Search

Objective To assess the outcomes of a contact-tracing programme to increase the diagnosis of tuberculosis in Cubal, Angola and offer preventive treatment to high-risk groups. Methods A health centre-based contact-tracing programme was launched in Hospital Nossa Senhora da Paz in March 2015 and we followed the programme until 2022. In that time, staffing and testing varied which we categorized as four periods: medical staff reinforcement, 2015-2017, with a doctor seconded from Vall d'Hebron University Hospital, Spain; routine staff, 2017-2021, with no external medical support; community directly observed treatment (DOT), 2018-2019 with community worker support; and enhanced contact tracing, 2021-2022, with funding that allowed free chest radiographs, molecular and gastric aspirate testing. We assessed differences in contacts seen each month, and testing and treatment offered across the four periods. Findings Overall, the programme evaluated 1978 contacts from 969 index cases. Participation in the programme was low, although it increased significantly during the community DOT period. Only 16.6% (329/1978) of contacts had a chest radiograph. Microbiological confirmation increased to 72.2% (26/36) after including molecular testing, and 10.1% (200/1978) of contacts received treatment for tuberculosis. Of 457 contacts younger than 5 years, 36 (7.9%) received preventive tuberculosis treatment. Half of the contacts were lost to follow-up before a final decision was taken on treatment. Conclusion Contact tracing increased the diagnosis of tuberculosis although engagement with the programme was low and loss to follow-up was high. Participation increased during community DOT. Community-based screening should be explored to improve participation and diagnosis. Objectif Evaluer l'efficacite d'un programme de suivi des contacts pour ameliorer le depistage de la tuberculose a Cubal, en Angola, et proposer un traitement preventif aux groupes a haut risque. Methodes Un programme de suivi des contacts en centre de sante a ete lance en mars 2015 a l'Hospital Nossa Senhora da Paz, et nous l'avons accompagne jusqu'en 2022. Comme les effectifs et le depistage ont evolue durant cette periode, nous l'avons divisee en quatre phases: renforcement de l'equipe medicale entre 2015 et 2017, avec un medecin detache de l'hopital universitaire Vall d'Hebron, en Espagne; personnel regulier entre 2017 et 2021, sans assistance medicale externe; traitement sous surveillance directe (TSD) au niveau communautaire entre 2018 et 2019, avec l'aide des agents communautaires; et enfin, suivi renforce des contacts entre 2021 et 2022, avec un financement permettant d'effectuer gratuitement des radiographies thoraciques, ainsi que des tests moleculaires et d'aspiration gastrique. Nous avons evalue les differences dans les contacts vus chaque mois, mais aussi dans les tests et traitements proposes durant les quatre phases. Resultats Au total, le programme a examine 1978 contacts Issus de 969 cas Indicateurs. La participation au programme etait faible, bien qu'elle ait considerablement augmente au cours de la phase de TSD au niveau communautaire. A peine 16,6% (329/1978) des contacts ont fait l'objet d'une radiographie thoracique. La confirmation microbiologique a atteint 72,2% (26/36) apres avoir inclus les tests moleculaires, tandis que 10,1% (200/1978) des contacts ont recu un traitement contre la tuberculose. Sur les 457 contacts ages de moins de 5 ans, 36 (7,9%) se sont vus administrer un traitement preventif contre la tuberculose. La moitie des contacts ont ete perdus de vue avant qu'une decision finale n'ait ete prise en matiere de traitement. Conclusion Le suivi a permis de mieux diagnostiquer la tuberculose, malgre la faible participation au programme et le nombre eleve de contacts perdus de vue. La participation a augmente pendant la phase de TSD au niveau communautaire. Le depistage au niveau communautaire devrait etre renforce afin d'accroitre le taux de participation et de diagnostic. Objetivo Evaluar los resultados de un programa de rastreo de contactos para aumentar el diagnostico de la tuberculosis en Cubal (Angola) y ofrecer tratamiento preventivo a los grupos de alto riesgo. Metodos En marzo de 2015, se inicio un programa de rastreo de contactos basado en centros sanitarios en el Hospital Nossa Senhora da Paz y se siguio hasta 2022. En ese tiempo, la dotacion de personal y las pruebas variaron, lo que clasificamos en cuatro periodos: refuerzo del personal medico, de 2015 a 2017, con un medico enviado en comision de servicios desde el Hospital Universitario Vall d'Hebron (Espana); personal de rutina, de 2017 a 2021, sin apoyo medico externo; tratamiento directamente observado (TDO) en la poblacion, de 2018 a 2019, con apoyo de trabajadores comunitarios; y rastreo de contactos mejorado, de 2021 a 2022, con financiacion que permitio realizar radiografias de torax y pruebas moleculares y de aspirado gastrico gratuitas. Se evaluaron las diferencias en los contactos atendidos al mes y las pruebas y el tratamiento ofrecidos en los cuatro periodos. Resultados En total, el programa evaluo 1978 contactos de 969 casos de referencia. La participacion en el programa fue baja, aunque aumento de manera significativa durante el periodo de TDO en la poblacion. Solo el 16,6% (329/1978) de los contactos se sometieron a una radiografia de torax. La confirmacion microbiologica aumento al 72,2% (26/36) tras incluir las pruebas moleculares y el 10,1% (200/1978) de los contactos recibieron tratamiento para la tuberculosis. De 457 contactos menores de 5 anos, 36 (7,9%) recibieron tratamiento preventivo contra la tuberculosis. Se perdio el seguimiento de la mitad de los contactos antes de que se tomara una decision final sobre el tratamiento. Conclusion El rastreo de contactos aumento el diagnostico de la tuberculosis, aunque el compromiso con el programa fue bajo y la perdida del seguimiento fue alta. La participacion aumento durante el TDO en la poblacion. Se debe explorar el cribado en la poblacion para mejorar la participacion y el diagnostico., Introduction Increasing testing and diagnosis of tuberculosis (TB) is one of the main pillars of the End TB Strategy, together with rapid initiation of effective therapy and follow-up programmes. (1) [...]

Background: Urogenital schistosomiasis caused by Schistosoma haematobium is highly endemic in the municipality of Cubal in Angola. Currently, diagnosis is based on the observation of S. haematobium eggs in urine samples by microscopy but this method has low sensitivity. Few studies have been performed using molecular techniques in high-prevalence areas for the detection of S. haematobium. The objective of this study is to evaluate the usefulness of real-time PCR as a diagnostic technique for urogenital schistosomiasis among preschool-age children and its correlation with morbidity data. Methods: A cross-sectional study was conducted in Cubal, Angola, involving 97 urine samples from preschool-age children analyzed by the dipstick test, microscopic examination of filtered urine, and real-time PCR. The diagnosis of urogenital schistosomiasis was based on microscopy and/or real-time PCR results. Clinical and ultrasonography evaluation was performed to rule out complications of schistosomiasis. Results: We detected a total of 64.95% of samples positive by real-time PCR and 37.11% by microscopy. The sensitivity of parasitological diagnosis of urogenital schistosomiasis by real-time PCR and microscopy was 95.45% and 54.55%, respectively, and the sensitivity of real-time PCR compared with microscopy was 91.67%. A positive real-time PCR result was significantly related to older age (mean = 3.22 years), detection of eggs by microscopy, and abnormal urine dipstick results (18.56% with proteinuria, 31.96% with leukocyturia, and 31.96% with microhematuria) (p-value<0.05). Ultrasound analysis showed that 23.94% of children had urinary tract abnormalities, and it was significantly related to the real-time PCR diagnosis (p-value<0.05). Conclusions: Real-time PCR is a more sensitive technique than microscopy for urinary schistosomiasis diagnosis in preschool-age children in Cubal. This increase in sensitivity would allow earlier diagnosis and treatment, thus reducing the morbidity associated with schistosomiasis in its early stages. Author summary: Schistosomiasis is a neglected tropical disease that causes approximately 200,000 deaths worldwide each year. Urogenital schistosomiasis is caused by Schistosoma haematobium, which ultimately leads to lesions in the urinary tract due to egg deposition by the parasite. The World Health Organization recommends regular mass administration of praziquantel to prevent chronicity of the disease in high-endemicity areas. Preschool children are one of the most vulnerable groups, however, only children over two years of age are included in these strategies. The diagnostic techniques commonly used in endemic areas for egg detection by microscopy and urine hematuria have major limitations due to their low sensitivity. These limitations lead to misdiagnosis and undetected infections may eventually lead to the chronic form of the disease. Real-time PCR and microscopy were used to diagnose urogenital schistosomiasis in preschool children in Cubal, a high-transmission municipality in Angola. Urinary tract lesions were assessed by ultrasound. Of the samples tested, 64.95% were positive by real-time PCR, compared with 37.11% by microscopy, indicating sensitivities of 95.45% and 54.55%, respectively. Ultrasound analysis showed urinary tract alterations in 23.94% of the children. The results suggest that transmission of urogenital schistosomiasis in preschool children in Cubal is higher than previously estimated. [ABSTRACT FROM AUTHOR]

Background: Hypereosinophilic syndrome can produce cardiac involvement and endomyocardial fibrosis, which have a poor prognosis. However, there is limited information regarding cardiac involvement among migrants from Latin America with eosinophilia related to helminthiasis. Methods: We conducted a pilot observational study where an echocardiography was performed on migrants from Latin America with both eosinophilia (>450 cells/μL) and a diagnosis of helminth infection, and on migrants from Latin America without eosinophilia or helminth infection. Microbiological techniques included a stool microscopic examination using the Ritchie's formalin-ether technique, and a specific serology to detect Strongyloides stercoralis antibodies. Results: 37 participants were included, 20 with eosinophilia and 17 without eosinophilia. Twenty (54.1%) were men with a mean age of 41.3 (SD 14.3) years. Helminthic infections diagnosed in the group with eosinophilia were: 17 cases of S. stercoralis infection, 1 case of hookworm infection, and 2 cases of S. stercoralis and hookworm coinfection. Among participants with eosinophilia, echocardiographic findings revealed a greater right ventricle thickness (p = 0.001) and left atrial area and volume index (p = 0.003 and p = 0.004, respectively), while showing a lower left atrial strain (p = 0.006) and E-wave deceleration time (p = 0.008). An increase was shown in both posterior and anterior mitral leaflet thickness (p = 0.0014 and p = 0.004, respectively) when compared with participants without eosinophilia. Conclusions: Migrants from Latin America with eosinophilia related to helminthic infections might present incipient echocardiographic alterations suggestive of early diastolic dysfunction, that could be related to eosinophilia-induced changes in the endomyocardium. Author summary: A recent study in migrants from Sub-Saharan Africa with eosinophilia related to helminth infection describes initial findings on cardiac ultrasound in the form of thickening of the posterior leaflet of the mitral valve, but with no clinical manifestations, representing the early stage of the endomyocardial fibrosis process. The aim of the present study is to evaluate the relationship between eosinophilia secondary to helminth infection and cardiac involvement in Latin American patients. In our cohort, eosinophilia in patients was mainly due to Strongyloides stercoralis infection. Among patients with eosinophilia, echocardiographic findings revealed a greater right ventricle thickness and left atrial area and volume index, while showing a lower left atrial strain and E-wave deceleration time when compared with patients without eosinophilia. These alterations are suggestive of early diastolic dysfunction that could be related to eosinophilia-induced changes in the endomyocardium. [ABSTRACT FROM AUTHOR]

Chagas disease (CD) is recognized as one of the 20 neglected tropical diseases by the World Health Organization (WHO), posing a significant global health challenge. The objective of this work was to conduct a systematic methodology review to explore the different classifications used to describe the presence and degree of organ involvement in patients with CD since the disease's description in 1909. We searched relevant electronic medical databases from their inception dates to July 2023. We also delved into historical variations and revisions of each classification, the necessary diagnostic methods, their prognostic value, and their uptake. Our study underscores the conspicuous absence of a universally accepted CD classification system for cardiac and digestive involvement, both in the context of clinical trials and within current clinical guidelines. This endeavour will facilitate cross-population comparisons if clinical manifestations and complementary test results are available for each patient, constituting a pivotal stride toward identifying precise prognoses and establishing a minimum data set requisite for a fitting CD classification, tailored to the test availability in both endemic and non-endemic regions. Author summary: Chagas disease (CD) is a serious global health issue, and in our research, we aimed to investigate how doctors classify the impact of this disease on different organs. CD is one of the neglected tropical diseases recognized by the World Health Organization. It is important for us to understand how this disease affects people because it can lead to severe health problems. To conduct our study, we reviewed the various ways doctors have classified CD since it was first described in 1909. We looked at how these classifications have changed over time, the tests used to diagnose CD, and how these classifications are applied in clinical practice and research. One crucial discovery we made during our research is that there isn't a universally accepted classification system for CD, especially when it comes to assessing its impact on the heart and digestive system. This absence of a standard classification system makes it difficult to compare CD cases across different regions and to predict the disease's progression in individual patients. We believe that establishing a standardized classification system for CD is of utmost importance. Such a system would greatly assist doctors and researchers in gaining a better understanding of the disease, making more accurate predictions about how it will affect patients, and improving CD diagnosis and treatment, both in regions where the disease is prevalent and in areas where it's not. In summary, our study highlights the urgent need for a standardized method to classify Chagas disease, which is a significant global health concern. Establishing a common classification system would simplify the study and treatment of the disease, benefiting people worldwide. [ABSTRACT FROM AUTHOR]

Background People with pulmonary tuberculosis (PTB) are contagious, particularly to their household contacts. Their infectivity has been associated with the bacterial load in sputum samples. This study investigated if the bacterial load in sputum samples as quantified by Xpert MTB/RIF and Xpert Ultra is correlated with the extent that latent tuberculosis infection (LTBI) occurred in household contacts of people with PTB. Methods A retrospective study was performed including people with PTB presenting at Vall d'Hebron University Hospital, Barcelona, between 2011 and 2021. Their infection ratio, representing the proportion of household members found with LTBI in contact tracing investigation, was compared with the quantitative results of Xpert MTB/RIF and Xpert Ultra using ordinal regression analysis. Results A total of 107 people with PTB were included. Among their 398 household contacts, 126 (31.7%) cases of LTBI and 14 cases with active TB disease (3.5%) were reported. Higher bacterial load in Xpert MTB/RIF and Xpert Ultra baseline sputum was significantly associated with increased infection ratios, providing better estimates than conventional acid-fast bacilli (AFB) smear grading. Conclusions Xpert MTB/RIF and Xpert Ultra could serve as an alternative to AFB sputum-smear grading in determining contact tracing priorities. [ABSTRACT FROM AUTHOR]

Background High-speed global travel, increased trade, world population growth, migration, urbanization and climate change have favoured the emergence and spread of pathogens. We aimed to analyse the evolution of imported infections in Spain during 2012–2022 and the potential impact of some of the abovementioned factors on differential morbidity patterns. Methods In this retrospective study (January 2012 to December 2022), we analysed data collected by the +Redivi network across 25 health centres. The network's standardised database records new cases of imported infections, including patient demographics, travel history, pre-travel advice and diagnostic information. To assess outcome rates over time and potential interactions, we constructed penalized weighted models to reduce the bias related to a low event rate and used weighted logistic regression for morbidity outcomes. Results We recorded 25 632 episodes, comprising 13 913 migrants, 4047 visiting friends and relatives (VFR) immigrants, 392 VFR travellers and 7280 travellers. Most immigrants came from South America (48.3%), Sub-Saharan Africa (28.5%), North Africa (6.6%), South Central Asia (5.4%) and Central America/Caribbean (5.3%). The most common regions visited by travellers were Sub-Saharan Africa (33.5%), South America (24.5%), Central America/Caribbean (13.5%), Southeast Asia (12%) and South Central Asia (10%). The proportion of diagnoses of malaria, strongyloidiasis and unspecified self-limiting febrile syndrome < 3 weeks remained unchanged during the study period. An increased frequency of diagnosis was reported for schistosomiasis, blastocystosis, giardiasis, dengue, diarrhoea, new cases of HIV, latent and pulmonary tuberculosis, whereas a decrease was reported for syphilis, chikungunya fever, Chagas disease and eosinophilia. We detected interactions between time and sex or type of participant across the different diagnoses. Conclusions Our study underscores the importance of epidemiological data in understanding infectious diseases dynamics among travellers and migrants, emphasizing how demographic shifts, migration trends and healthcare policies affect disease profiles. Comprehensive data play an essential role in enhancing public health policies and travel advice. [ABSTRACT FROM AUTHOR]

Background More than half of childhood tuberculosis cases remain undiagnosed yearly. The World Health Organization recommends the Xpert-Ultra assay as a first pediatric diagnosis test, but microbiological confirmation remains low. We aimed to determine the diagnostic performance of Xpert-Ultra with stool and urine samples in presumptive pediatric tuberculosis cases in 2 high-tuberculosis-burden settings. Methods This Médecins Sans Frontières cross-sectional multicentric study took place at Simão Mendes Hospital, Guinea-Bissau (July 2019 to April 2020) and in Malakal Hospital, South Sudan (April 2021 to June 2023). Children aged 6 months to 15 years with presumptive tuberculosis underwent clinical and laboratory assessment, with 1 respiratory and/or extrapulmonary sample (reference standard [RS]), 1 stool, and 1 urine specimen analyzed with Xpert-Ultra. Results A total of 563 children were enrolled in the study, 133 from Bissau and 400 from Malakal; 30 were excluded. Confirmation of tuberculosis was achieved in 75 (14.1%), while 248 (46.5%) had unconfirmed tuberculosis. Of 553 with an RS specimen, the overall diagnostic yield was 12.4% (66 of 533). A total of 493 stool and 524 urine samples were used to evaluate the performance of Xpert-Ultra with these samples. Compared with the RS, the sensitivity and specificity of Xpert-Ultra were 62.5% (95% confidence interval, 49.4%–74%) and 98.3% (96.7%–99.2%), respectively, with stool samples, and 13.9% (7.5%–24.3%) and 99.4% (98.1%–99.8%) with urine samples. Nine patients were positive with stool and/or urine samples but negative with the RS. Conclusions Xpert-Ultra in stool samples showed moderate to high sensitivity and high specificity compared with the RS and an added diagnostic yield when RS results were negative. Xpert-Ultra in stool samples was useful in extrapulmonary cases. Xpert-Ultra in urine samples showed low test performance. Clinical Trials Registration NCT06239337 [ABSTRACT FROM AUTHOR]