Institute Of Tropical Medicine Research Articles

Malaria in Austria : Aretrospective analysis of malaria cases diagnosed at areference center in 2010-2020.

Although malaria is not endemic to Austria, each year infections are imported by travellers, migrants and refugees. This study aims to provide an overview of malaria cases diagnosed at an Austrian institute for tropical medicine between 2010 and 2020. Aretrospective, descriptive study was conducted based on the data of malaria cases confirmed at the Institute of Specific Prophylaxis and Tropical Medicine of the Medical University of Vienna. Laboratory diagnostics included microscopy, polymerase chain reaction (PCR) and real-time quantitative PCR. Overall, 122cases were identified. Annual case numbers were consistently higher from 2016 to 2020 than during the first half of the decade. Most malaria cases were diagnosed during summer and early autumn. This seasonal trend was not observed during the year 2020. With 55.1% (65/118) Plasmodium falciparum was the most common species, followed by Plasmodium vivax (19.5%, 23/118). The majority of patients were male (71.1%, 86/121) and the median age was 34.5 years (interquartile range, IQR 22.5-47.0 years). With amedian age of 20.0 years (IQR 14.0-32.0 years), patients with P.vivax infections were younger than those infected with other Plasmodium species. Moreover, they were mostly male (82.6%, 19/23). From 2010 to 2020, the number of malaria cases diagnosed at the center increased. Growing international mobility and changing travel behavior could at least partly be responsible for this trend and there are indications that particularly P.vivax infections were imported by migrants and refugees.

Treponema pallidum infection rate in patients attending the general hospital of Benguela, Angola

The objectives of this study were to estimate the rate of infection by Treponema pallidum and co-infection with Human Immunodeficiency Virus (HIV) in individuals attending the General Hospital of Benguela (GHB), Angola, to verify the Rapid Plasma Reagin (RPR) test performance for its diagnosis when compared with other RPR tests, and to compare a rapid treponemal test with the Treponema pallidum hemagglutination assay (TPHA). This is a cross-sectional study carried out between August 2016 and January 2017, at the GHB, 546 individuals attending the emergency room, the outpatient service or hospitalized at the GHB were included. All the samples were tested at the GHB with the routine hospital RPR test and a rapid treponemal test. The samples were then transported to the Institute of Hygiene and Tropical Medicine (IHMT) where RPR testing and TPHA testing were performed. The rate of T. pallidum active infection, demonstrated by a reactive RPR and TPHA result, was 2.9%, of which 81.2% corresponded to indeterminate latent syphilis and 18.8% to secondary syphilis. HIV co-infection was detected in 62.5% of individuals diagnosed with syphilis. Past infection, defined as a non-reactive RPR and reactive TPHA test, was diagnosed in 4.1% of individuals. The high rate of syphilis/HIV co-infection emphasizes the urgent requirement for adequate sexually transmitted infections (STIs) screening, prevention and treatment programs. In addition, implementation of quality control measures within RPR testing protocols at GHB are needed, including training for laboratory personnel, adequate equipment and introduction of other rapid testing.

Process evaluation of the scale-up of integrated diabetes and hypertension care in Belgium, Cambodia and Slovenia (the SCUBY Project): a study protocol

IntroductionIntegrated care interventions for type 2 diabetes (T2D) and hypertension (HT) are effective, yet challenges exist with regard to their implementation and scale-up. The ‘SCale-Up diaBetes and hYpertension care’ (SCUBY)...

Risk Factors for Death and Severe Neurological Sequelae in Childhood Bacterial Meningitis.

Acute bacterial meningitis (ABM) continues to be a challenge from a diagnostic and therapeutic point of view. Identifying severity risk factors and predictive scores may guide interventions to reduce poor outcome. Data from a retrospective study for ABM in children admitted to the Institute of Tropical Medicine in Paraguay was analyzed. ABM was defined as positive cerebrospinal fluid culture, positive latex agglutination, or identification of microorganism by real time-polymerase chain reaction. Univariate and multivariate analyses of risk factors at hospital admission that predicted major morbidity or death during hospitalization were performed. A point-based scoring system that included variables, which were clearly different among those who passed away, was constructed. One hundred fourteen children hospitalized with ABM were eligible for the study. The mean age was 46 ± 57 months (range, 1-192 months). The observed mortality was 33% (38/114 patients). When a point-based scoring system was used, for score of 0 (n = 29) and 1 (n = 12), no death was observed. Among patients with a score of 2 (n = 14), 3 (n = 10 patients), 4 (n = 12 patients), and 5 (n = 13 patients), the mortality rate was 14.3%, 40%, 50%, and 53.8%, respectively. When the score was 6 or higher, the mortality rate was at least 63.6%. The present score accurately discriminated the probability of death in children hospitalized with ABM, and it could be a useful tool to select candidates for admission to the intensive care unit and for adjunctive therapy in clinical trials.

Sequencing of S and N genes of SARS-CoV-2 strains circulating in Cuba during March- September 2020

ABSTRACT
 Objectives: The first confirmed cases of COVID-19 in Cuba were reported on March 11, 2020, followed by multiple introductions of infected travelers from Europe, America, and Asia. This work aimed to characterize the SARS-CoV-2 strains circulating in Cuba from March to September 2020 by partial nucleotide sequencing of the S and N genes. 
 Methods: Between March and September 2020, 38 nasopharyngeal exudates from 38 SARS-CoV-2 patients were received at the National Reference Laboratory for Influenza and Respiratory Viruses at the Institute of Tropical Medicine “Pedro Kourí” (IPK). The Sanger sequencing method was used to amplify and sequence a 2539 bp fragment of the spike gene (from position 22020 to 24550) and a 370 bp of the nucleoprotein gene (from position 28340 to 28710). The GISAID database was used to identify the mutation profile of both fragments, and phylogenetic analysis was used to confirm the clades. In addition, clinical and epidemiological data from patients were gathered.
 Results: There were 34 and 25 sequences from S and N genes, respectively. In 21 of them, both genes (S and N) were available, whereas, in the remaining 13 and 4, only S or N sequences could be obtained. Based on the presence of the D614G mutation, 32 samples (84.2%) were classified as clade G of SARS CoV-2, and two were classified as Wuhan. No classification was possible in the remaining four (where only the N sequence was available). In one sample each, five different mutations were detected in clade G samples: L517F, L517X, N603T, A846V, and E281V. The 26 N sequences obtained were 100.0% identical to those circulated in most countries. 
 The G30R mutation was detected in an infected patient in Cuba. Fourteen of the 38 patients studied were imported cases. The first three cases detected with COVID-19 in Cuba were clade G and originated in Italy. Ten individuals were asymptomatic, four presented severe forms of the disease (two fatal), and the remaining presented mild symptoms. No relationship was observed among the clades or the mutational profile with the clinical features, country of origin, and Cuban provinces. 
 Conclusion: The early establishment of SARS-CoV-2 genetic surveillance in Cuba was helpful for tracking the epidemic. It demonstrated that the SARS-CoV-2 clade G was introduced initially and was the variant that circulated in the country during 2020, although the Wuhan strain was also detected. J Microbiol Infect Dis 2022; 12(3):77-88.

Protocol for a controlled before-after quasi-experimental study to evaluate the effectiveness of a multi-component intervention to reduce gaps in hypertension care and control in low-income communes of Medellin, Colombia

IntroductionResearch on public health interventions to improve hypertension care and control in low-income and middle-income countries remains scarce. This study aims to evaluate the effectiveness and assess the process and...

MEMO: Monitoring of exotic mosquitoes in Belgium.

Monitoring of Exotic MOsquitoes in Belgium' is a sampling event dataset published by the Institute of Tropical Medicine (ITM) in Antwerp, Belgium. It forms part of the early detection of exotic mosquito species (EMS) along high-risk introduction routes in Belgium, where data are collected at defined points of entry (PoEs) using a standardised protocol. The MEMO dataset contains mosquito sampling counts performed between 2017 and 2020. MEMO+2020, an extension of the MEMO dataset, contains only Aedes albopictus mosquito trap counts performed in 2020. Here, we present these data published as a standardised Darwin Core archive, which includes, for each sampling event, an eventID, date, location and sampling protocol (in the event core); and an occurrenceID for each occurrence (tube), the number of collected individuals per tube, species status (present/absent), information on the identification and scientific name (in the occurrence extension).

TBE in Belgium

In 2018, the two first human tick-borne encephalitis (TBE) cases with possible/probable autochthonous infection were diagnosed at the National Reference Centre (NRC) of Arbovirus (The Institute of Tropical Medicine, Antwerp, Belgium). Every year, some imported cases of TBE are also detected, infected in other European countries such as Germany, Scandinavia, Austria, Kyrgyzstan or Slovenia and Russia.

Predicting COVID-19 Symptoms From Free Text in Medical Records Using Artificial Intelligence: Feasibility Study.

BackgroundElectronic medical records have opened opportunities to analyze clinical practice at large scale. Structured registries and coding procedures such as the International Classification of Primary Care further improved these procedures. However, a large part of the information about the state of patient and the doctors’ observations is still entered in free text fields. The main function of those fields is to report the doctor’s line of thought, to remind oneself and his or her colleagues on follow-up actions, and to be accountable for clinical decisions. These fields contain rich information that can be complementary to that in coded fields, and until now, they have been hardly used for analysis.ObjectiveThis study aims to develop a prediction model to convert the free text information on COVID-19–related symptoms from out of hours care electronic medical records into usable symptom-based data that can be analyzed at large scale.MethodsThe design was a feasibility study in which we examined the content of the raw data, steps and methods for modelling, as well as the precision and accuracy of the models. A data prediction model for 27 preidentified COVID-19–relevant symptoms was developed for a data set derived from the database of primary-care out-of-hours consultations in Flanders. A multiclass, multilabel categorization classifier was developed. We tested two approaches, which were (1) a classical machine learning–based text categorization approach, Binary Relevance, and (2) a deep neural network learning approach with BERTje, including a domain-adapted version. Ethical approval was acquired through the Institutional Review Board of the Institute of Tropical Medicine and the ethics committee of the University Hospital of Antwerpen (ref 20/50/693).ResultsThe sample set comprised 3957 fields. After cleaning, 2313 could be used for the experiments. Of the 2313 fields, 85% (n=1966) were used to train the model, and 15% (n=347) for testing. The normal BERTje model performed the best on the data. It reached a weighted F1 score of 0.70 and an exact match ratio or accuracy score of 0.38, indicating the instances for which the model has identified all correct codes. The other models achieved respectable results as well, ranging from 0.59 to 0.70 weighted F1. The Binary Relevance method performed the best on the data without a frequency threshold. As for the individual codes, the domain-adapted version of BERTje performs better on several of the less common objective codes, while BERTje reaches higher F1 scores for the least common labels especially, and for most other codes in general.ConclusionsThe artificial intelligence model BERTje can reliably predict COVID-19–related information from medical records using text mining from the free text fields generated in primary care settings. This feasibility study invites researchers to examine further possibilities to use primary care routine data.

Diagnostic Performance of Three rK39 Rapid Diagnostic Tests and Two Direct Agglutination Tests for the Diagnosis of Visceral Leishmaniasis in Southern Iran.

To evaluate the diagnostic performance of five alternative serodiagnostic tests, serum samples from 100 confirmed visceral leishmaniasis (VL) patients, 197 healthy endemic individuals, and 58 non-VL patients living in southern Iran were compared. The VL patients were defined as individuals with a positive result of the immunofluorescent antibody test (IFAT), having clinical signs and symptoms and appropriate response to treatment. The index tests were two direct agglutination tests, DAT-ITM (Institute of Tropical Medicine, Antwerp, Belgium) and DAT-KIT (Royal Tropical Institute, Amsterdam, The Netherlands), and three rapid diagnostic tests (RDTs), Kalazar Detect (InBios International Inc., USA), IT Leish (Bio-Rad, catalog 710124), and Leishmania test (Cypress Diagnostic Company, Belgium). Sensitivities of DAT-ITM and DAT-KIT were low, respectively, 56% and 59%, while specificities were acceptable, respectively, 98% and 93%. Observed sensitivities and specificities of RDTs were higher (71%, 81%, 70% and 99%, 99%, 98% for Kalazar Detect, IT Leish, and Leishmania test, respectively). Even with a maximum sensitivity of 81%, RDTs missed almost one-fifth of VL patients that were positive in IFAT. We conclude that RDTs in VL patients do not possess adequate performance in southern Iran and require some improvement, but they can still be helpful in the diagnosis and screening of the disease in this region due to their high specificity and speed.

Contemplation and interaction? An intervention in public schools to motivate the concern in hygiene and transmission of diseases

Non family health education is controversial by the different family models and is done in a contemplative way, which generates small fixation of concepts or behavioral changes and the child may have flawed personal sanitary concepts. As the school offers only a contemplative view, individual interactive experiences could pinpoint and emphasize these concepts. With this, the Institute of Tropical Medicine of the University of São Paulo and the Faculty of Medicine of the University of São Paulo, with the support of the Pro-Rectory of Extension and Culture of University of São Paulo, we constructed an interactive exhibition for students of public schools of the fundamental cycle, addressing the essential concepts of disease transmission and prevention. An initial contemplative view was offered during the waiting queue, then each individual performs experiments of interpersonal contact, transmission by fomites, variation of agents, and "contamination" is demonstrated by fluorescent lighting. The interaction was presented in 5 public schools, with intense collaboration of the students and teachers, with 1300 students participating in all experiments with more than 70% participation. Events of this type, which raise awareness about hygiene and the transmission and prevention of communicable diseases can be done interactively among students, allowing greater fixation and greater acceptance. The exposition is interactive with active participation of students in essays and revelation of landmark events, such as demonstrating interpersonal contamination at various levels of personal relationship.

Keynote Message - Dr. Anthony S. Fauci

Warm greetings to you all. My name is Dr. Tony Fauci, and I am the Director of the National Institute of Allergy and Infectious (NIAID) at the U.S. National Institutes of Health and Chief Medical Adviser to President Joe Biden. I sincerely appreciate being asked to help open the National Academy of Science and Technology, Philippines’ 43rd Annual Scientific Meeting with its focus on learning from the past to inform the future. Among the most important lessons we have learned from the COVID-19 pandemic is that sustained biomedical research is essential to global well-being, as manifested by the successful development of highly effective vaccines against SARS-CoV-2. We also have seen that an effective response to emerging infectious diseases requires international scientific cooperation. Keeping in mind the theme of this meeting, I would like to briefly highlight the value and importance of research cooperation between the United States and the Philippines while expressing my hope that this cooperation will continue and thrive in the coming years. The institute I lead, NIAID, has supported US and Filipino scientists working together for more than 30 years. As we now fight SARS-CoV-2, HIV, and other viral diseases together, our efforts continue to grow when scientific importance and public health value. Over the years, much productive NIAID supported collaborative research in the Philippines has focused on HIV and tuberculosis co-infections. Talented Filipino scientists from your outstanding institutions have participated in multiple AIDS clinical research networks that have advanced the global understanding of HIV prevention, treatment, and care particularly while addressing TB as a comorbidity in resource challenge settings. Participation of the Philippines in these multi-country networks has helped ensure that your scientists are among the core of key contributors advancing biomedical discoveries that have made AIDS a preventable chronic disease rather than an acute one with a high degree of mortality. In addition to participation in HIV/AIDS research, Filipino scientists have helped lead the way in studies of tuberculosis particularly multidrug-resistant TB (MDR TB). The work in the Regional Prospective Observational Research in Tuberculosis (RePORT) network has been especially important and promising. With continuing support from the Department of Science and Technology (DOST), the Philippines is sure to make significant contributions to the global fight against TB. Philippine institutions also have played an important in other infectious diseases research. For example, Filipino scientists continue to lead research on dengue (another flaviviruses), malaria, and schistosomiasis building on prior NIAID support for Filipino studies on these pathogens. For many years the Research Institute for Tropical Medicine (RITM) received NIAID funding as a tropical medicine research center of excellence. Hopefully, this institution and others will continue to receive Philippine government support so that they will remain competitive for both funding and talent. Given this track record, I also can foresee great value in the Philippines expanding its scientific leadership role in the Asia-Pacific region. In this regard, we are pleased to partner with the Department of Science and Technology through the e-ASIA Joint Research Program (e-ASIA JRP). In the future, this program–which supports collaborative research involving US and Filipino scientists–has the potential of adding real value to our overall research efforts, as long as it is adequately supported by all the participating agencies. In closing, I want to emphasize the importance of sustained local support for scientists and scientific institutions in the Philippines and elsewhere. This support is necessary foundation to attract funding from outside the country. It is also an essential element for economic vitality and growth. In addition, as we have seen with COVID-19, science–particularly biomedical research–is fundamentally important to pandemic preparedness and effective outbreak responses that save lives and stabilize societies. Fortunately, the Philippines has long recognized the value of science. Just four (4) months ago, we saw this again when NIAID and DOST jointly sponsored a special COVID-19 workshop focused on research findings and scientists in this region. With the success of that workshop, we look forward to convening the 2022 emerging infectious diseases of the Pacific Rim Conference which DOST has offered to co-host along with NIH and Japan’s AMED. Thank you again for a long-standing scientific partnership and for the continuing commitment of the Philippines to the global research enterprise. Through decades of collaboration, we have learned from each other and share the tradition of excellence in science and technology particularly in biomedical research. I am confident that our future collaborations will continue to contribute to scientific discovery through basic and clinical research and the training of the talented new scientists. I wish you every success with your 43rd Annual Scientific Conference and with the implementation of its results.

Community-driven health research in the Torres Strait.

In July 2018, participants at a Waiben (Thursday Island) conference declared that it was time for a locally driven research agenda for the Torres Strait and Queensland Northern Peninsula Area. For decades, they felt exploited by outside researchers. They identified a lack of respect and consultation, with few benefits for their people. In response, the Australian Institute of Tropical Health and Medicine (Waiben Campus-Ngulaigau Mudh) invited a consultative group of elders and senior health providers to develop a research program based on local cultural and health needs. The aim was to promote research skills through a learn-by-doing approach. Four workshops were conducted over 2019. Key financial and in-kind support was provided by the Australian Institute of Tropical Health and Medicine, Hot North, and Queensland Health's Torres and Cape Hospital and Health Service. The first workshop attracted 24 people; none had previous research experience. The workshop format evolved over 2019, mainly guided by the participants. Overall, feedback was positive, and participant research proposals remain in various stages of development. Although suspended during the COVID-19 pandemic, this is a long-term investment in community-driven research that seeks to translate health benefits to the people. This model may apply to other communities, especially in rural and remote Australia. Warning: This article contains the names and/or images of deceased Aboriginal and Torres Strait Islander peoples.

Convection heat transfer analysis in rats and mice

Heat transfer is a vitally important mechanism in thermal control of living beings. It is no different for rats and mice, which are widely used for academic, pharmaceutical and medicinal research. The objective of the present study was to estimate the convective heat transfer in rats and mice confined in a vivarium at the UFRN’s Institute of Tropical Medicine. Twenty rats and twelve mice were used for the experiment, where the following measurements were made: surface skin temperature, body length, and weight. The study was able to determine mathematically an approximation of the natural and forced convection heat transfer rates produced by rats and mice, comparing them under the condition of 22°C in a controlled vivarium environment.

Human Toxocariasis in Portugal-An Overview of a Neglected Zoonosis over the Last Decade (2010-2020).

Toxocariasis is one of the most widespread and important zoonotic parasitic diseases, although neglected. Data regarding human Toxocara infection in Portugal are almost absent. This article gives an overview of the situation of toxocariasis in Portugal over the last decade based on casuistic data. A total of 846 serum samples from individuals suspected of toxocariasis, collected from 2010 to 2020, were analyzed at the Institute of Hygiene and Tropical Medicine. Sera were tested for IgG antibodies to Toxocara canis excreted–secreted larval antigens by enzyme-linked immunosorbent assay and counterimmunoelectrophoresis. Positivity was detected in 18.8% (159/846) [CI 95%: 16.3–21.6], with positives detected throughout continental Portugal. Overall, 59.7% of the positives were diagnosed in younger than 20 years (35.2% aged 0–9 years and 24.5% aged 10–19 years). Eosinophilia was the most frequent feature reported (27.7%). Pediatrics (41.5%) and Infectiology (25.8%) were the specialties with the highest number of positives. An average of 77 samples/year were received, recording a maximum positivity in 2012 (41.5%, n = 27/65) and a minimum in 2020 (6.4%, n = 3/47). These numbers may reflect the effectiveness of current preventive measures, highlighting the need to maintain public awareness to control this helminthozoonosis and promote a higher public health standard.

Capacity building of health professionals in Guinea: a successful e-learning experience (2017-2021)

Abstract Background Strengthening the capacities of health professionals (HPs) in public health is a necessity in the context of recurrent epidemics in Africa. The objective of this study was to describe the process and results of an innovative online training program implemented in the post-Ebola context in Guinea between 2017 and 2021. Methods The courses were developed in French in 2017-2018 by the Maferinyah Training and Research Center in Guinea with technical support from the Institute of Tropical Medicine (ITM) of Antwerp (Belgium). The Moodle platform was used to locally manage and deliver these courses. A cross-sectional study using mixed research methods was carried out. Results Three courses of three months duration each (6 to 8 modules) were developed and delivered between 2018 and 2021 on primary health care (eSSP), management of sexual and reproductive health services (eSSR), and research methodology. The online training on the Moodle platform was followed by a face-to-face capacity-building workshop. Of 479 HPs from 13 nationalities enrolled in the courses, 68.1% (326/479) completed the training and 80.4% of them (262/326) validated it (54.7% among all registrants). The success rate of women (56.7%) was higher than that of men (54%) and remained higher among Guineans (55.3%) compared to foreigners (51.4%) but these differences were not statistically significant. The success rates for the eSSP (47.7%), eSSR (58.5%) and eMR (59.1%) courses were also comparable. The learner satisfaction score ranged from 60 to 100% for different aspects of the courses. Conclusions It is possible to offer online courses in a limited resource setting like Guinea. However, involving women in online training remains a challenge. Key messages It is possible to offer online courses in a limited resource setting like Guinea. Involvement of women in online training remains a challenge.

Molecular Identification of Trypanosoma theileri and Biology of Trypanosomes

Trypanosoma theileri (T. theileri ) is a non-pathogenic, cosmopolitan, and commensal protozoa of cattle. The main objective of the current study was to investigate the biology and feasibility of T. theileri as a model candidate for the discovery of a novel drug. In the present study, the isolates of T. theileri obtained from the Institute of Tropical Medicine (ITM) in SDM 79 were cultivated at 26oC. Eight experiments with different inoculum and different times were grown. The growth curve was plotted to check the growth trends. The doubling time in the logarithmic phase was determined to be 17.43 hours. In addition, an experimental infection was done on a 3-month-old Holstein Friesian calf to isolate the blood-streaming shape; however, it was not successful after the blood buffy coat smear and PBMC culture in RPMI 1640 and HMI 9. Furthermore, the viability was determined by quantitative colorimetric Resazurin assay in 96-well fluorescence Microplates containing 0.4 to 2.4 mM of Resazurin. On the other hand, the response to Pentamidine (1-100 ng/mL) showed a strong negative correlation between the fluorescence signal and the highest Pentamidine concentration. IC50 was 9.25 ng/mL. Genomic DNA was extracted using the phenol-chloroform method. The gradient PCR amplification using T. theileri specific PCR (Tth625-PCR) primers was detected at 465 base pair (bp). In addition, the full-length 18S rDNA sequence was detected at 730 bp. In the silico analysis using common anti-trypanosome drug targets, no significant similarity could be found on either the DNA or the protein level. Nevertheless, homologous sequences have been identified among the drug targets for Ornithine decarboxylase. Therefore, the analysis might show the possibility of using T. theileri as a model for the search of new drugs once they have entire genome sequences. Analysis of the whole genome and transcriptome indicated a phylogenetic relationship between T. theileri and other pathogenic trypanosomes which can be the basis for novel drug development.

Human Filariasis in Travelers and Migrants: A Retrospective 25-year Analysis at the Institute of Tropical Medicine, Antwerp, Belgium.

Information on human filariasis in international travelers is scarce. We describe the epidemiology, clinical presentation, and outcome of these infections in a reference travel clinic over the past decades. We reviewed all cases of filariasis diagnosed at the Institute of Tropical Medicine, Antwerp, Belgium, from 1994 to 2018. Diagnosis was obtained by either parasitological methods (confirmed) or strict clinical case definitions (probable). We assessed the characteristics of cases at diagnosis and response to therapy within 3-12 months. A total of 320 patients (median age: 41 years; 71% males) were diagnosed with 327 filarial infections (Wuchereria bancrofti = 6, Onchocerca volvulus = 33, Loa loa = 150, Mansonella perstans = 130, unspecified species = 8). Diagnosis was confirmed in 213/320 (67%) patients. European long-term travelers accounted for 166 patients (52%) and visitors/migrants from tropical countries for another 110 (34%). Central Africa was the likely region of acquisition for 294 (92%) patients. The number of filariasis cases decreased from 21.5/year on average in the 1990s to 6.3/year in the past decade, when loiasis became predominant. Cases reported symptoms in >80% of all filarial infections but mansonellosis (45/123 single infections; 37%). Lymphatic filariasis and onchocerciasis cases responded well to conventional therapy. However, 30% of patients with loiasis and mansonellosis experienced treatment failure (with diethylcarbamazine and levamisole-mebendazole, respectively). The burden and species distribution of filariasis in travelers evolved in the past decades. Most presentations were symptomatic. Case management would benefit from more effective therapies for loiasis and mansonellosis.

TBE in Belgium

In 2018, the two first human tick-borne encephalitis (TBE) cases with possible/probable autochthonous infection were diagnosed at the National Reference Centre (NRC) of Arbovirus (The Institute of Tropical Medicine, Antwerp, Belgium). Every year, some imported cases of TBE are also detected, infected in other European countries such as Germany,1 Scandinavia, Austria, Kyrgyzstan or Slovenia2 and Russia.

Characterization of Neonatal Infections by Gram-Negative Bacilli and Associated Risk Factors, Havana, Cuba.

Infections represent an important problem in neonates because of the high mortality. An increase in neonatal infections has been found in Cuban hospitals in recent years. The aim of this study was to provide evidence on the clinical and microbiological behavior of Gram-negative bacilli that cause neonatal infections in hospitals of Havana, Cuba. It was carried out as a descriptive cross-sectional investigation from September 2017 to July 2018 in The Tropical Medicine Institute “Pedro Kouri” (IPK). Sixty-one Gram-negative bacilli isolated from neonates with infections in six Gyneco-Obstetric and Pediatric Hospitals of Havana were analyzed for their species and antimicrobial susceptibility. Late-onset infections were more common than early-onset ones and included urinary tract infection in the community (87%) and sepsis in hospitals (63.3%). Catheter use (47%) and prolonged stay (38%) were the most frequent risk factors. Species of major pathogens were Escherichia coli (47%) and Klebsiella spp. (26%). The isolated Gram-negative bacilli showed high resistance rates to third-generation cephalosporins, ciprofloxacin and gentamicin, while being more susceptible to carbapenems, fosfomycin, colistin and amikacin. The present study revealed the clinical impact of Gram-negative bacilli in neonatology units in hospitals of Havana. Evaluation of antimicrobial susceptibilities to the isolates from neonates is necessary for selection of appropriate empirical therapy and promotion of the rational antibiotic use.