and transparency in medical diagnostics by describing which symptoms had the greatest impact on the model’s decisions and providing clear, understandable explanations. The models were implemented on Google Colab and Visual Studio Code because of their rich libraries and extensions. Results showed that the Random Forest model outperformed the other tested models; in addition, important features were identified with the LIME plots while ChatGPT 3.5 had a comparative advantage over other LLMs. The study integrates RF, LIME, and GPT in building a mobile app to enhance the interpretability and transparency in malaria and typhoid diagnosis system. Despite its promising results, the system’s performance is constrained by the quality of the dataset. Additionally, while LIME and GPT improve transparency, they may introduce complexities in real-time deployment due to computational demands and the need for internet service to maintain relevance and accuracy. The findings suggest that AI-driven diagnostic systems can significantly enhance healthcare delivery in environments with limited resources, and future works can explore the applicability of this framework to other medical conditions and datasets.
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Open AccessBrief Report
Murine Extraparenchymal Neurocysticercosis: Appropriate Model for Evaluating Anthelminthic and Anti-Inflammatory Treatment Schedules
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Vinícius Tadeu Oliveira, Tatiane de Camargo Martins, Renato Tavares Conceição, Diego Generoso, Vânia Maria de Vasconcelos Machado, Sabrina Setembre Batah, Alexandre Todorovic Fabro, Marco Antônio Zanini, Edda Sciutto, Agnès Fleury and Pedro Tadao Hamamoto Filho
Trop. Med. Infect. Dis. 2024, 9(9), 215; https://doi.org/10.3390/tropicalmed9090215 - 16 Sep 2024
Abstract
Background: Experimental models of neurocysticercosis (NCC) are helpful for an improved understanding of the pathophysiological mechanisms of human diseases and for testing novel therapeutic approaches. Controlling inflammation without reducing the effectiveness of anthelmintics is an important challenge in treating neurocysticercosis. This study investigates
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Background: Experimental models of neurocysticercosis (NCC) are helpful for an improved understanding of the pathophysiological mechanisms of human diseases and for testing novel therapeutic approaches. Controlling inflammation without reducing the effectiveness of anthelmintics is an important challenge in treating neurocysticercosis. This study investigates the effects of currently used drugs (Albendazole and Dexamethasone) in treating murine extraparenchymal NCC. Methods: Twenty-two rats were inoculated with Taenia crassiceps in the subarachnoid space. The animals underwent magnetic resonance imaging to ascertain the success of infection 3 months after inoculation. The infected animals were randomly assigned to one of the three groups (five rats each): control (no treatment), Albendazole (ABZ), or Albendazole + Dexamethasone (ABZ + DXM) for 14 days. The animals were subsequently euthanised for morphological assessment 2 weeks after the end of treatment. Results: Macroscopically integrated cysts were found in all animals. The ABZ + DXM animals demonstrated lower ventricular sizes, lymphocyte infiltration rates, and immunopositivity for IL-6, with statistical differences in lymphocytes within the arachnoid region. Conclusions: This experimental model, which has previously shown similarities to human infections, is also helpful in reproducing the morphological changes upon treatment with Albendazole and Dexamethasone.
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(This article belongs to the Section Neglected and Emerging Tropical Diseases)
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Community-Wide Active Case Finding for Tuberculosis: Time to Use the Evidence We Have
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Mikaela Coleman, Chris Lowbridge, Philipp du Cros and Ben J. Marais
Trop. Med. Infect. Dis. 2024, 9(9), 214; https://doi.org/10.3390/tropicalmed9090214 - 14 Sep 2024
Abstract
Tuberculosis, caused by the Mycobacterium tuberculosis (Mtb) bacteria, is one of the world’s deadliest infectious diseases. Despite being the world’s oldest pandemic, tuberculosis is very much a challenge of the modern era. In high-incidence settings, all people are at risk, irrespective
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Tuberculosis, caused by the Mycobacterium tuberculosis (Mtb) bacteria, is one of the world’s deadliest infectious diseases. Despite being the world’s oldest pandemic, tuberculosis is very much a challenge of the modern era. In high-incidence settings, all people are at risk, irrespective of whether they have common vulnerabilities to the disease warranting the current WHO recommendations for community-wide tuberculosis active case finding in these settings. Despite good evidence of effectiveness in reducing tuberculosis transmission, uptake of this strategy has been lacking in the communities that would derive greatest benefit. We consider the various complexities in eliminating tuberculosis from the first principles of the disease, including diagnostic and other challenges that must be navigated under an elimination agenda. We make the case that community-wide tuberculosis active case finding is the best strategy currently available to drive elimination forward in high-incidence settings and that no time should be lost in its implementation. Recognizing that high-incidence communities vary in their epidemiology and spatiosocial characteristics, tuberculosis research and funding must now shift towards radically supporting local implementation and operational research in communities. This “preparing of the ground” for scaling up to community-wide intervention centers the local knowledge and local experience of community epidemiology to optimize implementation practices and accelerate reductions in community-level tuberculosis transmission.
Full article
(This article belongs to the Special Issue Implementing TB Elimination Approaches in Indonesia: Operational Research on Case Finding, Treatment and Prevention of TB in Yogyakarta and Timika)
Open AccessArticle
Replacement Therapy with Blood Products in People Living with HIV
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Mihaela Cristina Olariu, Mihaela Adela Iancu, Mihai Hristu Olariu, Victoria Aramă, Mădălina Simoiu, Miruna Maria Cruceru, Ecaterina Constanta Barbu, Paul Balanescu and Mihai Lazar
Trop. Med. Infect. Dis. 2024, 9(9), 213; https://doi.org/10.3390/tropicalmed9090213 - 13 Sep 2024
Abstract
Cytopenias or coagulation deficiencies can occur in people living with HIV (PLWH). The severity of these disorders is influenced by the low levels of CD4+ lymphocytes, viral load, and the stage of viral infection. The aim of our retrospective observational study was to
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Cytopenias or coagulation deficiencies can occur in people living with HIV (PLWH). The severity of these disorders is influenced by the low levels of CD4+ lymphocytes, viral load, and the stage of viral infection. The aim of our retrospective observational study was to determine the frequency of cytopenias and coagulation deficiencies in PLWH as well as the need for replacement therapy with blood products. We sought to determine whether there is an association between severe anemia or thrombocytopenia (requiring replacement therapy) and CD4+T lymphocyte levels. All 29 patients were critically ill, with 27 out of 29 (93%) in advanced stages of HIV disease and 23 out of 29 (79%) having CD4+ lymphocyte counts below 200 cells/microL. Most patients were either late presenters (45%) or had been lost to follow-up (41%). In addition to HIV infection, various conditions that could alter hematologic parameters were associated, including co-infections with hepatitis viruses, tuberculosis at various sites, malignant diseases, sepsis, SARS-CoV-2 infection, or other opportunistic infections. No significant correlation was found between severe anemia or severe thrombocytopenia or coagulation deficiencies and the CD4+T lymphocyte count. Our data suggest that these hematological disorders in patients with advanced HIV infection are more likely to be associated comorbidities rather than the HIV infection per se.
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(This article belongs to the Special Issue HIV Testing, Prevention and Care Interventions)
Open AccessReview
Outbreaks in the Neonatal Intensive Care Unit: Description and Management
by
Chryssoula Tzialla, Alberto Berardi, Vito Mondì and on behalf of the Study Group of Neonatal Infectious Diseases
Trop. Med. Infect. Dis. 2024, 9(9), 212; https://doi.org/10.3390/tropicalmed9090212 - 12 Sep 2024
Abstract
Healthcare settings, especially intensive care units, can provide an ideal environment for the transmission of pathogens and the onset of outbreaks. Many factors can contribute to the onset of an epidemic in a neonatal intensive care unit (NICU), including neonates’ vulnerability to healthcare-associated
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Healthcare settings, especially intensive care units, can provide an ideal environment for the transmission of pathogens and the onset of outbreaks. Many factors can contribute to the onset of an epidemic in a neonatal intensive care unit (NICU), including neonates’ vulnerability to healthcare-associated infections, especially for those born preterm; facility design; frequent invasive procedures; and frequent contact with healthcare personnel. Outbreaks in NICUs are one of the most relevant problems because they are often caused by multidrug-resistant organisms associated with increased mortality and morbidity. The prompt identification of an outbreak, the subsequent investigation to identify the source of infection, the risk factors, the reinforcement of routine infection control measures, and the implementation of additional control measures are essential elements to contain an epidemic.
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(This article belongs to the Special Issue Microbial Infections and Antimicrobial Use in Neonates and Infants)
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Open AccessArticle
Comparative Efficacy and Safety of Moxifloxacin and Levofloxacin in a Short Standardised Rifampicin Resistant TB Regimen: A STREAM 2 Secondary Analysis
by
Stella M. Fabiane, Chen-Yuan Chiang, Sarah K. Meredith, Meera Gurumurthy, Adamu Bayissa, Andrew J. Nunn and Ruth L. Goodall
Trop. Med. Infect. Dis. 2024, 9(9), 211; https://doi.org/10.3390/tropicalmed9090211 - 11 Sep 2024
Abstract
(1) Background: The World Health Organisation (WHO) categorises moxifloxacin and levofloxacin as Group A drugs, which should be prioritised in the treatment of rifampicin-resistant tuberculosis. We compare their relative efficacy and safety using data from the STREAM trial; (2) Methods: Marginal structural models
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(1) Background: The World Health Organisation (WHO) categorises moxifloxacin and levofloxacin as Group A drugs, which should be prioritised in the treatment of rifampicin-resistant tuberculosis. We compare their relative efficacy and safety using data from the STREAM trial; (2) Methods: Marginal structural models were used to balance differences in the baseline characteristics of participants receiving the STREAM control regimen containing either moxifloxacin or levofloxacin as this was not a randomised comparison. The difference in proportions between regimens was estimated for favourable outcome, any grade 3/4 adverse event, QTcF increase to ≥500 ms, QTcF increase from baseline by at least 60 ms, and any grade 3/4 adverse event excluding QT events, using weighted analyses; (3) Results: In efficacy analyses (n = 123), the weighted risk difference (moxifloxacin—levofloxacin, wRD) for a favourable outcome was −0.045 (−0.213, 0.123), p = 0.60. Similarly, estimates from the safety analyses (n = 127) showed no evidence of a difference between the fluoroquinolones, other than a suggestion of fewer QTcF increases from baseline on levofloxacin (wRD 0.160 (−0.026, 0.346), p = 0.091); (4) Conclusions: In this small dataset, we found no statistically significant difference in key efficacy or safety outcomes between the moxifloxacin- and levofloxacin-containing regimens; there was a suggestion that QTcF increases from baseline were fewer on levofloxacin.
Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Multidrug-Resistant Tuberculosis: Insights from New Research and Clinical Trials)
Open AccessArticle
Admission Point-of-Care Testing for the Clinical Care of Children with Cerebral Malaria
by
David Wichman, Geoffrey Guenther, Nthambose M. Simango, Mengxin Yu, Dylan Small, Olivia D. Findorff, Nathaniel O. Amoah, Rohini Dasan, Karl B. Seydel, Douglas G. Postels and Nicole F. O’Brien
Trop. Med. Infect. Dis. 2024, 9(9), 210; https://doi.org/10.3390/tropicalmed9090210 - 11 Sep 2024
Abstract
Point-of-care testing (PoCT), an alternative to laboratory-based testing, may be useful in the clinical care of critically ill children in resource-limited settings. We evaluated the clinical utility of PoCT in the care of 193 Malawian children treated for World Health Organization-defined cerebral malaria
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Point-of-care testing (PoCT), an alternative to laboratory-based testing, may be useful in the clinical care of critically ill children in resource-limited settings. We evaluated the clinical utility of PoCT in the care of 193 Malawian children treated for World Health Organization-defined cerebral malaria (CM) between March 2019 and May 2023. We assessed the frequency of abnormal PoCT results and the clinical interventions performed in response to these abnormalities. We determined the association between abnormal PoCT results and patient outcomes. Overall, 52.1% of all PoCT results were abnormal. Of the children with abnormal results, clinical interventions occurred in 16.9%. Interventions most commonly followed abnormal results for PoCT glucose (100.0% of the patients had treatment for hypoglycemia), potassium (32.1%), lactate (22.0%), and creatinine (16.3%). Patients with hypoglycemia, hyperlactatemia, and hypocalcemia had a higher mortality risk than children with normal values. Future studies are needed to determine whether obtaining laboratory values using PoCT and the clinical response to these interventions modify outcomes in critically ill African children with CM.
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(This article belongs to the Section Vector-Borne Diseases)
Open AccessArticle
Paving the Way to Innovative, Child-Friendly Pediatric Diagnostic Methods for Tuberculosis: Introduction of Stool-Based Testing in Ukraine
by
Olena Diuzheva, Liudmyla Skoklyuk, Nina Zherebko, Anna Barbova, Myroslava Germanovych, Eveline Klinkenberg, Oleksii Bogdanov and Gunta Dravniece
Trop. Med. Infect. Dis. 2024, 9(9), 209; https://doi.org/10.3390/tropicalmed9090209 - 11 Sep 2024
Abstract
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Like many countries, Ukraine faces challenges with diagnosing tuberculosis (TB) in children due to the paucibacillary nature of the disease and difficulty obtaining respiratory samples. To improve diagnostic efficiency, stool testing is being integrated into routine pediatric TB services. This started with a
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Like many countries, Ukraine faces challenges with diagnosing tuberculosis (TB) in children due to the paucibacillary nature of the disease and difficulty obtaining respiratory samples. To improve diagnostic efficiency, stool testing is being integrated into routine pediatric TB services. This started with a pilot introduction at 12 regional TB facilities, where stool was collected for children with a preliminary diagnosis of TB, based on clinical and/or radiological or laboratory findings, in addition to routine testing. For 168 children, a stool test was conducted between November 2021 and September 2022, with samples submitted in all 12 pilot regions. For 132 children, other samples were available in addition to stool. Mycobacterium tuberculosis (MTB) was bacteriologically confirmed in 37 children (in stool for 18 children). For 7 of the 18 children with MTB in stool, stool was the only sample in which MTB was detected. Rifampicin resistance was detected in seven children (in stool for three). This noninvasive TB diagnostic sample is especially beneficial for young children who cannot produce sputum. Early detection of TB and its drug-resistant strains in children will allow medical workers to provide safer and more effective treatment and save more lives. Based on the pilot implementation, Ukraine’s national TB program began implementing stool testing throughout the country.
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Open AccessArticle
Untargeted Liquid Chromatography–High-Resolution Mass Spectrometry Metabolomic Investigation Reveals Altered Lipid Content in Leishmania infantum Lacking Lipid Droplet Protein Kinase
by
Juliana Martins Ribeiro, Gisele André Baptista Canuto, Alisson Samuel Portes Caldeira, Ezequias Pessoa de Siqueira, Carlos Leomar Zani, Silvane Maria Fonseca Murta and Tânia Maria de Almeida Alves
Trop. Med. Infect. Dis. 2024, 9(9), 208; https://doi.org/10.3390/tropicalmed9090208 - 10 Sep 2024
Abstract
Leishmaniasis is a complex disease caused by different species of Leishmania. To date, no vaccine for humans or ideal therapy has been developed owing to the limited efficacy and toxicity of available drugs, as well as the emergence of resistant strains. Therefore,
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Leishmaniasis is a complex disease caused by different species of Leishmania. To date, no vaccine for humans or ideal therapy has been developed owing to the limited efficacy and toxicity of available drugs, as well as the emergence of resistant strains. Therefore, it is necessary to identify novel therapeutic targets and discover therapeutic options for leishmaniasis. In this study, we evaluated the impact of deleting the lipid droplet protein kinase (LDK) enzyme in Leishmania infantum using an untargeted metabolomics approach performed using liquid chromatography and high-resolution mass spectrometry. LDK is involved in lipid droplet biogenesis in trypanosomatids. Thirty-nine lipid metabolites altered in the stationary and logarithmic growth phases were noted and classified into five classes: (1) sterols, (2) fatty and conjugated acids, (3) ceramides, (4) glycerophosphocholine and its derivatives, and (5) glycerophosphoethanolamine and its derivatives. Our data demonstrated that glycerophosphocholine and its derivatives were the most affected after LDK deletion, suggesting that the absence of this enzyme promotes the remodeling of lipid composition in L. infantum, thus contributing to a better understanding of the function of LDK in this parasite.
Full article
(This article belongs to the Special Issue Advances in Parasitic Neglected Tropical Diseases)
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Open AccessArticle
Effects of Five Years of Treatment of Onchocerciasis with Ivermectin under Community Guidelines in Resurgent Areas of Burkina Faso: A before-and-after Analysis
by
Micheline O. Ouedraogo, Ivlabèhirè Bertrand Meda, Karifa Kourouma, Fanny Yago Wienne, Dieudonné Nare, Clarisse Bougouma, Justin Compaore and Seni Kouanda
Trop. Med. Infect. Dis. 2024, 9(9), 207; https://doi.org/10.3390/tropicalmed9090207 - 9 Sep 2024
Abstract
Background: Almost the entire country of Burkina Faso was endemic to onchocerciasis. Onchocerciasis control efforts thus brought the prevalence of O. volvulus to a level where the disease was no longer a public health problem in 2002. A resurgence of onchocerciasis cases has
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Background: Almost the entire country of Burkina Faso was endemic to onchocerciasis. Onchocerciasis control efforts thus brought the prevalence of O. volvulus to a level where the disease was no longer a public health problem in 2002. A resurgence of onchocerciasis cases has been observed in two regions (Cascades and the Southwest) located around several river basins in 2010–2011. In accordance with WHO guidelines for the management of resurgent cases, community-directed treatment with ivermectin (CDTI) was implemented in the affected areas. The aim of this study was to determine the effects of this intervention on parasitological indices of onchocerciasis, depending on the distance between villages and rivers. Methodology: We conducted a paired pre-post study using aggregated village-level data from two cross-sectional surveys conducted in each region. A Wilcoxon signed-rank test was used to compare the standardized microfilarodermia prevalence and community microfilarial load (CMFL). Results: A total of 43 villages in 6 health districts, in the Southwest (18) and Cascades (25) regions were included in the study. The key findings were that standardized microfilaria prevalence and CMFL decreased significantly after the implementation of CDTI in both regions (p < 0.0001). The median standardized microfilaria prevalence was 2.8 [interquartile range (IQR): 0.2–6.6] before CDTI and 0.72 [IQR: 0.0–2.17] after CDTI. The results showed also a decline in standardized microfilaria prevalence and CMFL in all villages, regardless of the distance separating the village from the streams. However, the results were not statistically significant for the villages located 5 km or more from streams (p = 0.0816 and 0.0542 for standardized microfilaria prevalence and CMFL, respectively). Conclusion: Our results thus show that the implementation of effective CDTI could stop the transmission of O. volvulus in these two regions. The main challenge for stopping transmission could be the migration of populations to neighboring countries and migration of the vector from one country to another, as Burkina Faso shares some river basins with neighboring countries.
Full article
(This article belongs to the Special Issue Insights on Neglected Tropical Diseases in West Africa)
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