Asian Pacific Journal of Tropical Medicine

49-59

Authors: Marli do Carmo Cupertino, Rebeca Garcia, Andréia Patrícia Gomes, Sérgio Oliveira de Paula, Nicholas Mayers, Rodrigo Siqueira-Batista

Yellow fever is an acute viral disease endemic to tropical countries, like Brazil, where, since the 1940s, has no significant documented outbreaks similar to that observed between 2016/2018 (2 045 confirmed cases and 677 deaths; caused by the sylvatic form). The principal manipulating factors inciting this change were absence of appropriate vaccination campaigns and increased urbanization & population growth in forest areas, with prevalence of the virus in the species inhabiting of these areas. The 2016/2018 outbreaks exhibited incidence in areas with historically low or no yellow fever virus activity, triggering a surge in recorded deaths - mainly in the Southeastern states of Brazil. The Brazilian government aggressively responded, reforming the countries’ prophylactic measures, including vaccine implementation - as of March, 2018, switching from the former double dose regimen of the vaccine, to a single dose protocol, deemed as adequate. Moreover, some states appropriated the fractionated dosage (1/5 of the standard dose), in foresight of potential vaccine shortages. To prevent the uprising of new sylvatic yellow fever cases in Brazil, it’s obligatory the development of effective combative plans, including adaptation of prophylactic measures individually (use of repellents, protective clothing etc. ), applicable vaccination campaigns in every endemic region, to raise awareness to locals and visitors alike. Notwithstanding these preventative strategies, the persistence of cases and the recent outbreaks in Brazil, highlight the possible ineffectiveness of combative measures. Based on these considerations, the objective of this review was to raise more awareness of the epidemiological impact of the disease in Brazil.

67-71

Authors: Suksai Parut, Onket Rattanaporn, Wiriyarat Witthawat, Sangkachai Nareerat, Lekcharoen Paisin, Sariya Ladawan

Objective: To determine the occurrence of Chlamydia spp. in wild birds in Thailand. Methods: Cloacal and tracheal swabs of 313 wild birds from 11 orders, 27 families, and 51 species were tested to determine the occurrence of Chlamydia infection. The outer membrane protein A (ompA) gene was amplified from positive samples to construct a phylogenetic tree. Results: At the time of sample collection, none of the birds showed clinical signs of any disease. Of 313 wild birds, two Asian openbill stork (Anastomus oscitans) were positive for Chlamydia spp., representing 0.64% (2/313) and 4.9% (2/41) occurrence for birds overall and for the Asian openbill stork, respectively. Phylogram analysis based on deduced amino acid of the ompA gene showed that Chlamydia spp. in Asian openbill storks was closely related to that in wildfowl (Pica pica and Cygnus olor) from Poland in a different branch with a 95% bootstrap value and had a shorter evolutionary distance to Chlamydia abortus. Conclusions: Asymptomatic Asian openbill storks could be a potential source of Chlamydia infection in domestic animals, poultry, and humans who share their habitat.

79-86

Authors: Ahmad Rohani, Abdul Rahman Aidil Azahary, Ke-Xin Yu, Mohamed Nor Zurainee, Wan Mohamad Ali Wan Najdah, Han Lim Lee

Objective: To assess the insecticide susceptibility status of Anopheles cracens (An. cracens) and Anopheles maculatus (An. maculatus) from knowlesi malaria endemic areas in Peninsular Malaysia towards DDT, malathion and deltamethrin and to determine the resistance mechanism involved. Methods: Adult and larval mosquitos were collected for surveillance. Susceptibility status of Anopheles was determined using the standard WHO adult bioassay, larval bioassay and biochemical enzyme assay. Results: WHO adult bioassay results indicated An. cracens collected from Kampung Sungai Ular, Pahang was resistant towards 4% DDT, while An. maculatus collected from Kampung Sokor, Kelantan and Kampung Sungai Lui, Selangor exhibited resistance towards 4% DDT. However, the enzyme activity profiles varied according to strains and species. The resistance ratio of larval bioassay, showed that all strains and species tested were susceptible to malathion and temephos. Conclusions: Since only a few anopheline strains exhibited low level of insecticide resistance towards malathion, DDT and temephos. These insecticides are still considered effective for vector control program towards An. cracens and An. maculatus.

91-94

Authors: Yao-Tien Chang, Sung-Yuan Hu, Che-An Tsai

The Aeromonas species, belonging to the family Aeromonadaceae, are opportunistic pathogens found in humans with an incidence rate of 76 cases per million inhabitants in Southern Taiwan. The incidence of Aeromonas septicemia is relatively low, accounting for less than 15% of cases. Patients diagnosed with Aeromonas hydrophila bacteremia who were presented with skin blisters and septic shock have been reported to have a mortality rate of 100%. Aeromonas infection must be considered in the differential diagnosis of gangrene-like tissue damage or skin lesions in patients with end-stage renal disease, due to the potential sources of infections. A 49-year-old Taiwanese diabetic woman with end-stage renal disease had underwent regular hemodialysis. She was referred to our hospital due to a one-day course of fever, dyspnea, hypotension, and fulminant hemorrhagic blisters covering her whole body. A physical examination uncovered multiple hemorrhagic blisters, along with a ruptured blister over the lower left leg. Laboratory tests revealed an elevation of liver enzymes, impaired renal function, lactatemia, and high anion-gap metabolic acidosis. Cultures of both blood and hemorrhagic blister fluid grew Aeromonas hydrophila. However, she experienced persistent shock despite aggressive intravenous fluid, empiric antibiotics, and inotropic agents with norepinephrine and dopamine. Early diagnosis and prompt management using intravenous fluids, antibiotics and surgical debridement is recommended in order to improve a patient’s survival rate.