Asian Pacific Journal of Tropical Medicine

153-160

Authors: Hongchun Du, Yajuan Zhu, Yan Chen, Shidan Zhou, Jiani Tong, Yingnan Deng, Dingmei Zhang

Objective: To describe the current reporting of pneumonia of unknown etiology (PUE) and factors that affect reporting by clinicians in China using the PUE surveillance system in order to provide a reference for improving PUE reporting rates in the future. Methods: Clinicians were recruited via the Sojump platform and requested to complete an anonymous self-administered questionnaire. Multivariate logistic regression analysis was used to assess factors influencing clinicians’ reporting activities. Results: This study showed a low PUE case reporting rate and a poor understanding of PUE reporting among the investigated clinicians. Of the 136 clinicians who had diagnosed PUE cases, multivariate logistic regression analysis results showed that clinicians who had attended in-hospital training were more likely to report PUE than those who had not (OR 4.48, 95% CI 1.49-13.46). Clinicians with an expert panel on PUE in their hospital were more likely to report PUE cases than those without (OR 5.46, 95% CI 1.85-16.11). Conclusions: There is a need to promote and reinforce PUE surveillance system training among medical staff. In addition, PUE testing technologies in hospital laboratories should be upgraded, especially in primary and unclassified hospitals, to increase surveillance efficiency and improve PUE reporting rates.

171-178

Authors: Oya Baydar Toprak, Sennur Ozen, Berker Ozturk, Burcu Ozturk, Ebru Ozturk, Mehmet Kitapci, Nurdan Kokturk

Objective: To identify effects of various nationwide vaccination protocols on the evolution of new SARS-CoV-2 infections among adult population and to evaluate the safety of mRNA (BioNTech/ Pfizer) vaccine. Methods: Totally 10 735 adult volunteers that received at least one dose of BioNTech/Pfizer or triple doses of CoronaVac participated in this cross-sectional-online survey between 1 and 10 September 2021. The information was collected covering a 5-month period from April 2021 to September 2021. Information about people who were vaccinated with only single and double dose CoronaVac were not included in this study. Results: At least one side effect after single and double dose of BioNTech/Pfizer and triple doses of CoronaVac were observed in 42.1%, 42.5% and 10.9%, respectively. The most common side effects were shoulder/arm pain, weakness/fatigue, muscle/joint pain and headache. The side effects were the most frequent in single BioNTech/Pfizer, while it was the least in triple CoronaVac. The rate of positive PCR tests before vaccination was 17.6%, and decreased to 3.0% after vaccination. The rates of positive SARS CoV-2-PCR were 18.8%, 3.5%, 3.1%, 0.5% and 4.6% in single BioNTech/Pfizer, double BioNTech/Pfizer, double CoronaVac+single BioNTech/Pfizer, double CoronaVac+double BioNTech/Pfizer and triple CoronaVac, respectively. While 1.8% of PCR positive COVID-19 cases needed intensive unit care in the pre-vaccination period, intensive care unit was required in 0%, 1.5%, 2.4%, 0% and 4.2% after single BioNTech/ Pfizer, double BioNTech/Pfizer, double CoronaVac+single BioNTech/ Pfizer, double CoronaVac+double BioNTech/Pfizer and triple CoronaVac, respectively. Reinfection rate after vaccination was 0.4%. Conclusions: The rarity of COVID-19 infection after vaccination suggests that efficacy of vaccines is maintained. On the other hand, the data underscore the critical importance of continued public health mitigation.

183-185

Authors: Madhumita Pal, Moumita Sengupta, Keya Basu, Arpita Roychowdhury

Rationale: Genitourinary tuberculosis can develop during the disease course of disseminated disease and the distinctive histological finding is epithelioid granuloma with or without caseation and accompanied Langhans-type giant cells. Barely, the lesion is only restricted to kidney involving both glomerular and extraglomerular compartment. Association with immune complex-mediated glomerulonephritis has been sparsely reported in the literature. Patient concern: A 42-year-old non-diabetic, non-hypertensive male presented with generalized body swelling and frothing of urine for 3 months. Diagnosis: Membranous nephropathy with tuberculous interstitial nephritis. Intervention: Anti-tuberculous therapy for extrapulmonary tuberculosis was administered along with low dose corticosteroid. Outcomes: Reduction of proteinuria was achieved at one month follow-up visit. Lessons: Tuberculosis should be considered as a potentially treatable cause of secondary membranous nephropathy as pharmacotherapy greatly helps improve the outcome.

188-190

Authors: Kadriye Avcı

None.

106-113

Authors: David Susanto, Arthur H. P. Mawuntu, Finny Warouw, Windy M. V. Wariki

Objective: To examine the differences in effectiveness and side effects between pyrimethamine-based and non-pyrimethamine-based regimens for toxoplasma encephalitis since the availability of pyrimethamine in Indonesia is currently limited due to its withdrawal from the market. Methods: A systematic review and meta-synthesis study that was carried out by following a protocol guided by the Preffered Reporting Items for Systematic Review and Meta-analysis (PRISMA). Effectiveness measures included clinical improvement, mortality, and radiological improvement. We evaluated selected articles narratively because of the limitations of homogeneity. The risk of bias in RCTs was assessed using the Cochrane Risk of Bias tool for RCT (ROB 2.0) and cohort studies were assessed using the Risk of Bias In Non-Randomized Studies of Interventions (ROBINS-1) tool. Research quality was assessed using the GradePro software. Results: We included two retrospective cohort studies and one RCT. Narrative outcome assessment in these three studies did not show significant difference in effectiveness between pyrimethamine-based and non-pyrimethamine-based regimens for toxoplasma encephalitis treatment. However, drug side effects were consistently higher in the pyrimethamine-based regimen. Conclusions: This study has a high risk of bias. The quality of the research also has a low recommendation value. However, the results may be considered for application if a standard regimen is not available.

121-127

Authors: Abebe Fenta, Bewket Mesganaw, Feven Belachew, Getachew Teshale, Gashaw Abebaw, Elias Tesfa, Getaye Alemayehu

Objective: To assess the prevalence and associated factors of soil transmitted helminths (STHs) among Endemata primary school in North West Ethiopia, 2021. Methods: A cross-sectional study with 195 school children was conducted from May to July 2021 at Endemata primary school. The study participants were selected by using systematic random sampling technique. Stool samples were processed via direct wet mount and formol-ether concentration techniques. Data was entered by Epi-Dara version 3.1 and data analysis was done using SPSS version 20.0. Variables were considered to be statistically significant if P<0.05 at 95% confidence level. Results: The overall prevalence of STHs was 10.8% (95% CI 7.1-16.0). The prevalence of Ascaris lumbricoides, hookworm and Trichuris trichiura were 5.6% (95% CI 3.1-9.9), 3.1% (95% CI 1.3- 6.7) and 2.1% (95% CI 0.6-5.3), respectively. Grade 1-4 students were more likely to get infected with STHs as compared to grade 5-8 students (adjusted OR 4.7, 95% CI 1.3-16.6). Students who did not have latrines at their home were at higher risk to develop STHs infection comparing with those who had latrine at their home (adjusted OR 5.0, 95% CI 1.7-15.2). Similarly, the school children who did not wear shoes were more likely to be infected by STH parasite than those who did it (adjusted OR 6.3, 95% CI 1.9-20.7). The odds of being infected by STH parasites in children who did not trim their fingernails were 4.9 as compared to those who did it (adjusted OR 4.9, 95% CI 1.5-15.7). Conclusions: The prevalence of STHs among Endemata primary school children was low. Student grade level, latrine availability, shoes wear and nail status were significantly associated with STHs infection. Therefore, we recommend policy makers and stakeholders to follow the integration of deworming with water, hygiene and sanitation as well as the consistent health education of school children to control and prevent STH infections.

135-142

Authors: Nayana Gunathilaka, Yashoda Wijebandara, Deepika Amerasinghe, Lahiru Udayanga, Thusitha P. Muhandiramlage

Objective: To assess the larvicidal activity of mangosteen (Garcinia mangostana) against larval stages of Aedes aegypti mosquitoes. Methods: A crude extract was prepared in ethanol from powdered mangosteen pericarps. A concentration gradient (0.01-4.92 g/ L) was prepared from the stock solution. Seven batches of 25 third instar larvae of Aedes aegypti were used for larval bioassays. Larval mortality rates were observed after one and 24 hours. Cholesterol and total lipid contents in 20 randomly selected dead larvae at each trial were assessed by colorimetric method. The experimental setup was repeated five times. The General Linear Model and Probit analysis were used to evaluate the relationship of mortality with cholesterol level, total lipid level and cholesterol to total lipid ratio. Results: The percentage mortalities significantly varied with different concentrations (F7,32=385.737; P<0.001). The LC50 and LC99 values were (0.041 ± 0.006) g/L and (10.616 ± 1.758) g/ L, respectively after 24 hours. There was no mortality recorded within the one-hour exposure time. Only the cholesterol content (F5,24=173.245; P<0.001) in larvae exposed to different concentrations denoted a significantly decreasing trend within 24- hour exposure. Larvae that were exposed to the lowest concentration (0.55 g/L) showed a higher cholesterol level (22.67 ± 1.33) μg. Conclusions: The Garcinia mangostana extract acts as an effective sterol carrier protein inhibitor that inhibits cholesterol uptake in Aedes aegypti mosquitoes. Hence, it could be explored for use as a key source for the development of an environment-friendly plantbased larvicide.

53-55

Authors: Muhammad Suleman Rana, Muhammad Usman, Muhammad Masroor Alam, Aamer Ikram, Muhammad Salman, Rani Faryal, Massab Umair

None.

63-70

Authors: Mamtaz Sultana, Nazmul Hasan, Mamunur R. Mahib, Mohammad M. Islam

Objective: To identify the residue determinants of the serospecificity and sero-cross-reactivity of dengue virus (DENV) envelope protein domain 3 (ED3), which contains two major putative epitopes of DENV. Methods: We constructed ED3 from DENV3 (3ED3) and DENV4 (4ED3), and six epitope-grafted variants, where we transferred epitope 1 (L304I, K305D, V309M, and S310A) and/or epitope 2 (D383N, K384S, K387T, and N389H) of 4ED3 onto 3ED3 and vice-versa. Swiss albino mice aged 3-4 weeks were immunized against wildtype and epitope-grafted ED3 variants and anti-ED3 IgG antibody responses were determined using ELISA. Results: Mouse immunization using 3ED3 and 4ED3 generated serotype-specific antisera, as expected. Similarly, most epitopegrafted ED3s produced antisera serospecific to the template ED3 with little or no cross-recognition of ED3 of the serotype from which the epitopes were taken. These indicated that a mere grafting of the epitope was not sufficient to transfer serospecificity, contrary to our expectations. However, one epitope-grafted ED3 mutant, where epitope 1 of 3ED3 was grafted onto 4ED3 (4ED3epi1), generated antisera that was serospecific to both 4ED3 and 3ED3. Conclusions: The 4ED3epi1 is a chimeric ED3 that produces antisera possessing serospecificity to both 3ED3 and 4ED3 onto a common 4ED3 scaffold. The 4ED3epi1, therefore, provides a unique tool for analyzing serospecificity and sero-cross-reactivity in dengue. We believe that chimeric ED3 may provide a template for future recombinant ED3 possessing serospecificity of multiple DENVs onto a single scaffold and may pave a way developing tri-and/or tetravalent anti-DENV antisera.

79-86

Authors: Aileen Gonzalez Rizo, Camilo E Castañet Martinez, Celeste Ramírez Cardentey, Ariamys Companioni Ibañez, Zulema Menéndez Díaz, Lianet Monzote Fidalgo, Hilda M Hernandez Álvarez

Objective: To evaluate 11 Cuban native Bacillus (B.) thuringiensis isolates in order to select one with the best larvicidal activity against Aedes (Ae.) aegypti and low cytotoxicity. Methods: The cry and cyt genes of the isolates (A21, A51, L95, L910, M29, R84, R85, R87, R89, U81 and X48) were amplified by PCR. The influence of organic matter and NaCl on the larvicidal activity was tested by bioassays. Cytotoxicity was assayed on peritoneal macrophages of BALB/c mice. Results: The cyt1 (Aa, Ab, Ba), cyt2, cry4aA, cry4Ba, cry11 (Aa, Ba, Bb) and cry10 genes were identified in all native Cuban isolates. The larvicidal activity (LC90) of seven isolates was affected by the presence of organic matter in the water, while A21, A51, L910, R84, U81 and X48 had better LC50, LC90, LC95 than the 266/2 9-桏-98 control strain. The LC50 of two isolates was affected by the presence of NaCl and A21, A51, R85 isolate had better larvicidal activity than the 266/2 9-桏-98 control strain. In terms of toxicity against macrophages, the extracts of nine isolates were less cytotoxic than the control strains. Conclusions: Native isolate A21 had the main virulence factors against Ae. aegypti larvae, displayed a good larvicidal activity in presence of different factors related with Ae. aegypti breeding sites, and had low citotoxicity against macrophages. These results can contribute to the improvement of existing biological control strategies and the development of new biolarvicides.

90-92

Authors: Nupur Pal, Debalina Nag, Jayeeta Halder, Aritra Biswas, Raja Ray, Avijit Hazra, Chitrita Chatterjee

None.

95-96

Authors: Mustafa Hussain Ansari, Abdullahi Tunde Aborode, Youssef Aboufandi, Juveriya Hassan, Tarun Kumar Suvvari, Venkataramana Kandi

None.

529-530

Authors: Abdullah Nadeem, Khulud Qamar, Abdul Moiz Sahito

None.

542-550

Authors: Lee Siew-Keah, Kang Waye Hann, Shun Kah Hoe, Lai Rui En, Lim Boon Chin, Master Manfai Sae Chan, Tee Zhi Kang, Chua Ang-Lim

Objective: To investigate the knowledge, attitude, and practice levels and perceived barriers towards healthy living to prevent hypertension among young adults in Malaysia. Methods: Adults aged 18-25 years reside in Malaysia were recruited via convenience sampling. Sociodemographic characteristics, medical knowledge on hypertension (K1), knowledge (K), attitude (A), practice (P) and perceived barriers in practising healthy living to prevent hypertension were assessed. Average scores were categorised into good (80%-100%), upper-moderate (70%-79%), lower-moderate (60%-69%) and poor (<60%). Multivariate analysis was performed to test the difference and relationship of variables. Pearson correlation test was used to test the association of two continuous variables. Results: A total of 1 218 respondents participated in this survey. The mean score of K1 was 54.1%, while the knowledge, attitude, and practice towards healthy living were 82.7%, 78.2%and 68.5% respectively. The prevalence of high salt intake, high fat intakes, low fibre intake, sedentary lifestyle and lack of annual health screening was 83.2%, 81.4%, 70.3%, and 73.2%, respectively. Abnormal BMI was associated with low P scores, while lower socio-economic status, unawareness of self-blood pressure reading and those without family history of hypertension were associated with lower scores in K1, K, A, and P. K1, K, A and P are significantly inter-related. The main perceived barriers included self-proclaimed good fit status, frequent consumption of out-of-home food, and addiction to high salt/fat food. Conclusions: The national strategies for health management should be prioritized in reducing salt and fat, promoting annual health screening, physical activities and fibre intake in this age group.

558-567

Authors: Narges Amani Hamedani, Majid Pirestani, Abdolhossein Dalimi

Objective: To evaluate the clinical and molecular features of human cystic echinococcosis in Tehran, Iran. Methods: In this cross-sectional study, all human cystic echinococcosis patients admitted to Tehran’s hospitals from 2011 to 2019 were enrolled, and demographic characteristics, clinical findings, and laboratory data were collected. Formalin-fixed, paraffin-embedded and fresh tissue samples of 175 cystic echinococcosis patients were evaluated for molecular characterization. The samples’ isolated DNA was used to amplify cytochrome c oxidaseⅠand NADH dehydrogenase subunitⅠgenes. Also, the morphological features of fresh samples were examined. Results: In total, 175 patients with a mean age of 45 (9-98) years were admitted to Tehran’s hospitals diagnosed with cystic echinococcosis. Moreover, the highest (26.9%) and the lowest (2.9%) prevalence of cystic echinococcosis cases were in the 16- 30 and 1-15 years range, respectively. Male/female ratio was 0.96 (49.1% vs. 50.9%). The liver was affected in 92 patients (52.6%), and two or more organs were infected in 7 patients (4.0%). The cysts’ diameter varied from 1 to 25 cm, and 96.0% of the patients had a single hydatid cyst. All patients underwent radical surgery and the PAIR technique was applied for all cases. No significant difference was observed between the protoscolex hooks of pulmonary and hepatic cysts. G1-G3 had the highest percentage (99.4%) over other identified G6 genotypes (0.6%). Conclusions: The sheep-dog cycle plays an important role in transmitting the human cystic echinococcosis infection in Tehran.

571-572

Authors: Eric David B. Ornos, Jared Gabriel L. Dela Rosa, Jea Giezl N. Solidum, Jervy P. Garcia, Erika P. Ong, Rafael Lorenzo G Valenzuela, Ourlad Alzeus G. Tantengco

None.

479-484

Authors: Fusun Fakili, Pelin Duru Cetinkaya, Oya Baydar, Serap Argun Baris, Nurdan Kokturk, Seval Kul, Oguz Karcioglu, Pinar Aysert Yildiz, Ilim Irmak, Yonca Sekibag, Emel Azak, Sait Mulamahmutoglu, Caglar Cuhadaroglu, Bugra Kerget, Burcu Baran Ketencioglu, Hasan Selcuk Ozger, Gulcihan Ozkan, Zeynep Ture, Merve Ercelik, Tansu Ulukavak Ciftci, Ozlem Alici, Esra Nurlu Temel, Ozlem Ataoglu, Neslihan Kose, Muge Meltem Tor, Gulsah Gunluoglu, Sedat Altin, Onder Ozturk, Pinar Yildiz Gulhan, Ilknur Basyigit, Hasim Boyaci, I. Kivilcim Oguzulgen, Sermin Borekci, Bilun Gemicioglu, Ismail Hanta, Hacer Kuzu Okur, Gulseren Sagcan, Metin Akgun, Ali Fuat Kalyoncu, Oya Itil, Hasan Bayram

Objective: To determine post-discharge mortality and associated factors of the first-wave multicenter Turkish Thoracic Society (TTD)-TURCOVID study. Methods: In this retrospective cohort study, we analyzed the data of 18 of 26 centers included in the first TTD-TURCOVID study, and 1 112 cases diagnosed with COVID-19 between 11 March and 31 July 2020 participated in the study. All causes of death after COVID-19 discharge were recorded. Results: The mean age of the patients was (51.07±16.93) years, with 57.6% male patients. In the cohort group, 89.1% of COVID-19 treatment locations were hospital wards, 3.6% were intensive care units (ICUs), and 7.2% were community outpatients. In the long-term follow-up, the in-hospital mortality rate was 3.6% (95% CI 2.6- 4.8), the post-discharge mortality rate was 2.8% (95% CI 1.9-3.9), and the total mortality was 6.3% (95% CI 5.0-7.8). After discharge, 63.3% of mortality overall occurred during the first six months. Mortality rates in post-discharge follow-ups were 12.7% (95% CI 8.0-30.6) in cancer patients, 10.8% (95% CI 6.3-22.9) in chronic obstructive pulmonary disease patients, 11.1% (95% CI 4.4-22.7) in heart failure patients, 7.8 (95% CI 3.8-14.3) in atherosclerotic heart disease patients, and 2.3% (95% CI 0.8-5.6) in diabetes mellitus patients. In smokers/ex-smokers, the all-mortality rates were higher than in non-smokers. Conclusions: This multicenter study showed that patients over 65 years of age, males, former/active smoker, ICU stay, lung, heart disease, and malignancy should be followed up for at least the first six months after discharge due to COVID-19.

496-502

Authors: Ikram Waheed, Samreen Khalid, Zubia Jamil

Objective: To predict the factors associated with progression to severe dengue infection to prevent potentially fatal complications and to identify the determinants of severe complicated dengue. Methods: The study was conducted in a tertiary care hospital-dengue ward from September to November 2021 including confirmed dengue infected patients (positive NS1 antigen or anti-dengue-antibodies IgM). Secondary dengue infection was labelled by positive anti-dengue-antibodies IgG in active dengue infected patients. Detailed history, physical examination, laboratory and radiological parameters, hospital stay (days) and mortality percentages were noted. Patients were classified into three groups according to disease severity: dengue fever (DF), dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). The predictors of complicated dengue infection were determined by regression analysis. Results: The most common symptom was fever (96.9%). Among 129 patients, 62.8% had DF, 31.0% had DHF and only 6.2% developed DSS. History of previous symptomatic dengue and positive anti-dengue-antibodies IgG were present in 100% DSS patients and nearly 75.0% DHF patients (P<0.05). The moratlity rate in patients with DSS, DHF and DF was 50.0%, 2.5% and none respectively (P<0.05). Clinical parameters (body aches, bleeding, conjunctival hemorrhage, maculopapular rash, right hypochondrial tenderness, ascites, pleural effusion) and laboratory parameters (thrombocytopenia, raised alanine aminotransferase and secondary dengue infection) were determinants that complicate the dengue infection. Conclusions: Thrombocytopenia, raised alanine aminotransferase and secondary dengue infection are important laboratory parameters to complicate the disease process of dengue infection.

511-517

Authors: Ümmühan Çay, Derya Alabaz, Özlem Özgür Gündeşlioğlu, Aysun Hatice Uguz, Hande Yanar

Objective: To investigate granulomatous inflammation etiology based on clinical history and ancillary tests. Methods: Children aged <18 years with biopsy proven granulomatous lesions in any tissue specimens between January 2014 and January 2022 were included in the study. The diagnosis was based on the results of immunohistochemical staining, molecular tests, culture, serology, radiological and other auxiliary laboratory tests. Diagnoses were categorized into infectious and non-infectious causes. Results: In total, 174 patients with granulomatosis inflammation confirmed by histopathology were analyzed. Approximately 59.2% patients were males, and the median age was 4.48 (IQR 2.36-6.39) years (range: 16 months-18 years). The tissues/organs that were most commonly biopsied were lymph node, bone, skin, and lung (51.1%, 17.8%, 9.2%, and 5.7%, respectively). Infectious and non-infectious causes were identified in 73.0% and 12.6% patients, respectively, in terms of granulomatosis inflammation etiology; however, no cause was identified in 14.4% patients. The most common infectious cause was tuberculosis (in 51.7% patients), followed by toxoplasmosis, aspergillosis, mucormycosis, leishmaniasis, and cat-scratch disease (in 8.6%, 5.7%, 1.7%, 1.7%, and 1.1% patients, respectively). The common non-infectious cause was chronic granulomatous disease. Histopathological evaluation revealed granulomatosis inflammation in 33.3% patients, necrotizing granulomatosis inflammation in 30.5% patients, and caseating granulomatosis inflammation in 12.1% patients. When the pathology results of patients with and without tuberculosis were compared, the incidence of caseating granulomatosis inflammation (P=0.003) and necrotizing granulomatosis inflammation (P=0.005) was higher in patients with tuberculosis. Conclusions: Chronic granulomatous disease is the most common non-infectious cause in children. Moreover, primary or secondary immune deficiencies may cause granulomatosis inflammation, especially in pediatric patients.

522-524

Authors: Jessica Joyce R De Guia, Mary Jane C Flores, Derick Erl P Sumalapao, Eligio Santiago V Maghirang, Vicente Y Belizario Jr.

None.