Geographic Risk Factors Research Articles

A Cross-Sectional Population Study of Geographic, Age-Specific, and Household Risk Factors for Asymptomatic Plasmodium falciparum Malaria Infection in Western Kenya.

The burden of Plasmodium falciparum (Pf) malaria in Kenya is decreasing; however, it is still one of the top 10 causes of morbidity, particularly in regions of western Kenya. Between April 2015 and June 2016, we enrolled 965 apparently healthy children aged 0-15 years in former Nyanza and Western Provinces in Kenya to characterize the demographic, geographic, and household risk factors of asymptomatic malaria as part of an epidemiologic study to investigate the risk factors for endemic Burkitt lymphoma. The children were sampled using a stratified, multistage cluster sampling survey design. Malaria was assessed by rapid diagnostic test (RDT) and thick-film microscopy (TFM). Primary analyses of Pf malaria prevalence (pfPR) are based on RDT. Associations between weighted pfPR and potential risk factors were evaluated using logistic regression, accounting for the survey design. Plasmodium falciparum malaria prevalence was 36.0% (27.5%, 44.5%) by RDT and 22.3% (16.0%, 28.6%) by TFM. Plasmodium falciparum malaria prevalence was positively associated with living in the lake-endemic area (adjusted odds ratio [aOR] 3.46; 95% confidence interval [95% CI] 1.63, 7.37), paternal occupation as peasant farmer (aOR 1.87; 1.08, 3.26) or manual laborer (aOR 1.83; 1.00, 3.37), and keeping dogs (aOR 1.62; 0.98-2.69) or cows (aOR 1.52; 0.96-2.40) inside or near the household. Plasmodium falciparum malaria prevalence was inversely associated with indoor residual insecticide spraying (IRS) (aOR 0.44; 0.19, 1.01), having a household connected to electricity (aOR 0.47; 0.22, 0.98), and a household with two (aOR 0.45; 0.22, 0.93) or ≥ three rooms (aOR 0.41; 0.18, 0.93). We report high but geographically heterogeneous pfPR in children in western Kenya and significant associations with IRS and household-level socioeconomic factors.

Using mixed effects logistic regression models for complex survey data on malaria rapid diagnostic test results

BackgroundThe effect of malaria in Nigeria is still worrisome and has remained a leading public health issue in the country. In 2016, Nigeria was the highest malaria burden country among the 15 countries in sub-Saharan Africa that accounted for the 80% global malaria cases. The purpose of this study is to utilize appropriate statistical models in identifying socio-economic, demographic and geographic risk factors that have influenced malaria transmission in Nigeria, based on malaria rapid diagnostic test survey results. This study contributes towards re-designing intervention strategies to achieve the target of meeting the Sustainable Development Goals 2030 Agenda for total malaria elimination.MethodsThis study adopted the generalized linear mixed models approach which accounts for the complexity of the sample survey design associated with the data. The 2015 Nigeria malaria indicator survey data of children between 6 and 59 months are used in the study.ResultsFrom the findings of this study, the cluster effect is significant (P<0.0001) which has suggested evidence of heterogeneity among the clusters. It was found that the vulnerability of a child to malaria infection increases as the child advances in age. Other major significant factors were; the presence of anaemia in a child, an area where a child resides (urban or rural), the level of the mother’s education, poverty level, number of household members, sanitation, age of head of household, availability of electricity and the type of material for roofing. Moreover, children from Northern and South-West regions were also found to be at higher risk of malaria disease and re-infection.ConclusionImprovement of socio-economic development and quality of life is paramount to achieving malaria free Nigeria. There is a strong link of malaria risk with poverty, under-development and the mother’s educational level.

Predictors of uterine rupture in a large sample of women in Senegal and Mali: cross-sectional analysis of QUARITE trial data

BackgroundThe purpose of this study was to investigate predictors of uterine rupture in a large sample of sub-Saharan African women. Uterine rupture is rare in high-income countries, but it is more common in low-income settings where health systems are often under-resourced. However, understanding of risk factors contributing to uterine rupture in such settings is limited due to small sample sizes and research rarely considers system and individual-level factors concomitantly.MethodsCross-sectional data analysis from the pre-intervention period (Oct. 1, 2007- Oct. 1, 2008) of the QUARITE trial, a large-scale maternal mortality study. This research examines uterine rupture among 84,924 women who delivered in one of 46 referral hospitals in Mali and Senegal. A mixed-effects logistic regression model identified individual and geographical risk factors associated with uterine rupture, accounting for clustering by hospital.ResultsFive hundred sixty-nine incidences of uterine rupture (0.67% of sample) were recorded. Predictors of uterine rupture: grand multiparity defined as > 5 live births (aOR = 7.57, 95%CI; 5.19–11.03), prior cesarean (aOR = 2.02, 95%CI; 1.61–2.54), resides outside hospital region (aOR = 1.90, 95%CI: 1.28–2.81), no prenatal care visits (aOR = 1.80, 95%CI; 1.44–2.25), and birth weight of > 3600 g (aOR = 1.61, 95%CI; 1.30–1.98). Women who were referred and who had an obstructed labor had much higher odds of uterine rupture compared to those who experienced neither (aOR: 46.25, 95%CI; 32.90–65.02).ConclusionsThe results of this large study confirm that the referral system, particularly for women with obstructed labor and increasing parity, is a main determinant of uterine rupture in this context. Improving labor and delivery management at each level of the health system and communication between health care facilities should be a priority to reduce uterine rupture.

Prevalence, geographic risk factor, and development of a standardized protocol for fungal isolation in cystic fibrosis: Results from the international prospective study “MFIP”

BackgroundFungi are increasingly recognized for their potential role in contributing to pulmonary damage in Cystic Fibrosis (CF). We therefore designed a prospective international study aimed at (i) determining the prevalence of fungi isolated from sputum samples collected from a large CF population, (ii) comparing the performance of different media used for fungal culture, and (iii) proposing a standardized protocol suitable for CF routine microbiology. MethodsAn international, consensually designed prospective study was set up (https://www.ecfs.eu/special-projects/mucofong-international-project). All centers worked according to the same protocol approved by Lille Ethical Committee. CF sputa were inoculated onto eight semi-selective media incubated at 37 °C or 25 °C–30 °C for 15 days, and inspected twice weekly for fungal growth. ResultsA total of 469 sputa were collected from patients at 18 European and one Australian CF centers. Positive cultures for fungal growth were significantly associated with patient ages. Aspergillus fumigatus was the most frequently isolated mold. We identified a growing European North-to-South gradient of Scedosporium prevalence, while yeasts, Aspergillus section Fumigati, Cladosporium and Penicillium were significantly more prevalent in the Northern regions. ConclusionsAccording to the CHi-squared Automatic Interaction Detector method, we propose a consensual protocol based on two media (YPDA or Sabouraud medium, and B(+) medium) to detect the main opportunistic molds in CF context; the use of an additional medium being recommended according to the patient's clinical status. This standardized protocol allows us to have an accurate overview of the respiratory mycobiome on the culturomic side in CF.

Community-acquired acute meningitis and encephalitis: a narrative review.

Meningitis and encephalitis are medical emergencies. Patients need prompt evaluation and immediate empiric therapy to reduce the likelihood of fatal outcomes and chronic neurological sequelae. Conjugate bacterial vaccines have significantly reduced the incidence of bacterial meningitis, especially in children. As the results of changes in patterns of bacterial drug sensitivity, ceftriaxone is now part of the recommended empiric treatment for bacterial meningitis and should be administered as early as possible. Neuroimaging delays the treatment of meningitis and is not needed in most cases. Adjunctive corticosteroid therapy is of benefit for many patients with meningitis and should be initiated in most adults before antibiotic therapy. Molecular testing can assist the specific diagnosis of encephalitis and should be based on the exposure history and geographic risk factors relevant to the patient, but non-infectious causes of encephalitis are also common. Empiric therapy for encephalitis should be directed at the most frequently identified infectious pathogen, herpes simplex virus type 1 (ie, intravenous aciclovir). Vaccines can protect against the major pathogens of childhood infections (measles, mumps, rubella, polio, varicella viruses), influenza viruses, and exotic pathogens that cause meningitis and encephalitis (rabies, Japanese encephalitis, dengue, yellow fever, tick-borne encephalitis viruses, Mycobacterium tuberculosis).

EPIDEMIOLOGY OF NONTUBERCULOUS MYCOBACTERIUM FROM AN INNER-CITY PHILADELPHIA HOSPITAL IN PATIENTS WITHOUT HIV

SESSION TITLE: Chest Infections 2 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: Nontuberculous mycobacterium (NTM) are free-living organisms that are ubiquitous in the environment, however the importance of NTM disease in humans is increasingly evident. As NTM is a non-reportable disease and as environmental exposure is dependent on geographical areas, the incidence and risk factors of NTM in our area are ill-defined. This study is to help us determine the incidence of NTM in inner Philadelphia in those without HIV infection, the risk factors which lead to disease and the speciation related to the different diseases. METHODS: We conducted a retrospective study of patients without known HIV infection who had an AFB culture positive from 2016 to 2017. Patients with blood cultures or tissue biopsy positive for NTM were concluded to have disease; respiratory disease was considered if they met ATS guidelines: 1. chest radiograph or, in the absence of cavitations, chest high-resolution computed tomography; 2. Positive cultures from sputum samples or one bronchial wash; and 3. Exclusion of other disorders, such as TB. The data was collected from cultures at Hahnemann University Hospital in Philadelphia. This was an IRB study. RESULTS: From 2016-2017, there were 87 total patients who were identified to have NTM positive cultures, of which 61 were in patients who were not infected with HIV, of those 42 were identified to have an active NTM infection. Demographics include: average age 57, 27 males and 15 females, and 20 White, 14 Black, 5 Asian and 3 Hispanic patients. Out of the 42 infections, there were 36 respiratory infections, 3 positive tissue cultures, 2 positive blood cultures and 1 urinary culture. Species identified included 33 cultures positive for MAC, 4 cultures M. abscessus, 3 cultures M. bolletii, 2 cultures each of M. chelonae and M. kansasii, and 1 culture each for M. xenoxpix and M. szulgai. Coexisting medical illnesses included 24 with underlying lung disease, 6 patients immunocompromised, 4 patients with cancer, 3 transplant patients and 6 with no underlying medical illness. There were 3 patients on immunosuppressants, 2 on steroids, 1 on chemotherapy and 1 on an immunomodulator. There were patients who occasionally had >1 NTM in the AFB culture, more than one source of culture positivity or more than one underlying medical co-illness. CONCLUSIONS: Although MAC was shown to be the most prevalent in the community, 31% of cultures grew disease causing NTM species other than MAC with the next most common being M. abscessus and M. bolletii. It is important to note that in those with underlying lung disease, various species of NTM can be attributed to disease and should be treated. CLINICAL IMPLICATIONS: This small study gives us an insight into the types of infections and the speciation of those with disease that is prevalent in this community. Although MAC being the most common, patients with other infectious NTM species should be considered for treatment also. DISCLOSURES: No relevant relationships by Janpreet Mokha, source=Web Response No relevant relationships by Ekamjeet Randhawa, source=Web Response No relevant relationships by Michael Stephen, source=Web Response

The Impact of Racial, Geographic, and Socioeconomic Risk Factors on the Development of Advanced-Stage Cervical Cancer.

Despite screening, disparities exist in cervical cancer incidence and outcomes. Demographic factors are associated with diagnosis at advanced stage (AS), but less is known about geographic factors. We sought to investigate risk factors for developing AS cervical cancer in Alabama. We identified women treated for cervical cancer from 2005 to 2015 at our institution. Stages II-IV were considered AS. ZIP codes were categorized by federal Rural-Urban Commuting Area Codes, and 16 historically underserved counties were categorized as Black Belt rural. Using data from the American College of Obstetricians and Gynecologists, we identified women's health provider locations. We explored associations between stage and multiple factors using logistic regression. Of 934 patients, 29.2% were black, 52.7% had AS cancer, and 63.4% lived in urban areas. Average distance to nearest American College of Obstetricians and Gynecologists Fellow in urban, rural, and Black Belt rural areas was 5.0, 10.6, and 13.7 miles, respectively. Black race, public insurance and age of older than 65 years were associated with increased risk of AS cancer. Living in a rural area trended toward higher risk but was not significant. When stratified by race, insurance status and age were associated with AS cancer in white women only. Living further from a women's health provider or in a rural area was not associated with a higher risk of AS cervical cancer. Black women had a higher risk of AS than white women regardless of age, insurance status, and geography. Disparities in cervical cancer are multifactorial and necessitate further research into socioeconomic, biologic, and systems causes.

Risk patterns of lung cancer mortality in northern Thailand

BackgroundOver the past decade, lung cancers have exhibited a disproportionately high mortality and increasing mortality trend in Thailand, especially in the northern region, and prevention strategies have consequently become more important in this region. Spatial analysis studies may be helpful in guiding any strategy put in place to respond to the risk of lung cancer mortality in specific areas. The aim of our study was to identify risk patterns for lung cancer mortality within the northern region of Thailand.MethodsIn the spatial analysis, the relative risk (RR) was used as a measure of the risk of lung cancer mortality in 81 districts of northern Thailand between 2008 and 2017. The RR was estimated according to the Besag-York-Mollié autoregressive spatial model performed using the OpenBUGS routine in the R statistical software package. We presented the overall and gender specific lung cancer mortality risk patterns of the region using the Quantum Geographic Information System.ResultsThe overall risk of lung cancer mortality was the highest in the west of northern Thailand, especially in the Hang Dong, Doi Lo, and San Pa Tong districts. For both genders, the risk patterns of lung cancer mortality indicated a high risk in the west of northern Thailand, with females being at a higher risk than males.ConclusionsThere was distinct geographical variation in risk patterns of lung cancer mortality in Thailand. Differences could be related to differences in risk factors such as ground-based radon and air pollution. This study provides a starting point for estimating the spatial pattern of the risk of lung cancer mortality and for examining associations between geographic risk factors and lung mortality for further studies.

Estimating the prevalence of Echinococcus in domestic dogs in highly endemic for echinococcosis

BackgroundCystic echinococcosis (CE) and alveolar echinococcosis (AE) are highly endemic in Xiji County of Ningxia Hui Autonomous Region (NHAR) in China where the control campaign based on dog de-worming with praziquantel has been undertaken over preceding decades. This study is to determine the current prevalence of Echinococcus granulosus and E. multilocularis in domestic dogs and monitor the echinococcosis transmission dynamics.MethodsStudy villages were selected using landscape patterns (Geographic Information System, GIS) for Echinococcus transmission “hot spots”, combined with hospital records identifying risk areas for AE and CE. A survey of 750 domestic dogs, including copro-sampling and owner questionnaires, from 25 selected villages, was undertaken in 2012. A copro-multiplex PCR assay was used for the specific diagnosis of E. granulosus and E. multilocularis in the dogs. Data analysis, using IBM SPSS Statistics, was undertaken, to compare the prevalence of the two Echinococcus spp. in dogs between four geographical areas of Xiji by the χ2 test. Univariate analysis of the combinations of outcomes from the questionnaire and copro-PCR assay data was carried out to determine the significant risk factors for dog infection.ResultsThe highest de-worming rate of 84.0% was found in the northwest area of Xiji County, and significant differences (P < 0.05) in the de-worming rates among dogs from the four geographical areas of Xiji were detected. The highest prevalence (19.7%, 59/300) of E. multilocularis occurred in northwest Xiji, though the highest prevalence (18.1%, 38/210) of E. granulosus occurred in southwest Xiji. There was no significant difference (P > 0.05) in the prevalence of E. granulosus in dogs from the northwest, southwest, northeast, and southeast of Xiji, but there were significant differences (P < 0.05) between dogs infected with E. multilocularis from the four areas. None of the other independent variables was statistically significant.ConclusionsThe results from this study indicate a high prevalence of both E. granulosus and E. muiltilocularis in dogs in Xiji County, NHAR. Transmission of E. multilocularis was more impacted by geographical risk-factors in Xiji County than that of E. granulosus. Dogs have the potential to maintain the transmission of both species of Echinococcus within local Xiji communities, and the current praziquantel dosing of dogs appears to be ineffective or poorly implemented in this area.

A Role for Clusterin in Exfoliation Syndrome and Exfoliation Glaucoma?

The multifunctional protein clusterin (CLU) is a secreted glycoprotein ubiquitously expressed throughout the body, including in the eye. Its primary function is to act as an extracellular molecular chaperone, preventing the precipitation and aggregation of misfolded extracellular proteins. Clusterin is commonly identified at fluid-tissue interfaces, and has been identified in most body fluids. It is a component of exfoliation material, and CLU mRNA is reduced in eyes with exfoliation syndrome compared with controls. SNPs located in the CLU genomic region have been associated with Alzheimer disease (AD) at the genome-wide level and several CLU SNPs located in an apparent regulatory region have been nominally associated with XFS/XFG in Caucasians with European ancestry and in south Indians. Interestingly, clusterin associates with altered elastic fibers in human photoaged skin and prevents UV-induced elastin aggregation in vitro. In light of the known geographic risk factors for XFS/XFG, which could include UV light, investigations of CLU-geographic interactions could be of interest. Future studies investigating rare CLU variation and other complex interactions including gene-gene interactions in XFS/XFG cases and controls may also be fruitful. Although CLU has been considered as a therapeutic target in AD, cancer and dry eye, a role for clusterin in XFS/XFG needs to be better defined before therapeutic approaches involving CLU can be entertained.

¡Nosotros corremos, nosotros jugamos! [we run, we play!]: Children’s perceptions of physical activity in Mexican-origin border communities

The US border between Texas and Mexico has a growing population of Mexican-origin children that are at high risk for obesity and have a lack of physical activity opportunities, resources, and environmental infrastructure. The purpose of this research was to explore children’s perspectives of their physical activity behaviors through in-depth interviews. Five children (ages: 7–11) were recruited to participate and describe facilitators, barriers, and current and desired physical activities. Interviews were transcribed verbatim, harmoniously coded, and analyzed for content. The most common physical activity type was football for boys, jump rope for girls, and general play activities for all. Having friends as social supporters and ability to be active at school were physical activity facilitators for all children; enjoyment was identified for boys and having general play activities for girls. Lack of equipment at home was a barrier identified by all children; homework was identified by boys and lack of social support from siblings for girls. All children desired to do more activities with friends. Girls wanted to visit the park more, where boys wanted more equipment to begin new activities. Gender differences are common and have previously been attributed to societal norms. Desired physical activity consisted of longing to participate in more of their current activities involving contact sports for boys and general play for girls. Interviews conducted in neutral settings can allow for natural, unrestricted responses from children. New activities should be introduced to expand desired activity and subsequently increase physical activity within these populations. Social, economic, and geographic risk factors combined with a lack of access to physical activity resources and opportunities predispose children within the colonias of the Texas border to have elevated risk for childhood obesity. Additionally, these children face many barriers to establishing and maintaining nationally recommended physical activity levels. Asking children their perspective regarding physical activity is useful in gaining insight into current and desired behavior. Children’s responses to questions regarding facilitators and barriers for physical activity behavior may be used to inform priority areas for health promotion initiatives.

More than a snapshot in time: pathways of disadvantage over childhood.

Disadvantage rarely manifests as a single event, but rather is the enduring context in which a child's development unfolds. We aimed to characterize patterns of stability and change in multiple aspects of disadvantage over the childhood period, in order to inform more precise and nuanced policy development. Participants were from the Longitudinal Study of Australian Children birth cohort (n = 5107). Four lenses of disadvantage (sociodemographic, geographic environment, health conditions and risk factors), and a composite of these representing average exposure across all lenses, were assessed longitudinally from 0 to 9 years of age. Trajectory models identified groups of children with similar patterns of disadvantage over time for each of these lenses and for composite disadvantage. Concurrent validity of these trajectory groups was examined through associations with academic performance at 10-11 years. We found four distinct trajectories of children's exposure to composite disadvantage, which showed high levels of stability over time. In regard to the individual lenses of disadvantage, three exhibited notable change over time (the sociodemographic lens was the exception). Over a third of children (36.3%) were exposed to the 'most disadvantaged' trajectory in at least one lens. Trajectories of disadvantage were associated with academic performance, providing evidence of concurrent validity. Children's overall level of composite disadvantage was stable over time, whereas geographic environments, health conditions and risk factors changed over time for some children. Measuring disadvantage as uni-dimensional, at a single time point, is likely to understate the true extent and persistence of disadvantage.

Developmental defects of enamel in the population of Polish adolescents aged 18 years old: the prevalence and selected socio-demographic factors. A cross-sectional study

Introduction. There has been a lack of current epidemiological data regarding the prevalence of developmental defects of enamel in Polish adolescents. Aim. To evaluate the prevalence of developmental defect of enamel in the permanent dentition in the population of adolescents aged 18 years old, including the impact of selected sociodemographic factors. Material and methods. A cross-sectional study conducted in 2017 covered adolescents aged 18 years old attending schools in 16 Polish voivodeships, selected by stratified sampling. Sociodemographic factors such as sex, place of residence, parents’ education level and subjective economic status were collected with a survey. The condition of enamel was assessed with the use of DDE Index modified by Clarkson and Dean’s Indicator by dentists specially trained and calibrated for this study. Prior to its initiation, the study was approved by the Bioethics Committee of the Medical University in Warsaw (Ref. No.: KB/134/217 of 6.06.217). Results. A total of 1611 adolescents were examined (with 52.6% female and 50.5% were residents of rural areas). Developmental defects of enamel were identified in 16.3% of the participants of the study, most frequently in the form of demarcated opacities (10.4%). In 2.7%, they were classified as fluorosis, most frequently questionable. Maxillary central incisors and first premolars were most frequently affected. In 2.5% of the examined adolescents, the defects involved single teeth, whereas in 0.6% the defects were generalised. Defects not classified as fluorosis were more commonly identified in males. There were statistically significant differences in the prevalence between voivodeships, with defects most commonly observed in participants from southern voivodeships. No other sociodemographic factors, however, were identified as significant. Conclusions. The highest prevalence of demarcated opacities suggests the significance of local factors in the aetiology of developmental enamel defects of permanent dentition in Poland. Fluorosis is a rarely encountered entity. The lack of the significance of sociodemographic factors and the regional differences in the prevalence of developmental defects of enamel suggest the need for further research, aimed at identifying geographical risk factors.

Environmental factors and eosinophilic esophagitis

The incidence and prevalence of eosinophilic esophagitis (EoE) have markedly increased over the past 2decades, outpacing increased detection of the disease. Although genetic susceptibility markers for EoE have begun to be elucidated, the rate at which EoE has increased in incidence suggests environmental factors predominate. Despite many advances in understanding of the pathogenesis of EoE, the cause of EoE is unknown. This article reviews the emerging data related to environmental risk factors for EoE. Many of these environmental factors are rooted in the theoretical framework of the hygiene hypothesis, specifically mediation of disease development through dysbiosis. Other hypotheses are based on associations that have been observed in studies of non-EoE allergic disease. We describe the evidence that early-life exposures, including antibiotic use, acid suppression, and cesarean delivery, can increase the risk of disease. We also describe the evidence that infectious agents, such as Helicobacter pylori, are inversely associated with disease. Current evidence on geographic risk factors, such as population density, climate zone, and seasonality, is reviewed. We also describe behavioral factors that have been evaluated. Limitations of the existing research are discussed, and recommendations for future areas of research, including assessment of gene-environment interaction, are presented.

F56. Description of neurophysiological findings in mononeuritis multiple as a neurologic manifestation of borrelia burgdorferi infection - Case report

Introduction The infection for Borrelia burgdorferi is a zoonosis, in which the spirochaetes can be transmitted to human beings only by the bite of infected ixodid ticks, the spirochaete is maintained at high levels in populations of field mice or birds, the likelihood of having it is dependent on geography, recreational habits of the patient, and season. It is a multisistemic disease it can affect central nervous system. Neurological manifestations often referred to as Lyme neuroborreliosis are reported in up to 12% of patients with Lyme disease. In Europe and the United States seroprevalencia is 1–27%. This has not been determined in Mexico yet. In Mexico are few reports and series of cases published about Lyme neuroborreliosis, being a subdiagnosed disease in patients with neurological clinical manifestations. Methods Male 23 yo, carpenter. He started eight months earlier with symmetric paresthesias of both hands with ascending distribution from distal to proximal, presented inability to hold work tools with both hands, paresthesias in the plantar region and paresis of the lower limbs, ascending from distal to proximal, preventing him from walking and requiring help, finally prostration. PE: Generalized atrophy of distal predominance, interosseous atrophy of thenar and hypothenar, proximal upper limb 4/5, distal 3/5, proximal and distal lower limbs 4/5, absent bilateral patellar reflex. Bilateral plantar flexor response. Hypopallesthesia, altered arthrokinesia in both lower limbs and right hand. Unsteady gait with a broad base, short and slow steps with help. Romberg positive. Results Neurophysiological studies. Somatosensory evoked potentials (SSEP) of upper limbs with peripheral response integration at the level of the brachial plexus (N9) asymmetric by left prolongation and absence of responses from posterior cords (N13). SSEP of lower limbs with complete and bilateral absence of responses from popliteal fossa. N. median left, N. ulnar right, delay in nerve conduction velocity. Bilateral tibial with prolonged latency. N. median left with prolongation of peak latency. N. ulnar voltage asymmetry by right depression. F response of bilateral ulnar nerve did not elicit response. Bilateral tibial nerve with prolonged latencies and frequency of reduced evocation. The neurophysiological study showed evidence of multiple mononeuropathy that involves all four limbs asymmetrically. Ig G by Western blot versus Borrelia burgdorferi was positive in blood. It was prescribed ceftriaxone 1 g IV BID for 14 days, after this treatment showed neurological improvement, he continued with doxycycline 100 mg orally BID for a month. Conclusion Neuropathies in patients with chronic Lyme disease commonly present as non-vasculitic multiple mononeuritis, the motor deficit follows the multiple pattern. This case is based on an unusual neurological manifestation together with the exclusive predilection for affection of the central nervous system, having as main geographical and occupational risk factors.

Role of Environmental Factors in Shaping Spatial Distribution of Salmonella enterica Serovar Typhi, Fiji.

Fiji recently experienced a sharp increase in reported typhoid fever cases. To investigate geographic distribution and environmental risk factors associated with Salmonella enterica serovar Typhi infection, we conducted a cross-sectional cluster survey with associated serologic testing for Vi capsular antigen–specific antibodies (a marker for exposure to Salmonella Typhi in Fiji in 2013. Hotspots with high seroprevalence of Vi-specific antibodies were identified in northeastern mainland Fiji. Risk for Vi seropositivity increased with increased annual rainfall (odds ratio [OR] 1.26/quintile increase, 95% CI 1.12–1.42), and decreased with increased distance from major rivers and creeks (OR 0.89/km increase, 95% CI 0.80–0.99) and distance to modeled flood-risk areas (OR 0.80/quintile increase, 95% CI 0.69–0.92) after being adjusted for age, typhoid fever vaccination, and home toilet type. Risk for exposure to Salmonella Typhi and its spatial distribution in Fiji are driven by environmental factors. Our findings can directly affect typhoid fever control efforts in Fiji.

Risk factors for Newcastle disease in broiler farms in Israel

Following a large outbreak of Newcastle disease (ND) in Israel, a cross-sectional study was conducted in the broilers sector. The aim of the study was to find geographical and farm related risk factors for ND. Information was available on 96% of the broiler farms in Israel. Of these, farms diagnosed with ND in the years 2010–2012 were compared with the other farms. Risk factors for ND were analyzed, using Generalized Estimating Equation models. Six variables were found to be associated with the risk for ND outbreak: a distance of less than 300m from another farm (OR=1.77, 95% CI 1.07–2.93), a distance of less than 6000m from a national border (OR=2.00, 95% CI 1.22–3.30), farm location in the Ha’amakim district (OR=2.46, 95% CI 1.32–4.61), village type: a Moshav (village) vs. Kibbutz (Cooperative village) (OR=1.96, 95% CI 1.04–3.70), and carcass disposal in an uncovered bin (OR=1.96, 95% CI 1.18–3.26). A distance of less than 800m from an inter-city road was found to be a protective factor (OR=0.60, 95% CI 0.37–0.98). The results of this study provide information that may be used to improve surveillance and control of ND.

Tropical Parasitic Infections in Individuals Infected with HIV.

Neglected tropical diseases share both geographic and socio-behavioral epidemiological risk factors with HIV infection. In this literature review, we describe interactions between parasitic diseases and HIV infection, with a focus on the impact of parasitic infections on HIV infection risk and disease progression, and the impact of HIV infection on clinical characteristics of tropical parasitic infections. We limit our review to tropical parasitic infections of the greatest public health burden, and exclude discussion of classic HIV-associated opportunistic infections that have been well reviewed elsewhere. Tropical parasitic infections, HIV-infection, and treatment with antiretroviral therapy alter host immunity, which can impact susceptibility, transmissibility, diagnosis, and severity of both HIV and parasitic infections. These relationships have a broad range of consequences, from putatively increasing susceptibility to HIV acquisition, as in the case of schistosomiasis, to decreasing risk of protozoal infections through pharmacokinetic interactions between antiretroviral therapy and antiparasitic agents, as in the case of malaria. However, despite this intimate interplay in pathophysiology and a broad overlap in epidemiology, there is a general paucity of data on the interactions between HIV and tropical parasitic infections, particularly in the era of widespread antiretroviral therapy availability. Additional data are needed to motivate clinical recommendations for detection and management of parasitic infections in HIV-infected individuals, and to consider the implications of and potential opportunity granted by HIV treatment programs on parasitic disease control.

Syphilis in the Americas: a protocol for a systematic review of syphilis prevalence and incidence in four high-risk groups, 1980\u20132016

BackgroundSyphilis infection has recently resurfaced as a significant public health problem. Although there has been a tremendous amount of research on the epidemiology of syphilis, there has been limited work done to synthesize the extensive body of research and systematically estimate patterns of disease within high-risk groups in the Americas. The purpose of this systematic review and meta-analysis is to (1) summarize recent patterns of syphilis infection in North and South America among four high-risk groups (MSM, transgender women, sex workers, and incarcerated individuals) from 1980 to 2016, (2) identify and differentiate regional geographic epidemiologic characteristics, and (3) compare the epidemics of the economically developed countries of North America from the developing countries and public health systems of Latin America and the Caribbean.Methods/designPrimary studies reporting syphilis prevalence and/or incidence in at least one of the four high-risk groups will be identified from Medline/PubMed, Embase, Lilacs, SciELO, The Cochrane Library, Web of Science, Scopus, ProQuest, CINAHL, Clase, and Periódica, as well as “gray” literature sources (conference abstracts, country reports, etc.). Studies published from 1980 through 2016 will be included. Data will be extracted from studies meeting inclusion and exclusion criteria and a random effects meta-analysis of prevalence and incidence estimates will be conducted. Heterogeneity, risk of bias, and publication bias will be assessed. Pooled prevalence and incidence estimates will be calculated for comparisons based on geographic region, risk factors, and time period.DiscussionOur systematic review and meta-analysis aims to contribute to an improved understanding of global epidemiologic patterns of syphilis infection in most-at-risk populations. Through systematic classification of the existing literature, and comparison of disease patterns across regional, temporal and socio-behavioral differences, we hope to improve public health surveillance and improve efforts to control the spread of disease across the Americas.Systematic review registrationPROSPERO CRD42016047306.

Multiple Sclerosis and Schizophrenia.

The psychiatric and neurological aspects of health may present methodological challenges in the diagnosis and treatment of disease. This is especially true for patients whose symptoms indicate the coexistence of multiple sclerosis (MS) and schizophrenia (SCZ). These cases raise critical questions regarding the relationship between the mind and the brain. Studies have noted that patients with MS have an increased risk of developing SCZ or bipolar disorder (BD). It is suggested here that MS and a subgroup of SCZ have similar etiologies. Factors such as gender, ethnicity, geography and season also have an influence on the occurrence of MS and SCZ. This paper aims to examine the differences and similarities between SCZ and MS. For this purpose, scientific papers examining various factors associated with these disorders were reviewed, and similarities and differences in genetic, immunological, seasonal, geographical, and gender-related risk factors and limited similarities in ethnic factors between the two diseases were identified. The findings suggest that subgroups of these two diseases may belong to the same class of disorders.