The American journal of tropical medicine and hygiene
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Am. J. Trop. Med. Hyg. · Sep 2013
First detection of heartland virus (Bunyaviridae: Phlebovirus) from field collected arthropods.
Heartland virus (HRTV), the first pathogenic Phlebovirus (Family: Bunyaviridae) discovered in the United States, was recently described from two Missouri farmers. In 2012, we collected 56,428 ticks representing three species at 12 sites including both patients' farms. Amblyomma americanum and Dermacentor variabilis accounted for nearly all ticks collected. ⋯ Sequence data from the nonstructural protein of the Small segment indicates that tick strains and human strains are very similar, ≥ 97.6% sequence identity. This is the first study to isolate HRTV from field-collected arthropods and to implicate ticks as potential vectors. Amblyomma americanum likely becomes infected by feeding on viremic hosts during the larval stage, and transmission to humans occurs during the spring and early summer when nymphs are abundant and actively host seeking.
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Am. J. Trop. Med. Hyg. · Sep 2013
Effective use of household water treatment and safe storage in response to the 2010 Haiti earthquake.
When water supplies are compromised during an emergency, responders often recommend household water treatment and safe storage (HWTS) methods, such as boiling or chlorination. We evaluated the near- and longer-term impact of chlorine and filter products distributed shortly after the 2010 earthquake in Haiti. ⋯ Effective use varied by HWTS product (from 8% to 63% of recipients in the acute phase and from 0% to 46% of recipients in the recovery phase). Higher rates of effective use were associated with programs that were underway in Haiti before the emergency, had a plan at initial distribution for program continuation, and distributed products with community health worker support and a safe storage container.
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Am. J. Trop. Med. Hyg. · Aug 2013
Recruiting trainees for a global health research workforce: the National Institutes of Health Fogarty International Clinical Research Scholars Program selection process.
Between 2004 and 2012, the National Institutes of Health Fogarty International Clinical Research Scholars (FICRS) Program provided 1-year mentored research training at low- and middle-income country sites for American and international health science doctoral students. We describe the centralized application process, US applicant characteristics, and predictors of selection/enrollment. FICRS received 1,084 applicants representing many health professions and biomedical disciplines at 132 US academic institutions; 219 students from 72 institutions were accepted and enrolled. ⋯ Applicants from institutions with higher applicant numbers were two times as likely to be selected. In 2012, FICRS was decentralized among 20 institutions in five consortia (Global Health Fellows), with autonomous selection processes that emphasize post-doctoral trainees. If academia, government, or charitable foundations offer future opportunities to health professions students for international research, the FICRS experience predicts that they can attract substantial numbers of motivated trainees from diverse backgrounds.
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Am. J. Trop. Med. Hyg. · Jul 2013
Case ReportsDrug-resistant tuberculosis treatment complicated by antiretroviral resistance in HIV coinfected patients: a report of six cases in Lesotho.
Treating drug-resistant tuberculosis (DR-TB) is particularly challenging in high human immunodeficiency virus (HIV) prevalence settings. Neither antiretroviral resistance testing nor viral load monitoring is widely available in sub-Saharan Africa, and antiretroviral resistance can complicate the clinical management for DR-TB/HIV coinfected patients. ⋯ Favorable DR-TB treatment outcomes in coinfected patients require successful management of their HIV infection, including treatment with an effective ART regimen. Coinfected patients undergoing DR-TB treatment may require closer monitoring of their response to ART, including routine viral load testing, to ensure that they receive an effective ART regimen concurrent with DR-TB treatment.
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A 53-year-old malnourished man, presented to the emergency room with 2 months of poor appetite, malaise, high spiking fevers, 10 Kg weight loss and night sweats; he also noted progressive exertional dyspnea and anterior chest pain developing over the last 2 days. On physical examination he was afebrile, had 90/60 arterial pressure, 100 × min heart rate, pulsus paradoxus, jugular vein engorgement, sudden inspiratory splitting of the second heart sound, and soft heart sounds on auscultation. A contrasted tomography of the thorax showed a large pericardial effusion with pericardial contrast enhancing and no pulmonary opacities. Histologic examination of pericardial tissue showed multinucleated giant cells with scarce acid-fast bacillae, and on pericardial culture grew Mycobacterium tuberculosis.