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1.  Longitudinal analysis of antigen specific response in individuals with Schistosoma mansoni infection in an endemic area of Minas Gerais, Brazil 
Background
Immunoepidemiologic studies have shown a relationship between IgE and IgG4 antibodies with age and with resistance and susceptibility to infection. It is believed that the IgE and IgG4 responses to soluble egg antigen (SEA) can be used for serological analysis of infection and post-treatment status. This study aimed to evaluate the association between Schistosoma mansoni infection and anti-SEA IgG4 and IgE reactivities, and determine whether these reactivities could be used as biomarkers of infection.
Methods
Between 2001 and 2009, a longitudinal study was performed in which parasitologic and blood specimens and socioeconomic and water-contact information were collected from 127 individuals. All patients positive for S. mansoni infection were treated.
Results
Schistosomiasis prevalence and the geometric mean of the egg count in 2001 were 59% and 61.05, respectively, decreasing to 26.8% and 8.78 in 2009. IgG4 anti-SEA reactivity in infected individuals was significantly higher than that in uninfected individuals at all time points. Analysis of receiver-operating characteristic (ROC) area showed that the IgG4 anti-SEA antibodies were able to predict infection by S. mansoni at each time point.
Conclusion
IgG4 anti-SEA reactivity can be used as a biomarker for immune monitoring of the presence of infection with S. mansoni in endemic areas.
doi:10.1093/trstmh/trt091
PMCID: PMC3888303  PMID: 24189480
Schistosomiasis; Longitudinal study; IgG4; IgE; Immunoepidemiology; Biomarkers
2.  Longitudinal analysis of antigen specific response in individuals with Schistosoma mansoni infection in an endemic area of Minas Gerais, Brazil 
Background
Immunoepidemiologic studies have shown a relationship between IgE and IgG4 antibodies with age and with resistance and susceptibility to infection. It is believed that the IgE and IgG4 responses to soluble egg antigen (SEA) can be used for serological analysis of infection and post-treatment status. This study aimed to evaluate the association between Schistosoma mansoni infection and anti-SEA IgG4 and IgE reactivities, and determine whether these reactivities could be used as biomarkers of infection.
Methods
Between 2001 and 2009, a longitudinal study was performed in which parasitologic and blood specimens and socioeconomic and water-contact information were collected from 127 individuals. All patients positive for S. mansoni infection were treated.
Results
Schistosomiasis prevalence and the geometric mean of the egg count in 2001 were 59% and 61.05, respectively, decreasing to 26.8% and 8.78 in 2009. IgG4 anti-SEA reactivity in infected individuals was significantly higher than that in uninfected individuals at all time points. Analysis of receiver-operating characteristic (ROC) area showed that the IgG4 anti-SEA antibodies were able to predict infection by S. mansoni at each time point.
Conclusion
IgG4 anti-SEA reactivity can be used as a biomarker for immune monitoring of the presence of infection with S. mansoni in endemic areas.
doi:10.1093/trstmh/trt091
PMCID: PMC3888303  PMID: 24189480
Schistosomiasis; Longitudinal study; IgG4; IgE; Immunoepidemiology; Biomarkers
3.  Efficacy of malaria prevention during pregnancy in an area of low and unstable transmission: an individually-randomised placebo-controlled trial using intermittent preventive treatment and insecticide-treated nets in the Kabale Highlands, south western Uganda 
Intermittent preventive treatment of malaria during pregnancy (IPTp) and insecticide-treated nets (ITN) are recommended malaria interventions during pregnancy; however, there is limited information on their efficacy in areas of low malaria transmission in sub-Saharan Africa.
An individually-randomised placebo-controlled trial involving 5775 women of all parities examined the effect of IPTp, ITNs alone or ITNs used in combination with IPTp on maternal anaemia and low birth weight (LBW) in a highland area of southwestern Uganda. The overall prevalence of malaria infection, maternal anaemia and LBW was 15.0%, 14.7% and 6.5%, respectively. Maternal and foetal outcomes were generally remarkably similar across all intervention groups (p>0.05 for all outcomes examined). A marginal difference in maternal Hb was observed in the dual intervention group (12.57 g/dL) compared with the IPTp and ITN alone groups (12.40 g/dL and 12.44 g/dL respectively; p=0.04), but this was too slight to be of clinical importance.
In conclusion, none of the preventive strategies was found to be superior to the others, and no substantial additional benefit to providing both IPTp and ITNs during routine antenatal services was observed. With ITNs offering a number of advantages over IPTp, yet showing comparable efficacy, we discuss why ITNs could be an appropriate preventive strategy for malaria control during pregnancy in areas of low and unstable transmission.
Trial Registration: www.ClinicalTrials.gov NCT0042207
doi:10.1016/j.trstmh.2011.07.012
PMCID: PMC4205472  PMID: 21962292
malaria prevention; pregnancy; intermittent preventive treatment; insecticide-treated nets; low transmission; highlands
4.  Multicenter study of hypoxemia prevalence and quality of oxygen treatment for hospitalized Malawian children 
Background
Although hypoxemic children have high mortality, little is known about hypoxemia prevalence and oxygen administration in African hospitals. We aimed to determine the hypoxemia prevalence and quality of oxygen treatment by local clinicians for hospitalized Malawian children.
Methods
The study was conducted in five Malawian hospitals during January–April 2011. We prospectively measured the peripheral oxygen saturation (SpO2) using pulse oximetry for all children <15 years old and also determined clinical eligibility for oxygen treatment using WHO criteria for children <5 years old. We determined oxygen treatment quality by Malawian clinicians by comparing their use of WHO criteria for patients <5 years old using two standards: hypoxemia (SpO2 <90%) and the use of WHO criteria by study staff.
Results
Forty of 761 (5.3%) hospitalized children <15 years old had SpO2 <90%. No hospital used pulse oximetry routinely, and only 9 of 40 (22.5%) patients <15 years old with SpO2 <90% were treated with oxygen by hospital staff. Study personnel using WHO criteria for children <5 years old achieved a higher sensitivity (40.0%) and lower specificity (82.7%) than Malawian clinicians (sensitivity 25.7%, specificity 94.1%).
Conclusion
Although hypoxemia is common, the absence of routine pulse oximetry results in most hospitalized, hypoxemic Malawian children not receiving available oxygen treatment.
doi:10.1093/trstmh/trt017
PMCID: PMC4030433  PMID: 23584373
Pneumonia; Pediatrics; Hypoxemia; Pulse oximetry; Integrated Management of Childhood Illness; Africa
5.  Leptospirosis in a subsistence farming community in Brazil 
Summary
Leptospirosis has been reported in rural areas of Brazil. However, there is limited information about the exposure risk or the risk of Leptospira infection for rural-based populations. A cross-sectional study was carried out in order to determine the prevalence and risk factors for prior Leptospira infection in a rural subsistence farming region of the state of Rio Grande do Norte, an area in which outbreaks of leptospirosis have occurred. Among 290 individuals enrolled, 44 (15.2%) had anti-Leptospira IgM antibodies as determined by IgM ELISA. Infection tended to occur with activities related to the rice fields (P = 0.08). Our findings indicate that Leptospira infection occurs even in years of low rainfall, and may have an important impact among poor rural-based subsistence farmers in Brazil. Additional studies are needed to characterize the mode of transmission in this region.
doi:10.1016/j.trstmh.2008.05.010
PMCID: PMC3970206  PMID: 18599101
Leptospirosis; Disease outbreaks; Surveillance; Prevalence; Rural population; Brazil
6.  Bloodfeeding patterns of sylvatic arbovirus vectors in southeastern Senegal 
Background
Dengue (DENV), yellow fever (YFV) and chikungunya (CHIKV) viruses circulate in sylvatic, enzootic transmission cycles in southeastern Senegal, but understanding of the vector–host interactions involved is limited.
Methods
The vertebrate hosts of several potential mosquito vectors of the three viruses were identified by PCR amplification and sequencing portions of the cytochrome b gene from bloodmeals of mosquitoes collected in Kedougou, Senegal, June 2010–January 2011.
Results
We identified the sources of 65 bloodmeals of 82 engorged mosquitoes. Aedes taylori was the only species that fed on monkeys (Chlorocebus sabaeus and Papio papio). The majority of the avian-derived blood-meals were from the Western Plantain-eater (Crinifer piscator).
Conclusion
These findings corroborate the importance of Ae. taylori and African monkeys in the sylvatic cycles of YFV, DENV and CHIKV and suggest the possible involvement of other vertebrates.
doi:10.1093/trstmh/trs095
PMCID: PMC3913185  PMID: 23423342
Arboviruses; Vertebrate hosts; Mosquitoes; Disease vectors; Bloodmeal; Senegal
7.  Presidential addresses of the Royal Society of Tropical Medicine and Hygiene: 1907–2013 
Presidents have been required to give an inaugural address on commencing office at the Royal Society of Tropical Medicine and Hygiene (RSTMH) since its foundation in 1907. All presidential addresses were identified, sourced and assembled into an annotated bibliography. The majority of presidential addresses have been published in Transactions of the Royal Society of Tropical Medicine and Hygiene. Unpublished and in some cases ‘lost’ contributions have now been sourced where possible and archived at the RSTMH. This unique, rich and rewarding archive provides a vista into the development of the RSTMH and the discipline of tropical medicine. The archive is freely available to all.
doi:10.1093/trstmh/trt066
PMCID: PMC3892027  PMID: 24026462
Inaugural address; Tropical medicine; RSTMH; STMH
8.  Risk factors for active trachoma in The Gambia 
Transactions of the Royal Society of Tropical Medicine and Hygiene  2008;102(12):10.1016/j.trstmh.2008.04.022.
Summary
Trachoma has been endemic in The Gambia for decades but national surveys indicate that the prevalence is falling. Risk factor data can help guide trachoma control efforts. This study investigated risk factors for active trachoma and ocular Chlamydia trachomatis infection in children aged below 10 years in two Gambian regions. The overall prevalence of C. trachomatis infection was only 0.3% (3/950) compared with 10.4% (311/2990) for active trachoma, therefore analyses were only performed for active trachoma. After adjustment, increased risk of trachoma was associated with being aged 1—2 years (odds ratio (OR) 2.20, 95% CI 1.07—4.52) and 3—5 years (OR 3.62, 95% CI 1.80—7.25) compared with <1 year, nasal discharge (OR 2.07, 95% CI 1.53—2.81), ocular discharge (OR 2.68, 95% CI 1.76—4.09) and there being at least one other child in the household with active trachoma (OR 11.28, 95% CI 8.31—15.31). Compared with other occupations, children of traders had reduced risk (OR 0.53, 95% CI 0.30—0.94). At the household level, only the presence of another child in the household with active trachoma was associated with increased risk of active trachoma, suggesting that current trachoma control interventions are effective at this level. In contrast, child-level factors were associated with increased risk after adjustment, indicating a need to increase control efforts at the child level.
doi:10.1016/j.trstmh.2008.04.022
PMCID: PMC3836170  PMID: 18502459
Trachoma; Chlamydia trachomatis; Prevalence; Risk factors; Control; The Gambia
9.  Using malarial retinopathy to improve the classification of children with cerebral malaria 
Summary
The mechanisms leading to death in cerebral malaria (CM) remain unclear. We compared clinical and laboratory data among children with CM, categorized by ocular fundus findings, to elucidate differences that suggest different underlying pathological processes. From 1999—2005, standard examinations, treatment and record keeping were used for children with a clinical diagnosis of CM. Children were divided into ocular subgroups: normal fundus (N), malarial retinopathy (R), or papilloedema alone (P) and appropriate statistical tests were used to compare clinical and laboratory findings among groups. Eight hundred and eighty children who had eye examinations within 6 h of admission were included in the analysis. The groups differed significantly in case-fatality rates: Group P, 44.4% (95% CI 25.3—63.2), Group R, 18.0% (95% CI 15.6—22.3) and Group N, 7.0% (95% CI 4.2—9.8). There were also significant differences among the groups in blood pressure, prevalence of deep breathing, haematocrit, parasite density, platelet concentration and, among survivors, hours taken to recover from coma. Differences among groups suggest that different underlying pathophysiological processes are operating in children with CM defined by existing criteria. Our proposed classification, by improving the specificity of diagnosis, would enhance consistency among different study sites and prove useful in future research studies.
doi:10.1016/j.trstmh.2008.06.014
PMCID: PMC3804549  PMID: 18760435
Cerebral malaria; Children; Retinopathy; Pathophysiology; Papilloedema; Malawi
10.  Incidence and risk factors for hepatitis C infection in a cohort of women in rural Egypt 
Summary
A prospective cohort study of the incidence and risk factors for hepatitis C virus (HCV) infection was performed in 2171 pregnant women in three rural Egyptian villages who were HCV antibody (anti-HCV) and RNA (HCV-RNA) negative at baseline. During an average of 2.2 years follow up, 25 incident cases were observed, giving an estimated HCV incidence of 5.2/1000 person-years (PY). The infection rate correlated with community anti-HCV prevalence in pregnant women, while the perinatal incidence rate of 11.2/1000 PY was almost five times that of the non-perinatal rate (2.3/1000 PY). The data suggested iatrogenic perinatal risk factors were associated with infection in one village, while health education reduced infections in another. Among the 25 incident cases, eight were HCV-RNA negative when they were first found to be anti-HCV positive and one-third of the 15 viraemic cases with follow-up data available cleared their HCV-RNA after an average of 1.3 years. None of the 25 incident cases were jaundiced or had symptoms of hepatitis but elevated serum alanine aminotransferase levels confirmed hepatitis in nine. Our data suggest that asymptomatic HCV infections frequently occurred during the perinatal period but often cleared and that educating medical personnel on safe practices possibly reduced HCV transmission.
doi:10.1016/j.trstmh.2008.04.011
PMCID: PMC3793640  PMID: 18514243
Hepatitis C virus; Incidence; Risk factors; Pregnancy; Rural health; Egypt
11.  Presidential addresses of the Royal Society of Tropical Medicine and Hygiene: 1907–2013 
Presidents have been required to give an inaugural address on commencing office at the Royal Society of Tropical Medicine and Hygiene (RSTMH) since its foundation in 1907. All presidential addresses were identified, sourced and assembled into an annotated bibliography. The majority of presidential addresses have been published in Transactions of the Royal Society of Tropical Medicine and Hygiene. Unpublished and in some cases ‘lost’ contributions have now been sourced where possible and archived at the RSTMH. This unique, rich and rewarding archive provides a vista into the development of the RSTMH and the discipline of tropical medicine. The archive is freely available to all.
doi:10.1093/trstmh/trt066
PMCID: PMC3892027  PMID: 24026462
Inaugural address; Tropical medicine; RSTMH; STMH
12.  Mode of action and choice of antimalarial drugs for intermittent preventive treatment in infants 
Intermittent preventive treatment in infants (IPTi) is an effective and safe malaria control strategy. However, it remains unclear what antimalarials should be used to replace sulfadoxine-pyrimethamine (SP) when and where SP is no longer an effective drug for IPTi. Work recently conducted in Tanzania, combined with the findings of previous studies, indicates that IPTi is essentially intermittent chemoprophylaxis; consequently, long-acting antimalarials that provide a long period of post-treatment prophylaxis will be the most effective alternative to SP. However, because of concerns about development of drug resistance, new combinations of long-acting drugs are urgently needed.
doi:10.1016/j.trstmh.2009.06.007
PMCID: PMC3787296  PMID: 19740503
13.  Histoplasmosis among hospitalized febrile patients in northern Tanzania 
Histoplasmosis may be common in East Africa but the diagnosis is rarely confirmed. We report 9 (0.9%) cases of probable histoplasmosis retrospectively identified among 970 febrile inpatients studied in northern Tanzania. Median (range) age was 31 (6, 44) years, 6 (66.7%) were female, 6 (66.7%) HIV-infected; 7 (77.8%) were clinically diagnosed with tuberculosis or bacterial pneumonia. Histoplasmosis is an important cause of febrile illness in Tanzania but is rarely considered in the differential diagnosis. Increased clinician awareness and availability of reliable diagnostic tests may improve patient outcomes.
doi:10.1016/j.trstmh.2012.05.009
PMCID: PMC3392419  PMID: 22742942
Africa; Histoplasmosis; HIV; Tanzania; Tuberculosis
14.  A proposed new clinical staging system for patients with mucosal leishmaniasis 
Mucosal leishmaniasis occurs mainly in areas where Leishmania braziliensis is transmitted. It affects predominantly the nasal mucosa and, in more severe forms, can lead to significant tissue destruction. There is no standard method for grading the severity of disease. We categorised 50 patients with mucosal leishmaniasis according to a proposed clinical staging system. Their age ranged from 10 to 86 y (mean ± SD: 36 ± 16 y) and 43 (86%) patients were male. The different degrees of evolution of mucosal disease, from the initial stage to the more severe long-term cases, enabled mucosal leishmaniasis to be graded into five stages. Stage I is characterised by nodular lesions of the mucosa without ulcerations. Stage II is represented by superficial mucosal ulcerations with concomitant fine granular lesions. Stage III is characterised by deep mucosal ulcerations with granular tissue formation. In stage IV there are irreversible lesions leading to perforation of the cartilaginous nasal septum with necrosis. In stage V the nasal pyramid is compromised with alterations of facial features as a consequence of severe tissue destruction. These stages may be useful in characterising the severity of the lesion and optimising the therapeutic outcome.
doi:10.1016/j.trstmh.2012.03.007
PMCID: PMC3360834  PMID: 22578516
Leishmaniasis; Mucosal leishmaniasis; Disease stage; Nasal mucosa; Nose diseases; Brazil
15.  Sero-characterization of lipopolysaccharide from Burkholderia thailandensis 
Summary
We report the successful purification of lipopolysaccharide (LPS) from Burkholderia thailandesis, a Gram-negative bacterium, closely related to the highly pathogenic organisms Burkholderia pseudomallei and Burkholderia mallei. B. thailandensis LPS is shown to cross-react with rabbit and mouse sera obtained from inoculation with B. pseudomallei or B. mallei, respectively. These data suggest that B. thailandensis LPS shares similar structural features with LPS molecules from highly pathogenic Burkholderia species. This information may prove useful in ongoing efforts to develop novel vaccines and/or diagnostic reagents.
doi:10.1016/S0035-9203(08)70016-6
PMCID: PMC3656469  PMID: 19121690
lipopolysaccharide; immunogenic; Burkholderia
16.  [No title available] 
PMCID: PMC3636715  PMID: 19121689
17.  Pathways of care-seeking during fatal infant illnesses in under-resourced South African settings 
Summary
The purpose of this study was to examine care-seeking during fatal infant illnesses in under-resourced South African settings to inform potential strategies for reducing infant mortality. We interviewed 22 caregivers of deceased infants in a rural community and 28 in an urban township. We also interviewed seven local leaders and 12 health providers to ascertain opinions about factors contributing to infant death.
Despite the availability of free public health services in these settings, many caregivers utilised multiple sources of care including allopathic, indigenous and home treatments. Urban caregivers reported up to eight points of care while rural caregivers reported up to four points of care. The specific pathways taken and combinations of care varied, but many caregivers used other types of care shortly after presenting at public services, indicating dissatisfaction with the care they received. Many infants died despite caregivers’ considerable efforts, pointing to critical deficiencies in the system of care serving these families. Initiatives that aim to improve assessment, management and referral practices by both allopathic and traditional providers (for example, through training and improved collaboration), and caregiver recognition of infant danger signs may reduce the high rate of infant death in these settings.
doi:10.1016/j.trstmh.2011.10.008
PMCID: PMC3254810  PMID: 22136954
Infant mortality; Health care seeking behaviour; South Africa; Qualitative research
18.  Travel as a risk factor for uncomplicated Plasmodium falciparum malaria in the highlands of western Kenya 
Summary
In the 1980s, highland malaria returned to the tea estates of western Kenya after an absence of nearly a generation. In order to determine the importance of travel for the spread of malaria in this region, we prospectively collected blood films and travel, demographic and geographic information on well persons and outpatients on tea estates near the western rim of the Rift Valley. Risk factors for malaria asexual parasitaemia included: tribal/ethnic group, home province and home district malaria endemicity. Travel away from the Kericho tea estates within the previous two months showed an odds ratio (OR) for parasitaemia of 1.59 for well persons and 2.38 for outpatients. Sexual stages of malaria parasites (gametocytes) had an OR of 3.14 (well persons) and 2.22 (outpatients) for those who had travelled. Increased risk of malaria parasitaemia with travel was concentrated in children aged <5 years. An increase in population gametocytaemia is possibly due to increased chloroquine resistance and suppressed infections contracted outside of the tea estates.
doi:10.1016/j.trstmh.2004.04.001
PMCID: PMC3521062  PMID: 15550264
Plasmodium falciparum; Highland malaria; Travel; Kenya
19.  Norovirus prevalence in ‘pathogen negative’ gastroenteritis in children from periurban areas in Lima, Peru 
Summary
Norovirus was detected in 17.4% of 224 diarrhoeal samples from children younger than 24 months of age in Lima, in whom all common pathogens had been excluded (pathogen negative). Norovirus was identified more frequently in children older than 12 months of age than in younger children (34% vs 8%, P<0.001). Among norovirus-positive samples, genogroup II was the predominant group (92%). Compared with rotavirus, norovirus episodes tended to be of shorter duration and less severe. The role of norovirus as a cause of diarrhoea and the ascertainment of its severity in developing countries needs further confirmation by future epidemiological studies.
doi:10.1016/j.trstmh.2011.08.009
PMCID: PMC3215818  PMID: 21962615
Norovirus; gastroenteritis; viral genogroup; diarrhoea; children; Peru
20.  Prospective observational study of the frequency and features of intra-abdominal abscesses in patients with melioidosis in northeast Thailand 
Summary
Retrospective case series from Thailand have reported the presence of intra-abdominal abscesses in around half of patients with melioidosis, a much higher rate than our clinical experience would suggest. We performed a prospective, observational study of 230 adult patients with culture-confirmed melioidosis in which all patients underwent abdominal ultrasound. One or more abscesses were detected in the liver and/or spleen in 77 (33%) cases. These were often multiple (70%, 31/44 in hepatic abscesses and 88%, 50/57 in splenic abscesses) and clinically silent (27% of cases with abscesses presenting with abdominal pain). The mortality rate at 4 weeks post-discharge was lower in patients who were abscess-positive vs abscess-negative (10%, 8/77 vs 20%, 31/153).
doi:10.1016/j.trstmh.2012.05.007
PMCID: PMC3449236  PMID: 22770892
Melioidosis; Abscess; Liver; Spleen; Burkholderia pseudomallei; Ultrasound
21.  Application of ImageJ program to the enumeration of Orientia tsutsugamushi organisms cultured in vitro 
The ImageJ program was applied to the enumeration of Orientia tsutsugamushi organisms in cell culture using indirect immunofluorescence assay (IFA). The highest correlation (r = 0.984) was observed between manual counting methods and the ImageJ program (MaxEntropy threshold algorithm). This software-based methodology is cheaper, more standardised and better reproducible than a manual-based approach.
doi:10.1016/j.trstmh.2012.05.004
PMCID: PMC3449237  PMID: 22789674
ImageJ; Scrub typhus; Enumeration; Fluorescence; Orientia tsutsugamushi
22.  Evaluation of rk39 immunochromatographic test with Urine for diagnosis of Visceral leishmaniasis 
This study evaluates commercially available rK39 Immunochromatographic (ICT) strips using urine for diagnosis of visceral leishmaniasis (VL). Freshly collected urine and serum samples of 280 parasitologically confirmed VL patients and 66 endemic healthy control (EHC), 48 non-endemic healthy controls (NEHC) and 45 different diseases (DD) were tested with rK39 strips. The sensitivity of rK39 in urine were 96.4% while the specificity was low varying from 66.7% in EHC, 77.08% in NEHC to 62.2% in DD, With serum, sensitivity was 100% whereas the specificity was 100%, 92.4% and 95.55% for respective control group. In its present format, the ICT strips cannot be used for the diagnosis of VL using urine samples.
doi:10.1016/j.trstmh.2011.05.008
PMCID: PMC3163715  PMID: 21708392
rK39 ICT; Visceral leishmaniasis; Urine; diagnosis
23.  Seroepidemiological surveillance of Burkholderia pseudomallei in Bangladesh 
Melioidosis (Burkholderia pseudomallei infection) has yet to be demonstrated systematically in Bangladesh. A prospective, cross-sectional serological survey was conducted in 2010 at six Bangladeshi hospitals. Age, gender, occupation and residential address were recorded. Of 1244 patients, 359 (28.9%) were positive for B. pseudomallei by indirect haemagglutination assay. Farmers had an increased risk of seropositivity (risk ratio = 1.4, 95% CI 1.0–1.8; p = 0.03). There was no clear geographic clustering of seropositives. Melioidosis should be considered as a possible cause of febrile illness in Bangladesh. Further studies are needed to establish the incidence of clinical disease and distribution of environmental risk.
doi:10.1016/j.trstmh.2012.06.003
PMCID: PMC3424416  PMID: 22795754
Burkholderia pseudomallei; Melioidosis; Indirect haemagglutination assay; Seroprevalence; Epidemiological surveillance; Bangladesh
24.  Evaluation of the Standard Diagnostics Leptospira IgM ELISA for diagnosis of acute leptospirosis in Lao PDR 
The diagnostic utility of the Standard Diagnostics Leptospira IgM ELISA for detection of acute leptospirosis was assessed in febrile adults admitted in Vientiane, Laos. Using the cut-off suggested by the manufacturer [optical density (OD) ≥0.75], the assay demonstrated limited diagnostic capacity with a sensitivity of 95% and a specificity of 41% compared with the Leptospira microscopic agglutination test, which is the serological gold standard. However, re-evaluation of the diagnostic cut-off to an OD of 1.7 demonstrated improved diagnostic accuracy overall (sensitivity 70%; specificity 78%).
doi:10.1016/j.trstmh.2012.06.002
PMCID: PMC3464426  PMID: 22818757
Leptospira; ELISA; Diagnosis; Cut-off
25.  Consequences of poor maternal micronutrition before and during early pregnancy 
Summary
In developing countries, micronutrient deficiencies are common and associated with poor pregnancy outcomes, which may in turn have longer-term effects on human health. The peri-conceptional period represents a particularly sensitive window of feto-placental development, during which sub-optimal maternal micronutrition may have far-reaching consequences. The effects of targeted interventions during this period have been little studied in humans.
doi:10.1016/j.trstmh.2007.09.018
PMCID: PMC3428875  PMID: 17996910
micronutrient; vitamin; pregnancy; fetus; peri-conceptional; pre-conceptional

Results 1-25 (94)