The American Journal of Tropical Medicine and Hygiene - Volume 74, Issue 4, April 2006

The human body louse, the natural vector of Rickettsia prowazekii, is able to experimentally transmit the normally flea-borne rickettsia R. typhi, suggesting that the relationships between the body louse and rickettsiae are not specific. We used our experimental infection model to test the ability of body lice to transmit two prevalent tick-borne rickettsiae. Each of two rabbits was made bacteremic by injecting intravenously 2 × 106 plaque-forming units of either R. rickettsii or R. conorii. Four hundred body lice were infected by feeding on the bacteremic rabbit and were compared with 400 uninfected lice. Each louse group was fed once a day on a separate seronegative rabbit. The survival of infected lice was not different from that of uninfected controls. Lice remained infected for their lifespan, excreted R. rickettsii and R. conorii in their feces, but did not transmit the infection to their progeny. The nurse rabbit of uninfected lice remained asymptomatic and seronegative. Those rabbits used to feed infected lice developed bacteremia and seroconverted. Although the body louse is not a known vector of spotted fevers, it was able in our study to acquire, maintain, and transmit both R. rickettsii and R. conorii.

The human body louse is currently recognized as a vector of Rickettsia prowazekii, Borrelia recurrentis, and Bartonella quintana. Previous studies have reported the isolation of Acinetobacter baumannii from the body lice of homeless patients. To study how the body louse acquires A. baumannii, we infected a rabbit by infusing 2 × 106 colony-forming units of the louse strain of A. baumannii. Two hundred body lice were infected by feeding on the bacteremic rabbit and compared with 200 uninfected lice and two groups of 200 lice feeding on rabbits infected either with another strain of A. baumannii or A. lwoffii. Each louse group received maintenance feedings once a day on another seronegative rabbit. Body lice that fed on rabbits infused with each Acinetobacter species demonstrated a generalized infection. The body lice did not transmit their infection to the nurse rabbit by bite while feeding or to their progeny (eggs and larvae). The lice excreted living Acinetobacter species within their feces. Only the louse strain of A. baumannii was pathogenic for the body louse. An increased mortality rate was observed between the second and third days post-infection; however, they remained infected for their lifespan.

Fleas collected in Algeria in the district of Oran between July and September 2003 were tested by polymerase chain reaction for the presence of Rickettsia spp. DNA using primers amplifying gltA and OmpA genes. Two gltA sequences identical to those of an emerging pathogen, Rickettsia felis, were detected including i) R. felis California 2 in Ctenocephalides canis from rodents and ii) R. felis RF2125 in Archeopsylla erinacei from hedgehogs.

The study aimed at evaluating the seroprevalence of and sociodemographic, health, lifestyle, and environmental hygiene conditions associated with Helicobacter pylori infection in Vietnamese children. Data from 824 children, aged from 6 months to 15 years and gastrointestinal symptom free when consulted, admitted to a university hospital, were collected using a structured questionnaire and ELISA test for H. pylori infection. The data were examined using univariate and multivariate analyses. H. pylori seroprevalence was 34.0%. Age groups from 3 to 6 years and older than 6, and number of offspring were positively and independently associated with H. pylori seropositivity [adjusted OR (95% CI): 2.9 (1.5–5.5); 1.9 (1.1–3.1) and 1.8 (1.1–2.6), respectively]. Breastfeeding more than 6 months was negatively and independently associated with H. pylori seropositivity [adjusted OR (95% CI): 0.5 (0.3–0.9)]. Mother’s age, history of allergy, gastro-duodenal disease history in the past, initiating collective life before 6 years, sharing bed with parents and time of bed sharing with parents > 24 months were positively but not independently associated with H. pylori seropositivity. None of the other environmental or lifestyle conditions examined was associated with H. pylori infection. Our results support person-to-person transmission and the role of sociodemographic factors in H. pylori infection.

Enteric fever decreased in Israel in the last 50 years, but its current epidemiology is unknown. In a nationwide study, we evaluated all cases of enteric fever from 1995 to 2003. On hundred thirty-six cases met the case definition. During the period studied, the incidence of enteric fever decreased from 0.42 to 0.23/100,000. A total of 57.4% of the cases were acquired abroad. The incidence of endemic enteric fever was 2.7 times higher in Arabs than in Jews. In Arabs, Salmonella Typhi was the causative agent in all cases, and almost all cases were endemic. In Jews, most cases were imported, with a decrease in imported S. typhi, cases and an increase in imported S. Paratyphi A cases. Salmonella Paratyphi B was endemic, and restricted to the Jewish population. The reasons for the difference in causative agents along ethnic lines need further evaluation. A more efficient vaccine for travelers that includes S. Paratyphi A is needed.

Over the past decade, anti-malarial drug resistance has rapidly become a major public health problem in the Peruvian Amazon. This study compared polymerase chain reaction (PCR) to light microscopy for diagnosing and monitoring the parasitological response of malaria patients to anti-malarial chemotherapy in the Peruvian Amazon region of Iquitos. Typing of P. falciparum using MSP1, MSP2, and glutamine-rich protein distinguished among infecting parasites. Most (73%) P. falciparum patients were parasitologically resistant to sulfadoxine-pyrimethamine (RI = 10, RII = 1). Sensitivity of microscopy was lower than PCR (69% for P. vivax and 78% for P. falciparum), but parasite clearance times were comparable between microscopy and PCR. PCR sensitively and specifically detected mixed infections and low-level parasitemia indicative of drug resistance, making this approach of practical use for the control of malaria at the public health level. Genotyping malaria parasites will be useful to distinguish drug failure from new infections in clinical trials of anti-malarial drugs in the Peruvian Amazon region.

Two potential malaria virulence factors, parasite multiplication rate (PMR) and red blood cell selectivity (measured as selectivity index [SI]), were assessed in Plasmodium falciparum clinical isolates from Mali and Kenya. At both sites, PMRs were low (Kenya median = 2.2, n = 33; Mali median = 2.6, n = 61) and did not differ significantly between uncomplicated and severe malaria cases. Malian isolates from hyperparasitemic patients had significantly lower PMRs (median = 1.8, n = 19) than other Malian isolates (uncomplicated malaria median = 3.1, n = 23; severe malaria median = 2.8, n = 19; P = 0.03, by Kruskal-Wallis test). Selective invasion occurred at both sites (Kenya geometric mean SI = 1.9, n = 98; Mali geometric mean SI = 1.6, n = 104), and there was no significant association between the SI and malaria severity. Therefore, in contrast to previous results from Thailand, we found no association of PMR and SI with malaria severity in African children. This raises the possibility of differences in the mechanisms of malaria virulence between sub-Saharan Africa and Asia.

We analyzed malaria prevalence and evaluated the effect of malaria control measures in Henan Province, People’s Republic of China between 1993 and 2004. Data relating to malaria epidemics, malaria control measures and their effects, and vector surveillance between 1993 and 2004 were collected and analyzed. Mean malaria incidence during this period was 2.96/100,000. After integrated vector control measures and appropriate treatment of malaria cases were carried out, the number of malaria cases in Henan Province decreased from 4,815 in 2000 to 2,112 in 2004. The parasite-positive rate and the density of Anopheles anthropophagus were also reduced. Malaria control measures were effective and malaria incidence decreased in Henan. However, there are still more cases in this province than in 1992. Local malaria outbreaks and epidemics have occurred in areas where Anopheles anthropophagus and An. sinensis are present. Thus, malaria control measures should be strengthened.

Although malaria contributes to a significant public health burden, malaria diagnosis relies heavily on either non-specific clinical symptoms or blood smear microscopy methods developed in the 1930s. These approaches severely misrepresent the number of infected individuals and the reservoir of parasites in malaria-endemic communities and undermine efforts to control disease. Limitations of conventional microscopy-based diagnosis center on time required to examine slides, time required to attain expertise sufficient to diagnose infection accurately, and attrition from the limited number of existing malaria microscopy experts. Earlier studies described magnetic properties of Plasmodium falciparum but did not refine methods to diagnosis infection by all four human malaria parasite species. Here, following specific technical procedures, we show that it is possible to concentrate all four human malaria parasite species, at least 40-fold, on microscope slides using very inexpensive magnets through an approach termed magnetic deposition microscopy. This approach delivered greater sensitivity than a thick smear preparation while maintaining the clarity of a thin smear to simplify species-specific diagnosis. Because the magnetic force necessary to concentrate parasites on the slide is focused at a precise position relative to the magnet surface, it is possible to examine a specific region of the slide for parasitized cells and avoid the time-consuming process of scanning the entire slide surface. These results provide insight regarding new strategies for performing malaria blood smear microscopy.

Protective immunity against Plasmodium falciparum is partially mediated through binding of malaria-specific IgG antibodies to Fcγ receptors. Polymorphic variability in Fcγ RIIa (H/R-131) is associated with differential binding of IgG subtypes and malaria disease outcomes. However, the role of Fcγ RIIa-131 variability in conditioning susceptibility to severe malarial anemia, the primary manifestation of severe malaria in holoendemic P. falciparum transmission areas, is largely undefined. Thus, Fcγ RIIa-H131R polymorphism was investigated in 493 children who came to a hospital with acute malaria. Variation in Fcγ RIIa-131 was not significantly associated with severe malarial anemia (hemoglobin [Hb] < 6.0 g/dL) or malaria anemia (Hb < 8.0 g/dL). However, relative to the heterozygous genotype, homozygotes for the R131 alleles were protected against high-density parasitemia (≥ 10,000 parasites/μL; odds ratio [OR] = 0.58, 95% confidence interval [CI] = 0.37–0.92, P = 0.02), while homozygotes for the H131 alleles were mildly protective (OR = 0.71, 95% CI = 0.45–1.13, P = 0.14). Additional multivariate analyses showed that infection with human immunodeficiency virus type 1 did not influence the associations between FcγRIIa-H131R polymorphism and malaria disease outcomes. Genotypic results presented here parallel data illustrating that parasite density is unrelated to the severity of anemia in children with acute malaria. Thus, although homozygosity for the R131 allele protects against high-density parasitemia, FcγRIIa-131 polymorphism does not protect against malaria anemia.

The high frequencies of both α+ thalassemia and the sickle cell trait (hemoglobin AS [HbAS]) found in many tropical populations are thought to reflect selection pressure from Plasmodium falciparum malaria. For HbAS, but not for α+ thalassemia, protection appears to be mediated by the enhanced phagocytic clearance of ring-infected erythrocytes. We have investigated the genotype-specific distributions of peripheral blood leukocyte populations in two groups of children living on the coast of Kenya: a group of healthy P. falciparum parasite-negative children sampled at cross-sectional survey during a period of low malaria transmission, and a group of children attending the hospital with acute malaria. We report distinctive distributions of peripheral blood myeloid dendritic cells and monocytes in children with α+ thalassemia and HbAS during healthy periods and disease, and suggest ways in which these might relate to the mechanisms of protection afforded by these conditions.

The stability of anti-malarial immunity will influence the interpretation of immunologic endpoints during malaria vaccine trials conducted in endemic areas. Therefore, we evaluated cytokine responses to Plasmodium falciparum liver stage antigen-1 (LSA-1) and thrombospondin-related adhesive protein (TRAP) by Kenyans from a holoendemic area at a 9-month interval. The proportion of adults with interferon-γ (IFN-γ) responses to 9-mer LSA-1 peptides was similar at both time-points, whereas responses from children decreased (P < 0.05). Response to the longer, 23-mer LSA-1 peptide was variable, decreasing in adults and children over time (P < 0.02 and P < 0.001, respectively). The proportion of children with IFN-γ responses to either antigen at the second time-point was significantly lower than that of adults, yet more adults responded to 9-mer TRAP peptides (P < 0.02). In contrast, the proportion of interleukin-10 responses to LSA-1 and TRAP was similar at both time-points for both age groups. Most noteworthy was that even when the repeat cross-sectional frequency of cytokine responses was the same, these responses were not generated by the same individuals. This suggests that cytokine responses to LSA-1 and TRAP are transient under natural exposure conditions.

Sodium stibogluconate (Pentostam®; GlaxoSmithKline) is a pentavalent antimonial compound used in the treatment of leishmaniasis, which has an association with reactivation of varicella zoster virus (VZV). We report the first known case of an immunocompetent adult who developed VZV aseptic meningitis and dermatomal herpes zoster during treatment with sodium stibogluconate.

We determined the nucleotide sequence of the Babesia gibsoni cytochrome b (cytb) gene. DNA was extracted from B. gibsoni isolated from Aomori Prefecture, Japan, and 1,288 basepairs of the cytb gene, including 1,071 basepairs of the open reading frame, were sequenced. The cytb gene of B. gibsoni obtained from three dogs that had been experimentally infected with B. gibsoni and treated with atovaquone was also sequenced. The B. gibsoni cytb gene obtained from all three atovaquone-treated dogs contained a single polymorphism resulting in an amino acid change in one of the putative ubiquinone-binding sites of Plasmodium falciparum. This polymorphism was homologous to mutations in other apicomplexan protozoa that exhibit resistance to atovaquone. Two other single polymorphisms were identified in parasites isolated from two of the dogs. These results indicate that single nucleotide polymorphisms in the sequence for mitochondrial cytb gene may be associated with decreased susceptibility of Babesia species to atovaquone.

We describe here an ancient case of cysticercosis that was discovered in an Egyptian mummy of a young woman of about 20 years of age who lived in the late Ptolemaic period (second to first centuries b.c.). On removal of the stomach and its rehydration, a cystic lesion in the stomach wall was observed by naked eye. Microscopical examination of sections of this lesion revealed a cystic structure, with a wall, with numerous projecting eversions, a characteristic feature of the larval stage (cysticercus) of the human tapeworm Taenia solium (or “pig tapeworm”). Immunohistochemical testing with serum from a T. solium–infected human confirmed the identity of the cyst. This finding is the oldest on record of the antiquity of this zoonotic parasite. This observation also confirms that, in Hellenistic Egypt, the farming of swine, along with man an intermediate host of this parasite, was present, and supports other archeological evidence.

We performed a retrospective study of 164 human immunodeficiency virus (HIV)–infected patients with disseminated histoplasmosis to identify the risk factors for death. Death occurred in 32% of the cases. Univariate analysis identified the following risk factors: diarrhea (odds ratio [OR] = 3.9, P = 0.001), neurologic manifestations (OR = 5.8, ; P = 0.001), hemoglobin level < 8.0g/dL (OR = 2.7, P = 0.004), urea level 2 times the normal upper limit (OR = 5.0, P < 0.001), creatinine level > 1.5 mg/dL (OR = 2.9, P = 0.005), aspartate aminotransferase (AST) level > 2.5 times the normal upper limit (OR = 3.1, P = 0.01), respiratory insufficiency (OR = 9.7, P < 0.001), sepsis (OR = 20.2, P < 0.001), and acute renal failure (OR = 2.5, P = 0.011). A hemoglobin level < 8.0 g/dL (OR = 3.8, P = 0.008), an AST level ≥ 2.5 times the normal limit (OR = 1.0, P = 0.007), acute renal failure (OR = 2.96, P = 0.015), and respiratory insufficiency (OR = 12.2, P = 0.01) were independent risk factors for death.