Showing papers in "American Journal of Tropical Medicine and Hygiene in 1992"

Recommendations for treating leishmaniasis with sodium stibogluconate (Pentostam) and review of pertinent clinical studies.

Abstract: Pentavalent antimonial compounds have been the mainstay of the treatment of visceral, cutaneous, and mucosal leishmaniasis for approximately half a century. Pentostam (sodium stibogluconate) is the pentavalent antimonial compound available in the United States (through the Centers for Disease Control). As dosage regimens for treating leishmaniasis have evolved, the daily dose of antimony and the duration of therapy have been progressively increased to combat unresponsiveness to therapy. In the 1980s, the use of 20 mg/kg/day (instead of 10 mg/kg/day) of antimony was recommended, but only to a maximum daily dose of 850 mg. The authors have concluded on the basis of recent efficacy and toxicity data that this 850-mg restriction should be removed; the evidence to date, which is summarized here, suggests that a regimen of 20 mg/kg/day of pentavalent antimony, without an upper limit on the daily dose, is more efficacious and is not substantially more toxic than regimens with lower daily doses. We recommend treating all forms of leishmaniasis with a full 20 mg/kg/day of pentavalent antimony. We treat cutaneous leishmaniasis for 20 days and visceral and mucosal leishmaniasis for 28 days. Our judgment of cure is based on clinical criteria.

Liver Biochemical Tests and Dengue Fever

Abstract: The impact of dengue on liver function was studied by biochemical tests on 125 male and 145 female patients diagnosed with this disease during an outbreak that extended from November 1987 to December 1988. Abnormal levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), bilirubin, alkaline phosphatase, and gamma-glutamyl transpeptidase (G-GT) were observed in 93.3%, 82.2%, 7.2%, 16.3% and 83.0% of the patients, respectively. The elevation of transaminases was mild to moderate in most cases, but was 10-fold greater than the normal upper limit for AST and ALT in 11.1% and 7.4% of the patients, respectively. Initially, the level of AST was greater than that of ALT, increasing to maximum levels nine days after the onset of symptoms, then decreasing to normal levels within two weeks. Results of the biochemical tests did not differ significantly between the cases with and without hepatitis B or hepatitis C virus infection, but significantly higher elevations of AST, ALT, and G-GT were observed in patients with episodes of bleeding. Liver biopsies of two patients showed features of lobular hepatitis. Of the five fatal cases, three died of hepatic failure. It is concluded that dengue fever may cause hepatic injury and transaminase elevation similar to that in patients with conventional viral hepatitis. In epidemic or endemic areas, dengue fever infection should be considered in the differential diagnosis of hepatitis.

A model of the transmission of dengue fever with an evaluation of the impact of ultra-low volume (ULV) insecticide applications on dengue epidemics.

Abstract: We have developed a deterministic susceptible, exposed, infectious, resistant or removed (SEIR) model of dengue fever transmission that enables us to explore the behavior of an epidemic, and to experiment with vector control practices. Populations of both host and vector are divided into compartments representing disease status (susceptible, exposed, infectious, and, for humans, resistant), and the flow between compartments is described by differential equations. Examination of the equilibrium points leads to a formulation of the basic reproduction rate (Z0) of the disease. With a base set of parameters, Z0 = 1.9 and the model realistically reproduces epidemic transmission in an immunologically naive population. Control of adult mosquitoes by ultra-low volume (ULV) aerosols is simulated by an abrupt decrease in vector densities, followed by gradual recovery of the vector population. The model indicates that ULV has little impact on disease incidence, even when multiple applications are made, although the peak of the epidemic may be delayed. Decreasing the carrying capacity of the environment for mosquitoes, and thus the basic reproduction rate of the disease, by source reduction or other means, is more effective in reducing transmission.

Diarrhea as a cause and an effect of malnutrition: diarrhea prevents catch-up growth and malnutrition increases diarrhea frequency and duration.

Abstract: Diarrhea and malnutrition, alone or together, constitute major causes of morbidity and mortality among children throughout the tropical world. Data from northeast Brazil, taken with numerous other studies, clearly show that diarrhea is both a cause and an effect of malnutrition. Diarrheal illnesses impair weight as well as height gains, with the greatest effects being seen with recurrent illnesses, which reduce the critical catch-up growth that otherwise occurs after diarrheal illnesses or severe malnutrition. Malnutrition (whether assessed by impaired weight or height for age) leads to increased frequencies and durations of diarrheal illnesses, with a 37% increase in frequency and a 73% increase in duration accounting for a doubling of the diarrhea burden (days of diarrhea) in malnourished children. A multi-pronged approach focusing on those with prolonged diarrhea and severe malnutrition is suggested.

Drug resistance in leishmaniasis : its implication in systemic chemotherapy of cutaneous and mucocutaneous disease

Abstract: We report that in vitro sensitivity to pentavalent antimony (Sb5) of 35 Leishmania isolates as determined by the semiautomated microdilution technique (SAMT) showed an 89% and 86% correlation with clinical outcome after Pentostam and Glucantime treatment, respectively. These results suggest that in over 85% of the cases, the clinical outcome of treatment (cure or failure) could have been predicted by using the SAMT technique. Furthermore, the results clearly indicate that drug resistance is a problem, and that at least in some instances, failure to respond to treatment is due to the parasite as well as patient factors. Strains from Sb5-treated patients with American cutaneous and mucocutaneous disease who fail at least one complete course of Pentostam are as highly nonresponsive to this drug as laboratory-proven drug-resistant Leishmania strains. It was determined that some Leishmania isolates are innately less susceptible to Sb5 than others, and that moderate resistance to Sb5 exists in nature. A 10- and 17-fold increase was detected in the 50% inhibitory concentration (IC50) of Sb5 for L. mexicana and L. braziliensis isolates after subcurative treatment of the patients, when compared with the mean IC50 of seven and six isolates from the same endemic areas in Guatemala and Peru, respectively. Thus, we have correlated subcurative treatment to a decrease in drug sensitivity in at least these two cases. Collectively, these results indicate that under Sb5 pressure from undermedication, the parasites inherently most drug resistant are favored. The degree of resistance of a strain to antimony in association with host-specific factors will determine whether the clinical response to treatment with this drug is a total cure or a partial response followed by relapse(s), and possibly secondary unresponsiveness resulting in total resistance to antimony. It is evident from our in vitro test data that the SAMT is an extremely powerful and highly accurate technique for the prediction and determination of drug sensitivity of leishmanial isolates, as well as a means to screen for anti-leishmanial agents.

Vector density gradients and the epidemiology of urban malaria in Dakar, Senegal.

Abstract: The dispersion of anopheline mosquitoes from their breeding places and its impact on malaria epidemiology has been investigated in Dakar, Senegal, where malaria is hypoendemic and almost exclusively transmitted by Anopheles arabiensis. Pyrethrum spray collections were carried out along a 910-meter area starting from a district bordering on a permanent marsh and continuing into the center of the city. According to the distance from the marsh, vector density (the number of An. arabiensis per 100 rooms) at 0–160, 160–285, 285–410, 410–535, 535–660, 660–785, and 785–910 meters was 84, 40, 5, 2, 2, 0.4, and 0, respectively, during the dry season, and 414, 229, 110, 84, 99, 69, and 21, respectively, during the rainy season. The proportion of 8–11-year-old children with negative immunofluorescent antibody test results for Plasmodium falciparum was 17%, 28%, 44%, 54%, 50%, 63%, and 73%, respectively, in these different sections. Malaria prevalence in the community was maximum in the area bordering on the marsh where it ranged from 1% to 15% (average 6%) according to age and season of the year. These findings show the epidemiologic importance of vector density gradients in Dakar. The implications for malaria control in urban areas are discussed.

Prevalence and risk factors for Taenia solium taeniasis and cysticercosis in humans and pigs in a village in Morelos, Mexico.

Abstract: In a Mexican village in which Taenia solium infection was known to be endemic, we selected a cluster sample of 368 households (21% of the total) for demographic, environmental, and diagnostic surveys, and medical histories for taeniasis and cysticercosis. Coproparasitologic studies of 1,531 participants revealed infection by Taenia sp. in four (0.3%) individuals; however, 5.8% of the respondents reported a history of having passed tapeworm proglottids in feces. Of 1,552 human serum specimens, 10.8% tested positive in the cysticercosis immunoblot assay. Seropositivity increased with age and reached a maximum in subjects ages 46-55 years. Risk factors associated with seropositivity included a history of passing tapeworm proglottids, frequent consumption of pork, and poor personal and household hygiene (P less than 0.05). A history of seizures was also significantly associated with seropositivity (P less than 0.05); approximately one-third of persons with such histories were seropositive. Of 571 pigs examined by tongue inspection, 23 (4.0%) had cysticerci; infection rates increased with the age of pigs, and were higher in pigs that habitually ran loose or were fed human feces (P less than 0.05). Goodness of fit analysis confirmed that seropositive persons (but not infected pigs) were significantly clustered within households, particularly, in households in which a member reported a history of having passed tapeworm proglottids. The results of this study have identified community behavioral and environmental practices that must be modified to prevent continued transmission of cysticercosis and taeniasis.

A cluster of Coxiella burnetii infections associated with exposure to vaccinated goats and their unpasteurized dairy products.

Abstract: An outbreak of Q fever occurred among patients and staff of a psychiatric institution in southern France. Some of the patients and staff left the institution daily to work on a farm where goats were raised for raw milk and cheese production. The goats had all been vaccinated annually with a commercial vaccine containing phase II Coxiella burnetii antigen. A serologic survey revealed that 40 (66%) of the 61 patients and staff had elevated titers to C. burnetii. Seropositive persons were more likely to report an acute illness (P = 0.001), fever (P = 0.04), weakness (P = 0.04), arthralgia (P = 0.04), and headaches (P = 0.06) in the preceding year than were seronegative persons. Seropositivity rates were significantly higher among persons who worked on the farm and consumed unpasteurized milk products (69% [22 of 32]; P = 0.007), those who only had worked on the farm (75% [9 of 12]; P = 0.009), and those who only had consumed unpasteurized milk products (75% [9 of 12]; P = 0.009), compared with those who had not worked with the goats or consumed unpasteurized milk products (0 of 5). Despite vaccination against Q fever, no antibodies to C. burnetii were detectable in 17 (59%) of 29 goats. All 12 seropositive goats had antibodies to both phase I and phase II antigens, indicating that they were naturally infected, and two of three goats examined were shedding C. burnetii in their milk. Vaccination of this herd did not prevent the outbreak and might have increased shedding of C. burnetii in the dairy products.

Rosette formation in Plasmodium falciparum isolates and anti-rosette activity of sera from Gambians with cerebral or uncomplicated malaria

Abstract: The ability of Plasmodium falciparum-infected red blood cells (RBC) to form spontaneous erythrocyte rosettes was studied in 130 fresh isolates from Gambian children with cerebral or uncomplicated malaria from August to November 1990. All isolates (24 of 24) from patients with cerebral malaria formed rosettes, but only 61 of 106 isolates from children with uncomplicated malaria formed rosettes. The mean rate of rosette formation in isolates from children with cerebral malaria (28.3%) was significantly greater than that in isolates from children with uncomplicated malaria (8.5%). Giant rosettes were more frequently formed in isolates from patients with cerebral malaria than in those from patients with uncomplicated malaria. Sera of children with cerebral disease generally lacked anti-rosette activity, while many sera from children with uncomplicated malaria showed strong anti-rosette activity when tested against the patients' ow parasites. Some sera that were devoid of autologous rosette-disrupting activity were able to disrupt rosettes formed in other isolates, indicating the presence of different rosette formation mechanisms. Forty percent (6 of 15) of the sera from patients with cerebral malaria caused microagglutination of the patients' own uninfected and infected RBC, while only 10% (3 of 31) of sera from children with uncomplicated disease caused microagglutination. The ability of infected RBC to bind to melanoma cells grown in vitro did not differ between patients with cerebral or uncomplicated malaria. The results of this study, taken in conjunction with our previous findings, establish a strong association between rosette formation in P. falciparum-infected RBC and cerebral malaria.

Use of the Falcon assay screening test--enzyme-linked immunosorbent assay (FAST-ELISA) and the enzyme-linked immunoelectrotransfer blot (EITB) to determine the prevalence of human fascioliasis in the Bolivian Altiplano.

Abstract: A collaborative study between the University of Puerto Rico School of Medicine, the Centers for Disease Control, the Bolivian Ministry of Health, and private voluntary organizations (Foster Parents Plan International and Danchurchaid) working in Bolivia has identified a region in the northwestern Altiplano of Bolivia near Lake Titicaca as harboring the highest prevalence of human fascioliasis in the world reported to date. Two serologic techniques (the Falcon™ assay screening test-enzyme-linked immunosorbent assay [FAST-ELISA] and the enzyme-linked immunoelectrotranfer blot [EITB]) were used in the determination of its prevalence. One hundred serum samples and 73 stool samples were obtained from Aymara Indians from Corapata, Bolivia. Antibody absorbance levels to Fasciola hepatica excretion-secretion antigens were compared with EITB banding patterns using the same antigen preparation. A positive FAST-ELISA result was defined as an absorbance value greater than the mean plus three standard deviations of two sets of normal negative controls (Puerto Rican and Bolivian). Using this criterion, 53 of 100 sera tested were found positive by this technique. Within this group, 19 (95%) of 20 individuals who were parasite positive were also positive by FAST-ELISA. An additional 24 individuals who were negative for F. hepatica eggs and 10 individuals for whom no specimens were received were also positive by FAST-ELISA. Among the 53 individuals negative for F. hepatica eggs, 29 were also negative by FAST-ELISA. The EITB analysis of the sera from confirmed infected individuals revealed at least three F. hepatica (Fh) bands with molecular weights of 12, 17, and 63 kD, respectively. All 20 sera from infected individuals recognized the Fh12 band; the Fh17 and Fh63 bands were only observed in those individuals with the highest FAST-ELISA absorbances, which suggests that they may be markers for acute infection, in which antibody levels tend to be high. Additional serum samples from six individuals that were negative by coprology and FAST-ELISA did not recognize any of the above markers. Using EITB, 42 (79%) of the 53 persons who were positive by FAST-ELISA were confirmed. These studies support the use of immunologic techniques in the determination of prevalence in epidemiologic studies of human fascioliasis.

Use of genetic polymorphisms detected by the random-amplified polymorphic DNA polymerase chain reaction (RAPD-PCR) for differentiation and identification of Aedes aegypti subspecies and populations.

Abstract: Amplification of random regions of genomic DNA using 10-base primers in the random-amplified polymorphic DNA polymerase chain reaction (RAPD-PCR) was used to differentiate and identify mosquito populations based on genetic variation. Genomic DNA was extracted from individual mosquitoes from 11 geographic populations of Aedes aegypti and amplified in PCR reactions using single primers of arbitrary nucleotide sequence. Discriminant analysis of the population frequencies of RAPD fragments produced using three different primers allowed accurate discrimination between the geographic populations in 89% of individuals and between subspecies (Ae. aegypti aegypti versus Ae. aegypti formosus) in 100% of mosquitoes tested. The genetic relatedness of the populations was estimated using three different statistical methods, and unknown populations were correctly classified in a blind test. These results indicate that the RAPD-PCR technique will be useful in studies of arthropod molecular taxonomy and in epidemiologic studies of the relatedness of geographic populations and vector movement.

Efficacy of Bovine Milk Immunoglobulin Concentrate in Preventing Illness after Shigella Flexneri Challenge

Abstract: The protective efficacy of oral bovine immunoglobulin concentrates derived from colostrum against challenge with Shigella flexneri was studied in healthy adult volunteers in a randomized, double-blind fashion. Volunteers were given a product consisting of hyperimmune immunoglobulin concentrate with a high titer of anti-S. flexneri 2a lipopolysaccharide (LPS) with sodium bicarbonate or a control preparation with sodium bicarbonate three times a day for seven days. On the third day of treatment, volunteers received a challenge of 10(3) colony-forming units of S. flexneri 2a strain 2457T. None of the volunteers who received the high-titered hyperimmune product became ill, compared with 45% of volunteers who received the placebo (P less than 0.05). The duration of shedding of the challenge organism was decreased, and the active immune responses to S. flexneri LPS were less frequent and of lower magnitude in volunteers given the immunoglobulin concentrate than in those in the control group. High-titered, orally administered bovine immunoglobulin concentrate protects against shigellosis and may be useful in preventing shigellosis among travelers, military personnel, and individuals at risk during a Shigella outbreak.

Lyme borreliosis in genetically resistant and susceptible mice with severe combined immunodeficiency.

Abstract: The evolution of Lyme borreliosis was examined in genetically resistant C.B.-17 and susceptible C3H/He(C3H) mice homozygous for the severe combined immune deficiency (scid) gene, or their immunocompetent counterparts. The C.B-17, C.B-17-scid, C3H, and C3H-scid mice were inoculated intradermally with 104 Borrelia burgdorferi and examined on days 14, 21, 30, 45, and 60 after inoculation. Spirochetemia was detected through 30 days, but was cleared in all groups by 45 days. Kidney and brain were inconsistently culture positive, but spleen and ear punch samples were positive in most mice. Immunocompetent C.B-17 and C3H mice seroconverted with equivalent IgG titers to B. burgdorferi, while C.B-17-scid and C3H-scid mice did not seroconvert. Arthritis occurred in nearly all joints examined in all genotypes on day 14, was of equal severity among C.B-17, C.B-17-scid, and C3H mice, but was more severe in C3H-scid mice. By days 30 and 45, arthritis began to resolve in immunocompetent mice, with C3H mice having more severe disease than C.B-17 mice. Arthritis persisted in C.B-17-scid and C3H-scid mice. Carditis occurred to an equal degree in all groups on day 14, remained active in scid mice, but regressed in immunocompetent mice at later intervals. Many spirochetes were visualized with silver stain in inflamed synovial tissues of scid mice, and were present in other tissues in smaller numbers. These studies show that specific immunity is not involved in arthritogenesis or genetically determined susceptibility to arthritis, but is involved in arthritis and carditis regression.

A simple method to detect Plasmodium falciparum directly from blood samples using the polymerase chain reaction.

Abstract: We have developed a simple method for treating blood samples permitting direct detection of Plasmodium falciparum parasites using the P. falciparum-specific DNA probe pPF14 after polymerase chain reaction (PCR) amplification of target DNA sequences, and have compared this method with microscopic examination of thick blood smears. For PCR amplification, blood samples were lysed, then filtered onto filter paper. After drying, a piece of the filter paper was added directly to the PCR mixture for amplification. The presence of PCR products was detected using nonisotopically labeled probe. This method permits detection of less than than 10 parasites in a 20-microliters sample, and minimizes the effects of PCR inhibitors generally found in blood. Samples were collected from patients presenting at malaria clinics in Mae Sod and Mae Ramat, Thailand, and 626 were analyzed both by the PCR method and by conventional microscopy. Of these, 157 were positive both by microscopy and by PCR, while 297 were negative by both methods. PCR detected 131 samples that were negative by microscopy, and failed to detect 41 samples identified as positive by microscopy. All discordant samples were re-analyzed by microscopy and by PCR. Upon re-examination at a higher sensitivity, microscopy identified five additional positive cases, while six previously positive cases were found to be negative. This method of treating blood samples for PCR may also be useful in other diagnostic assays.

Carditis in Lyme Disease Susceptible and Resistant Strains of Laboratory Mice Infected with Borrelia Burgdorferi

Abstract: The clinical and pathologic evolution of cardiac Lyme disease was evaluated in four-week-old susceptible C3H/He (C3H) and resistant C57Bl/6 (B6) mice on days 3, 6, 10, 15, 30, 60, and 90 after intradermal inoculation with Borrelia burgdorferi strain N40. Culture, DNA polymerase chain reaction, in situ nucleic acid hybridization, immunoperoxidase histochemical analysis, and silver stain were used to detect spirochetes. Spirochetes were first detected by culture on day 6 in two of four C3H mice. The hearts of all mice of both genotypes were culture positive by day 10 and infection persisted through day 90. The spirochetes had a predilection for connective tissue in the heart base, especially around the aorta, epicardium of the upper ventricles and atria, myocardial interstitium, and endocardium. Carditis was first detectable on day 10, reaching a maximum severity on day 15, then resolved, except for persistence of periaortic lymphoplasmacytic infiltrates through day 90 in C3H mice and through day 60 in B6 mice. The C3H mice developed more severe disease than the B6 mice, and this was associated with the earlier appearance, greater numbers, and later clearance of spirochetes in C3H mice. Electrocardiographs of infected and control mice revealed bradycardia and tachycardia in many C3H mice, but in very few B6 mice. Serum creatinine phosphokinase levels did not become elevated at any interval.

Western blot analysis of antibodies to Leishmania infantum antigens: potential of the 14-kD and 16-kD antigens for diagnosis and epidemiologic purposes.

Abstract: When infected with Leishmania species, patients develop specific antibodies that constitute the basis of serodiagnosis. Using Western blot analysis, we studied the specificity of anti-L. infantum antibodies in patients with visceral leishmaniasis (including patients with acquired immunodeficiency syndrome [AIDS]) and in healthy subjects living in an endemic area. Sera from patients with visceral leishmaniasis recognized numerous antigens that had a molecular mass range of 12-120 kD. The 14-, 16-, 28-30-, 46-, and 68-kD antigens were recognized by 92%, 95%, 63%, 80%, 69%, and 89% of the patients' sera, respectively. The 14-16-kD antigens had the greatest specificity for leishmaniasis. The same pattern was found with sera from AIDS patients with proven leishmaniasis, but the 14-kD band was not present in some cases; recognition of the 16-kD band was constant. In these patients, Western blotting characterized specific antibodies even when the results of classic serologic tests (indirect immunofluorescent antibody test and enzyme-linked immunosorbent assay) were negative. Western blotting was found to be more sensitive than the IFA and ELISA, and it was used to detect antibodies to the 14-, 16-, 22-, and 24-kD antigens in subjects living in an endemic area. The detection of antibodies for the 14-kD and 16-kD Leishmania antigens would be a valuable tool both in the diagnosis of visceral leishmaniasis and in epidemiologic studies.

A new Genotype of Japanese Encephalitis Virus from Indonesia

Abstract: Primer-extension sequencing of the RNA template of polio, dengue, Rift Valley fever, and Japanese encephalitis (JE) viruses has provided new information on their geographic distribution, origin, and evolution. In a previous study of 46 diverse JE virus strains, we demonstrated the existence of three distinct JE genotypes in Asia. We now report the occurrence of a fourth genotype. In the present study, 19 JE virus isolates, representing various geographic regions of Asia and a 50-year time span, were compared with each other and with Murray Valley encephalitis, West Nile, and Kunjin viruses. Twelve of the JE strains from the Indonesian Archipelago and the Philippines had not been previously examined; the remainder were representatives of the three previously identified genotypes. Two hundred forty nucleotides from the pre-M gene region of the virus were used in these comparisons. Using 12% divergence as a cut-off point, the 19 JE strains fell into four distinct genotypic groups; maximum divergence across the comparison region was 21%. The newly recognized fourth genotype was comprised of five Indonesian isolates that were 7% divergent from the rest of the JE viruses.

Intraspecific chromosomal polymorphism in the Anopheles gambiae complex as a factor affecting malaria transmission in the Kisumu area of Kenya.

Abstract: The paracentric inversion polymorphisms of Anopheles gambiae and An. arabiensis populations in the Kisumu area of western Kenya were studied in relation to parameters of Plasmodium falciparum transmission. Anopheles gambiae (n = 1,387) was polymorphic for inversions b on chromosomal arm 2R and a on arm 2L, with frequencies of the inverted arrangements of 17% and 43%, respectively. Anopheles arabiensis (n = 484) was polymorphic for inversion b on chromosomal arm 2R and a on 3R, with frequencies of the inverted arrangements of 58% and 5%, respectively. Observed karyotypic frequencies did not deviate from Hardy-Weinberg equilibrium, indicating a condition of panmixia (i.e., random mating) for both species. The overall degree of intraspecific polymorphism was low, confirming findings from other zones of East Africa. No significant differences in inversion frequencies of either An. gambiae or An. arabiensis were observed, either between collecting sites or between similar sampling periods of consecutive years. At the same time, a stable, significant two-fold difference in Plasmodium infection rates was detected among An. gambiae carriers of different inversion karyotypes on chromosome 2. A significant non-uniform distribution of human- and bovid-fed specimens was also detected among the carriers of different 2Rb inversion karyotypes in indoor resting An. arabiensis. Relationships among inversion karyotypes of the two major malaria vectors in the An. gambiae complex and key factors affecting malaria transmission intensity emphasize that intraspecific variation could contribute significantly to the diversity and stability of malaria vectorial systems in Africa.

A longitudinal study of Junin virus activity in the rodent reservoir of Argentine hemorrhagic fever.

Abstract: We monitored Junin virus (JV) activity in rodent populations for 30 months at seven mark-recapture grids located in agricultural fields and adjacent roadsides and fence lines in endemic and nonendemic areas of Argentine hemorrhagic fever. Blood and oral swabs taken from rodents captured at five-week intervals were analyzed by enzyme-linked immunosorbent assay for JV antigen (Ag). Calomys laucha and C. musculinus were the most frequently captured rodents, making up 47% and 22% of captures, respectively. Of 41 Ag-positive captures, 37 were C. musculinus and four were C. laucha; 34 were from two trapping grids in the same locality. Antigen-positive Calomys were more frequently male (76%), and were found significantly more frequently among the oldest animals and the largest body mass classes. These patterns, combined with the greater mobility and higher frequencies of wounds among males than females, implicated horizontal transmission as the primary route of JV transmission between rodents. Seasonal maximum levels in JV prevalence (up to 25% of captured Ag-positive C. musculinus) occurred during periods of maximal population densities of Calomys. Spatial distribution of Ag-positive rodents reflected habitat preferences; most Ag-positive C. musculinus were captured from border habitats (roadsides and fence lines), and all Ag-positive C. laucha were captured in crop fields. These distinct, but previously undocumented, habitat preferences suggest that the disease in humans may be related to exposures to the primary reservoir species, C. musculinus, in border habitats rather than in crop fields.

Homing in on helminths.

Abstract: I am honored to give this lecture dedicated to the memory of Dr Fred Soper, whose pioneering efforts against the insect vectors of malaria and yellow fever are legendary Soper and his colleagues also played key roles in restoring the concept of eradication to respectability after the collapse of earlier campaigns to eradicate hookworm and yellow fever When Soper was himself invited to give the first of five Fred Soper Lectures to mark his retirement as regional director of the Pan American Health Organization in 1959, he entitled his lecture Rehabilitation of the Eradication Concept in Prevention of Communicable Diseases Ten years later, The World Health Organization (WHO)'s abandonment of the declared goal of malaria eradication marked another nadir in the acceptability of the concept of eradication, from which we are only now reemerging One measure of the change is that the Director-General of WHO in 1980 wrote that “Important lessons can be learned from smallpox eradication, but the idea that we should single out other diseases for worldwide eradication is not among them”

Detection of Borrelia burgdorferi in ticks by species-specific amplification of the flagellin gene.

Abstract: We developed a polymerase chain reaction (PCR) that specifically amplifies a fragment of the flagellin gene (fla) of Borrelia burgdorferi, the causative agent of Lyme disease. This fla target, amplified with nested primers, was conserved among all 80 strains of B. burgdorferi tested. Strains examined included cultures from ticks, humans, and rodents from major B. burgdorferi-endemic regions of the United States and parts of Europe and Asia. Templates from B. hermsii, B. parkeri, B. turicatae, and B. coriaceae were not amplified, nor were eukaryotic DNAs from three tick genera. Several host DNAs potentially present in a tick blood meal also were not amplified. Approximately six B. burgdorferi per PCR reaction could be detected by ethidium bromide staining of amplified DNA. Colony-raised Ixodes dammini were used to evaluate the method. One infected nymph in a pool of 40 ticks was routinely detected. The specificity of the assay for detecting B. burgdorferi-infected ticks in pools was 94% (29 of 31). This protocol should prove useful for assessing infection rates in other putative arthropod vectors.

Diarrheal disease as a cause of malnutrition.

Abstract: Although long associated with infectious diseases, malnutrition is recognized as a major effect of specific infections, especially those of the gastrointestinal tract. Synergistic exacerbation of infections and nutritional deficiency commonly begin with weaning, where the impact of repeated infections and possible monocyte mediator release may have an even greater effect on malnutrition of young children than that of deficient diets in many areas. Reviewed here are the detailed host alterations seen with specific enteric infections that lead to malnutrition. These include mucosal dysfunction, systemic metabolic responses, impaired intake, digestion and absorption, nutrient losses, altered immune responses, and ultimately, impaired growth, development, and nutrition. The tremendous health impact of diarrhea on both morbidity and mortality in many developing areas must be recognized and controlled along with correction of food shortages in order to improve the nutrition, growth, and survival of impoverished children.

Grading of hepatic schistosomiasis by the use of ultrasonography.

Abstract: Forty-three subjects with pure hepatic schistosomiasis having ultrasonographic assessment of periportal fibrosis were grouped according to the thickness of their portal tracts: grade I = 3-5 mm, grade II = greater than 5-7 mm, and grade III = greater than 7 mm. A history of hematemesis, blood transfusion, sclerotherapy, and lower limb edema correlated with the ultrasonographic grade of periportal fibrosis. With increasing grade, the average liver size was smaller and the average spleen size was larger, as determined by physical examination and by ultrasonography. Abnormalities in serum enzyme levels were more frequent in those with thicker portal tracts. Greater diameters of the portal and splenic veins and ultrasonographically detectable collateral blood vessels were associated with increasing thickness of portal tracts. The grade of endoscopically determined esophageal varices was highly correlated with the grade of periportal fibrosis. We concluded that this method of grading accurately reflects the hemodynamic changes and provides a good estimate of the clinical status of patients who have periportal fibrosis due to schistosomiasis mansoni. Where available, it should replace clinical grading based upon the liver and spleen size as detected by physical examination.

Results of a community-based Aedes aegypti control program in Merida, Yucatan, Mexico.

Abstract: This report describes the results of a community-based Aedes aegypti control program in Merida, Yucatan, Mexico. Baseline surveys concerning knowledge, beliefs, and practices of 577 women and a larval survey of 616 house lots were carried out in October 1989. Following development of a public health communication intervention from this data, the program was implemented in six communities. Evaluation used an untreated control group design with pretest and two post-tests, one at completion and one six months later. Significant changes in knowledge and behavior were seen in the treatment group in both post-tests. Women in the intervention group were able to identify the Ae. aegypti mosquito, the larval production sites of the mosquito, and appropriate control methods. A behavior change proxy was measured by examining changes in the Breteau (number of positive containers/100 houses surveyed) and container indices. The Breteau index remained the same in the intervention group while it increased significantly in the comparison group. Changes were also seen with respect to individual containers. This project demonstrated that a community-based communication program aimed at larval production site elimination or control can be effective in changing behavior and reducing larval production sites.

Lymphocytic choriomeningitis virus infection and house mouse (Mus musculus) distribution in urban Baltimore

Abstract: Four hundred eighty house mice (Mus musculus) were trapped primarily from urban sites in Baltimore, Maryland from 1984 to 1989 and tested for antibody to lymphocytic choriomeningitis virus (LCMV). The majority of mice (95%) were trapped in residences at two city locations (n = 260), or in an urban park (n = 196); five additional sites were sampled. Overall, 9.0% of the mice were LCMV antibody positive and infected animals were obtained from six of eight sites, including all three of the primary city sites, where the prevalence varied significantly (3.9–13.4%). The location with the highest prevalence was an inner city residential site where positive mice were found significantly clustered within blocks and households. In this location, LCMV antibody prevalence was also significantly correlated with estimates of mouse density within individual blocks. The focal nature of LCMV infection in house mice may result from contact or vertical transmission of virus in conjunction with the highly structured social system of mice, which promotes inbreeding and limited dispersal.

Immunodiagnosis of human cysticercosis (Taenia solium): A field comparison of an antibody-enzyme-linked immunosorbent assay (ELISA), an antigen-ELISA, and an enzyme-linked immunoelectrotransfer blot (EITB) assay in Peru

Abstract: We compared results of an enzyme-linked immunosorbent assay (ELISA) and an enzyme-linked immunoelectrotransfer blot (EITB) assay for the diagnosis of cysticercosis in sera and cerebrospinal fluid (CSF). Sera from 34 patients with confirmed cysticercosis were tested by both ELISA and EITB assays. Cerebrospinal fluid from some of these patients was also tested by ELISA for the presence of antibody (AB-ELISA) (n = 21) and antigen (AG-ELISA) (n = 15). Specificity in sera was examined by testing 51 serum samples from Bangladesh, where cysticercosis is not endemic. Cross-reactivity was evaluated in sera from patients with Echinococcus granulosus (hydatid) and Hymenolepis nana infections. Sensitivity in detecting cysticercosis in sera was 94% by EITB and 65% by AB-ELISA (P less than 0.01). Sensitivities in the CSF tested by EITB, AB-ELISA, and AG-ELISA were 86%, 62%, and 67%, respectively. The specificity of the EITB was 100%, while that of AB-ELISA was 63% (P less than 0.01). Cross-reactions occurred in the AB-ELISA with 11% and 20% of sera from hydatid and H. nana patients, respectively. Our results demonstrate that the EITB is the best assay available for the diagnosis of cysticercosis in both sera and CSF.

Effect of Plasmodium falciparum on blood feeding behavior of naturally infected Anopheles mosquitoes in western Kenya.

Abstract: Feeding behavior was compared between infected and uninfected field-collected groups of Anopheles gambiae sensu lato and An. funestus from western Kenya. A significantly greater percentage (81%) of Plasmodium falciparum-infected An. gambiae s.l. females probed on experimental hosts (hamsters) than did uninfected females (38%). Among those females that initiated probing, there was no effect of infection status on the ability to take a bloodmeal. Plasmodium falciparum-infected An. gambiae s.l. probed more often (mean = 4.0) and for a longer time (mean = 277 sec) than did their uninfected counterparts (mean = 2.4 probes and mean probing time = 214 sec). Results for the small number of An. funestus that fed followed the same trend. Among infected An. gambiae s.l. females, there was no effect of sporozoite density on either the number of probes made or the total probing time. Among uninfected females, there was no difference in feeding behavior between nulliparous and parous females. In laboratory experiments, female age had no effect on blood-feeding behavior. Our findings provide evidence that natural malaria infection modifies the feeding behavior of Anopheles females.

Renal abnormalities in microfilaremic patients with Bancroftian filariasis.

Abstract: To determine the frequency of renal abnormalities occurring with Bancroftian filarial infections and to assess the effects of treatment on such abnormalities, we initiated a prospective, hospital-based study of 20 microfilaremic and five amicrofilaremic patients with Wuchereria bancrofti infections. Thorough clinical evaluations and detailed renal assessments were made prior to treatment and at multiple time points for 60 days following a standard twelve-day course of treatment with diethylcarbamazine (DEC). There were two important findings. First, even prior to DEC treatment, almost half of the microfilaremic patients had hematuria and/or proteinuria. Second, treatment with DEC induced these same abnormalities in almost all of the remaining microfilaremic patients. However, this DEC-induced hematuria and/or proteinuria was transient, and the long-term response to DEC in all of the microfilaremic patients was resolution of the abnormal renal findings during the two-month followup period. In the amicrofilaremic study patients, no hematuria or proteinuria was detected before, during, or after treatment with DEC.

Transformation of an insect symbiont and expression of a foreign gene in the Chagas' disease vector Rhodnius prolixus.

Abstract: A shuttle plasmid was developed that is capable of replicating both in Escherichia coli and in Rhodococcus rhodnii, a bacterial symbiont of the Chagas' disease vector Rhodnius prolixus. We have been able to transform R. rhodnii with this plasmid, infect aposymbiotic R. prolixus with the transformed symbionts, select with the antibiotic thiostrepton, and re-isolate genetically altered symbionts from the insects following successive molts. Symbiotic bacteria are potentially valuable as vehicles for the stable introduction of foreign genes into insects with the goal of eventually altering the ability of the insect to transmit a pathogenic agent.

Outbreak of fatal illness among captive macaques in the Philippines caused by an Ebola-related filovirus.

Abstract: Following the detection of an Ebola-like virus in cynomolgus macaques recently imported into the United States from The Philippines, studies were initiated to document transmission at export facilities located in the latter country At one export facility, 528% of 161 monkeys that died over a 25-month period were shown to be infected with this virus using an enzyme-linked immunosorbent assay to detect antigen in liver homogenates A case fatality rate of 824% was documented for the infected monkeys The initial anti-viral antibody prevalence among the captive macaques at this facility was 259% (indirect fluorescent antibody titer greater than or equal to 1:16) Followup documented infection of 244% of initially seronegative animals and 87% of initially seropositive monkeys Being held in a gang cage versus a single cage was found to be a significant risk factor for subsequent virus infection, and the presence of IFA antibody was shown to predict protection This study documents unequivocally for the first time the presence of an Ebola-related filovirus in Asia