The American Journal of Tropical Medicine and Hygiene - Online First

This case report underlines the appearance of a “walking pneumonia” in a novel coronavirus disease (COVID-19) patient, with evidence of progressive lung involvement on chest imaging studies. The patient traveled from Wuhan, Hubei, China, to Thailand in January 2020. One of her family members was diagnosed with COVID-19. She presented to the hospital because of her concern, but she was without fever or any respiratory symptoms. Three days earlier, her nasopharyngeal and throat swabs revealed a negative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test by real-time reverse transcriptase polymerase chain reaction (RT-PCR). Her initial chest radiography was abnormal, and her first sputum SARS-CoV-2 test yielded inconclusive results. A subsequent sputum test was positive for SARS-CoV-2. Diagnosis in this patient was facilitated by chest imaging and repeat viral testing. Thus, chest imaging studies might enhance capabilities for early diagnosis of COVID-19 pneumonia.

Nomads and labor migrants constitute a vulnerable group beset with high healthcare costs due to lack of health insurance coverage. Their inability to pay for health care constitutes a threat to their well-being and health risk to the host community as they have higher morbidity from diseases and serve as a reservoir of infective agents. This study investigated how nomads and labor migrants pay and cope with necessary healthcare costs. A cross-sectional study was carried out among 323 migrants in four local government areas of Oyo State, which were selected purposively. A pretested semi-structured questionnaire that sought information on respondents’ sociodemographics, healthcare payment methods and coping strategies were employed. Data were analyzed using descriptive statistics and chi-square test to test the association between categorical variables at P ≤ 0.05. The mean age of the respondents was 34.4 ± 1.4 years and 53.2% were farmers. Of the 200 respondents who had used the formal healthcare system, 13 (6.5%) obtained free services via the National Health Insurance Scheme (NHIS) and 187 (93.2%) paid out of pocket for service. Coping with health bills, 115 (62.2%) paid from savings, 34 (18.4%) borrowed money, and 58 (31.4%) sold property. Those with formal education were more likely to pay through NHIS (χ2 = 9.7, P = 0.002). Nomads/migrants in this study have demonstrated the inability to cope with payment of health bills, suggesting the need to look into the policy on healthcare funding/support to migrants and educationally disadvantaged persons. The creation of prepaid pooled payment systems such as social and community health insurance schemes is suggested.

We investigated the prevalence of hypertension in Ghana using the 2017 American College of Cardiology/American Heart Association (ACC/AHA) criteria and compared with prevalence estimates using the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) criteria. Among 13,220 Ghanaians aged 15–49 years, the prevalence of hypertension was 30.4% (95% CI: 29.3–31.6) based on the 2017 ACC/AHA guideline compared with 12.8% (95% CI: 12.0–13.6) when using the JNC7 guideline. The overall increase in prevalence was 17.6% (95% CI: 16.8–18.6). The increment in prevalence was 19.0% (95% CI: 17.5–20.7) among men and 17.7% (95% CI: 16.1–18.2) among women. People aged 40–49 years had the highest prevalence (51.1%; 95% CI: 49.0–53.3). We used multiple logistic regressions to obtain odds ratios. Urban dwelling, tertiary education, or being in higher wealth status was significantly associated with the odds of hypertension. The 2017 ACC/AHA guideline resulted in a significant increase in the prevalence of hypertension in Ghana. Scaling up of existing prevention and control strategies for hypertension such as health education through already established community health implementation and planning programs as well as improved screening and diagnostic protocols for hypertension should be prioritized.

Two confirmed human cases of Zika virus (ZIKV) were reported in the district of Miri, Sarawak, in 2016. Following that, a mosquito-based ZIKV surveillance study was conducted within 200-m radius from the case houses. Mosquito surveillance was conducted using five different methods, that is, BG sentinel trap, modified sticky ovitrap, resting catch, larval surveillance, and conventional ovitrap. A total of 527 and 390 mosquito samples were obtained from the case houses in two localities, namely, Kampung Lopeng and Taman Shang Ri La, Miri, Sarawak, respectively. All mosquitoes collected were identified, which consisted of 11 species. Aedes albopictus, both the adult and larval stages, was the dominant species. Resting catch method obtained the highest number of adult mosquitoes (67%), whereas ovitrap showed the highest catch for larval mosquitoes (84%). Zika virus was detected in both adults and larvae of Ae. albopictus together with adults of Culex gelidus, and Culex quiquefasciatus using the real-time reverse transcriptase PCR technique. It was noteworthy that Ae. albopictus positive with ZIKV were caught and obtained from all four types of collection method. By contrast, Cx. gelidus and Culex quinquefasciatus adults collected from sticky ovitraps were also found positive with ZIKV. This study reveals vital information regarding the potential vectors of ZIKV and the possibility of transovarian transmission of the virus in Malaysia. These findings will be essentials for vector control program managers to devise preparedness and contingency plans of prevention and control of the arboviral disease.

Environmental factors, including high temperature and humidity, can influence dermal absorption of chemicals. Soldiers can be dermally exposed to permethrin while wearing permethrin-treated uniforms. This study aimed at examining the effects of high temperature and a combined high temperature and humid environment on permethrin absorption compared with ambient conditions when wearing a permethrin-treated uniform. Twenty-seven male enlisted soldiers wore study-issued permethrin-treated army uniforms for 33 consecutive hours in three different environments: 1) simulated high temperature (35°C, 40% relative humidity [rh]) (n = 10), 2) simulated high temperature and humidity (30°C, 70% rh) (n = 10), and 3) ambient conditions (13°C, 60% rh) (n = 7). Spot urine samples, collected at 21 scheduled time points before, during, and after wearing the study uniforms, were analyzed for permethrin exposure biomarkers (3-phenoxybenzoic acid, cis- and trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane-1-carboxylic acid) and creatinine. Biomarker concentrations were 60–90% higher in the heat and combined heat/humidity groups (P < 0.001–0.022) than the ambient group. Also, the average daily permethrin dose, calculated 12 hours after removing the treated uniforms, was significantly higher in the heat (P = 0.01) and the heat/humidity (P = 0.03) groups than the ambient group. There were no significant differences in biomarker concentrations or computed average daily dose between the heat and the heat/humidity groups. Both hot and combined hot and humid environmental conditions significantly increased permethrin absorption in soldiers wearing permethrin-treated uniforms.

Typhoid fever remains an important public health problem in low- and middle-income countries, with large outbreaks reported from Africa and Asia. Although the WHO recommends typhoid vaccination for control of confirmed outbreaks, there are limited data on the epidemiologic characteristics of outbreaks to inform vaccine use in outbreak settings. We conducted a literature review for typhoid outbreaks published since 1990. We found 47 publications describing 45,215 cases in outbreaks occurring in 25 countries from 1989 through 2018. Outbreak characteristics varied considerably by WHO region, with median outbreak size ranging from 12 to 1,101 cases, median duration from 23 to 140 days, and median case fatality ratio from 0% to 1%. The largest number of outbreaks occurred in WHO Southeast Asia, 13 (28%), and African regions, 12 (26%). Among 43 outbreaks reporting a mode of disease transmission, 24 (56%) were waterborne, 17 (40%) were foodborne, and two (5%) were by direct contact transmission. Among the 34 outbreaks with antimicrobial resistance data, 11 (32%) reported Typhi non-susceptible to ciprofloxacin, 16 (47%) reported multidrug-resistant (MDR) strains, and one reported extensively drug-resistant strains. Our review showed a longer median duration of outbreaks caused by MDR strains (148 days versus 34 days for susceptible strains), although this difference was not statistically significant. Control strategies focused on water, sanitation, and food safety, with vaccine use described in only six (13%) outbreaks. As typhoid conjugate vaccines become more widely used, their potential role and impact in outbreak control warrant further evaluation.

Multiple PCR-based approaches have been developed for Leishmania detection in clinical and laboratory samples, and this diversity limits inter-study comparisons, meta-analyses, and generalization of findings. Toward the harmonization of a molecular tool for detection of Leishmania (Viannia) for research purposes, we evaluated the concordance of 18SrDNA qPCR and minicircle kinetoplastid DNA (mkDNA) PCR followed by Southern blot (PCR-SB) in in vitro infection systems and in lesion and mucosal swab samples from Colombian patients with cutaneous leishmaniasis caused by L. (Viannia). The lower limit of parasite detection of 18SrDNA qPCR and mkDNA PCR-SB was 10−1 promastigotes and one intracellular amastigote per reaction. From cutaneous lesions (n = 63), an almost perfect concordance was found between the methods (κ = 0.92, 95% CI: 0.82–1.00). Despite equal limits of detection, mkDNA PCR-SB was more efficient for parasite detection in mucosal samples than 18SrDNA qPCR or 18SrDNA digital droplet PCR. The high concordance, sensitivity, scaling potential, and feasibility of implementation of the 18SrDNA qPCR support its selection as the L. (Viannia) in research laboratories as a first step toward harmonization of research protocols in the region.

Deformities of bones of the face and extremities are markers of leprosy (Hansen’s disease) which contribute to stigma associated with this disease. Among these deformities are articular alterations that can mimic rheumatoid arthritis (RA). In this case, a 64-year-old man presented with a history of having been treated for lepromatous leprosy and erythema nodosum leprosum episodes, which evolved with joint alterations similar to those of RA. Most cases of leprosy-related arthritis are associated with reactional episodes, of which a large number do not respond to conventional therapy for leprosy reactions. In cases of chronic arthritis not associated with leprosy reactions, although patients show considerable relief with anti-leprosy therapy, arthritis is not completely resolved. This emphasizes the need for early diagnosis and treatment of leprosy to prevent the development of osteoarticular alterations.

Poor nutrition and hand hygiene are risk factors for acute respiratory infections (ARIs). Safe drinking water and sanitation can reduce exposure to pathogens and encourage healthy immune responses, reducing the risk of ARIs. Within a trial assessing impacts of water, sanitation, and handwashing (WASH), and nutritional interventions, we evaluated effects on ARIs. The WASH Benefits cluster-randomized trial enrolled pregnant women from Kenyan villages and evaluated health outcomes in children born to enrolled mothers 1 and 2 years after intervention delivery. Geographically adjacent clusters were block-randomized into a passive control (no promotional visits), a double-sized active control (monthly visits to measure mid–upper arm circumference), and six intervention groups: chlorinated drinking water (W), improved sanitation (S), handwashing with soap (H), combined WSH, improved nutrition (N) through counseling and lipid-based nutrient supplementation (LNS), and combined WSHN. The main outcome was the prevalence of ARI symptoms (cough, panting, wheezing, or difficulty breathing) in children younger than 3 years. Masking participants was not possible. Analyses were intention-to-treat. Between November 2012 and May 2014, 702 clusters were enrolled, including 6,960 (year 1) and 7,088 (year 2) children with ARI data. The cluster-level intra-cluster correlation coefficient for ARIs was 0.026 across both years. Water, sanitation, and handwashing interventions with behavior change messaging did not reduce ARIs. Nutrition counseling and LNS modestly reduced ARI symptoms compared with controls in year 1 [PR: 0.87, 95% CI: 0.77–0.99], but no effect in the combined WSHN group weakens this finding.