Tungíase

Tungiasis is a neglected parasitic skin disease caused by the permanent penetration of the female sand flea (also called jigger flea) Tunga penetrans into the skin of its host. After penetration, most commonly on the feet, the flea undergoes an impressing hypertrophy, and some days later the abdominal segments of the flea have enlarged up to the size of about 1 cm. The flea infestation is associated with poverty and occurs in many resource-poor communities in the Caribbean, South America and Africa. In this review, a historical overview on tungiasis is given. The natural history, pathology, epidemiology, diagnosis, therapy and control of the parasitic skin disease are discussed. It is concluded that tungiasis is an important parasitosis causing considerable morbidity in affected populations. Future studies are needed to increase the knowledge on the biology, pathophysiology, epidemiology, therapy and control of the ectoparasite.A tungíase é uma ectoparasitose negligenciada causada pela penetração permanente da pulga Tunga penetrans (também chamada de bicho de pé) na pele de seu hospedeiro. Depois da penetração, mais comumente localizada nos pés, a pulga se hipertrofia, e alguns dias depois seus segmentos abdominais atingem o diâmetro de até 1 cm. A infestação pela pulga está associada à pobreza e ocorre em muitas comunidades economicamente desfavorecidas no Caribe, na América do Sul e na África. Nesta revisão, é apresentada uma visão histórica da tungíase. A história natural, patologia, epidemiologia, diagnóstico, terapia e controle dessa ectoparasitose são discutidos. Conclui-se que a tungíase é uma importante parasitose causadora de morbidade considerável em populações afetadas. Estudos futuros serão necessários para aumentar o conhecimento sobre a biologia, patofisiologia, epidemiologia, terapia e controle do ectoparasita

Tungiasis Infestation in Tanzania.

Tungiasis is caused by the jigger flea Tunga penetrans. We describe a case of severe infestation from Kigoma region, Western Tanzania. A 19-year-old male with epilepsy and mental disability presented with ulcerated and inflamed toes. Clinical examination revealed the presence of approximately 810 embedded jigger fleas on the feet, and another 60 lesions on the hands. The patient presented with fissures on the feet, hands and soles. He had difficulty walking and erythematous, oedematous, ulcerated and inflamed skin around the feet. Living conditions were precarious. The patient was assisted to extract the embedded fleas and his feet were washed with disinfectants. Oral antibiotics were given. The case shows that the disease may reach high parasite loads in Tanzanian individuals, with consequently severe pathology. There have been single reports of returning tourists from Tanzania with tungiasis, but the epidemiological situation and the geographic occurrence of the disease in this country are not known. Systematic studies are needed to increase knowledge on the epidemiological situation of tungasis in Tanzania and to identify endemic areas

HIV, appendectomy and postoperative complications at a reference hospital in Northwest Tanzania: cross-sectional study

Background\ud Appendicitis is a frequent surgical emergency worldwide. The present study was conducted to determine the prevalence of HIV, and the association of infection with clinical, intraoperative and histological findings and outcome, among patients with appendicitis.\ud Methods\ud We performed a cross sectional study at Weill-Bugando Medical Centre in northwest Tanzania. In total, 199 patients undergoing appendectomy were included. Demographic characteristics of patients, clinical features, laboratory, intraoperative and histopathological findings, and HIV serostatus were recorded.\ud Results\ud In total, 26/199 (13.1%) were HIV-seropositive. The HIV-positive population was significantly older (mean age: 38.4 years) than the HIV-negative population (25.3 years; p < 0.001). Leukocytosis was present in 87% of seronegative patients, as compared to 34% in seropositive patients (p = 0.0001), and peritonitis was significantly more frequent among HIV-positives (31% vs. 2%; p < 0.001). The mean (SD) length of hospital stay was significantly longer in HIV-positives (7.12 ± 2.94 days vs. 4.02 ± 1.14 days; p < 0.001); 11.5% of HIV patients developed surgical site infections, as compared to 0.6% in the HIV-negative group (p = 0.004).\ud Conclusion\ud HIV infections are common among patients with appendicitis in Tanzania, and are associated with severe morbidity, postoperative complications and longer hospital stays. Early diagnosis of appendicitis and prompt appendectomy are crucial in areas with high prevalence of HIV infection. Routine pre-test counseling and HIV screening for appendicitis patients is recommended to detect early cases who may benefit from HAART

Intestinal schistosomiasis associated with intussusception: a case report

We report a case of intestinal schistosomiasis associated with iliocaecal intussusception resulting from obstructions of the terminal part of the ileum by schistosome egg-induced fibrosis. A 7-year-old boy presented with the history of abdominal pain and difficulties in passing stool for two months. Ultrasound examination revealed doughnut signs characterized with multiple concentric rings at the lateral abdomen, and the bowel loop appeared distended. Exploratory laparatomy confirmed intussusception of the terminal part of the ileum into the caecum, extending to the ascending colon. Hemicolectomy and end-to-end iliocolostomy was performed. Histological examination of the resected bowel revealed Schistosoma mansoni eggs within the mucosa, submucosa of the ileum, caecum and ascending colon, granulomatous inflammation with foreign body giant cells accompanied by fibrosis and eosinophilic infiltrate into the mucosa. Postoperatively, the patient recovered well. There may have been a synergistic effect of schistosomiasis with other underlying conditions, leading to intussusception. In conclusion, it is important to consider S. mansoni infection as a differential diagnosis for intestinal obstruction in endemic areas

Hansen's disease in children under 15 years old in the state of Tocantins, Brazil, 2001-2012: epidemiological patterns and temporal trends

Introduction: Tocantins is the most hyperendemic state for leprosy in Brazil. Objective: To describe the epidemiological characteristics and temporal trends of leprosy indicators in children under 15 years old in Tocantins between the years of 2001 and 2012. Methodology: Data analysis of the Notification of Injury Information System (SINAN). New cases under the age of 15 have been included in the state. The indicators were calculated and the temporal trends were analyzed through the join-point regression. Results: There were 1,225 cases in children, mean age of 10.8 years, and male predominated (52%). The mode of detection by spontaneous demand prevailed (55.8%) and more than 9% had some physical disability. Detection in < 15 years was significantly increased between 2001 and 2008 (anual percent change - APC = 3.8%; confidence interval of 95% - 95%CI 0.1 - 7.6), and showed significant decline between 2008 and 2012 (APC = -9.4%; 95%CI -17.2 - -0.8). There was stability for the detection of grade 2 cases (APC = 4.2%; 95%CI -6.7 - 16.3), proportion of grade 2 cases (APC = 4.1%; 95%CI 6.7 - 16.3), proportion of grade 1 cases (APC = 1.3%; 95%CI -6.2 - 9.3), multibacillary ratio (APC = 2.9%; 95%CI -1.7 - 7.7), and proportion of paucibacillary (APC = 2.9%; 95%CI -1.7 - 7.7). Conclusion: Leprosy remains an important public health problem in Tocantins, with active transmission and persistence of transmission foci. The stability of the indicators points out the permanence of the late diagnosis and the repressed demands

Trends and spatial patterns of mortality related to neglected tropical diseases in Brazil

We analysed nationwide trends and spatial distribution of NTD-related mortality in Brazil. We included all death certificates in Brazil from 2000 to 2011, in which NTDs were recorded as any causes of death. A total of 100,814/12,491,280 (0.81%) death certificates were identified, which mentioned at least one NTD. Age-adjusted NTD-related mortality rates showed a significant decrease over time (annual percent change [APC]: − 2.1%; 95% CI: − 2.8 to − 1.3), with decreasing mortality rates in the Southeast, South, and Central-West regions, stability in the Northeast region, and increase in the North region. We identified spatial and spatiotemporal high-risk clusters for NTD-related mortality in all regions, with a major cluster covering a wide geographic range in central Brazil. Despite nationwide decrease of NTD-related mortality in the observation period, regional differences remain, with increasing mortality trends especially in the socioeconomically disadvantaged regions of the country. The existence of clearly defined high-risk areas for NTD-related deaths reinforces the need for integrated prevention and control measures in areas with highest disease burden

ZIKATracker: a mobile app for reporting cases of ZIKV worldwide

We have developed a mobile App called ZIKATracker (zikatracker.net) to voluntarily be used to report ZIKV cases on a public or private level. As the Zika virus (ZIKV) infection zones are rapidly expanding across South, Central, and North America, and reports have emerged linking ZIKV infection with developmental defects and neurological sequelae, reporting the movement and sequelae of ZIKV is essential. ZIKATracker is a multi-lingual App (English, French, Spanish, and Portuguese) freely available to anyone worldwide wishing to report a suspected or confirmed case of Zika virus and related symptoms. Knowledge gained from the use of this App will help direct the implementation of mosquito control measures in needed areas, bring aid to those affected by the Zika virus, and understand the movement and sequelae of ZIKV as it spreads through communities and across continents

Knowledge, attitudes and practices regarding malaria and mosquito net use among women seeking antenatal care in Iringa, south-western Tanzania

To improve control measures against malaria, Tanzania has increased the distribution of free and subsidized insecticide-treated mosquito nets (ITNs) to pregnant women. However, data on knowledge, attitudes and practices of these women regarding malaria are scarce. This study was carried out to describe knowledge, attitudes and practices towards malaria, mosquito net ownership and use among women seeking antenatal care at Iringa Regional Hospital in south-western Tanzania. The study involved women attending the antenatal clinic of the hospital. A pre-tested structured questionnaire was applied to collect information on socio-demographic characteristics, mosquito net ownership and use, as well as knowledge, attitudes and practices about malaria and its control. Among the 222 pregnant women included, 173 (78%, 95%CI, 72-84.2) owned a mosquito net, and 150 (68%, 95%CI, 61-75) reported to sleep always under a mosquito net. The use of mosquito nets was mentioned by 142 (64%, 95%CI, 56.2-72). Of the 46 women who did not own a mosquito net, seven (15.2%) reported cost as the main obstacle for owning one. About 53% (95%CI, 44-62) preferred to use mosquito nets they bought rather than the one provided for free. Several factors such as gravidity, fearing of getting malaria, knowledge on the cause, marital status, and ways used to prevent malaria were significantly associated with mosquito net ownership (all

Temporal trends of leprosy in a Brazilian state capital in Northeast Brazil: epidemiology and analysis by joinpoints, 2001 to 2012

The objective of this study was to characterize epidemiological and temporal trends of leprosy in the city of Fortaleza, Ceará, Brazil, from 2001 to 2012. A total of 9,658 new cases were reported. Their temporal trend was analyzed by the jointpoint regression model. The overall detection rate showed a declining trend, with annual percent change (APC) of ‑4.0 and 95% confidence interval (95%CI) ‑5.6 – ‑2.3. The detection rate in children under 15 years of age (APC = ‑1.4; 95%CI ‑5.4 – 2.8) and the detection rate of disability grade 2 (APC = ‑0.8; 95%CI ‑4.5 – 3.1) were stable. The proportion of female patients was descending (APC = ‑1,5; 95%CI ‑2.3 – ‑0.8). The proportion of multibacillary cases from 2005 to 2012 (APC = 1.4; 95%CI 0.6 – 2.3) and among them, lepromatous cases from 2004 to 2012 (APC = 6.0; 95%CI 3.4 – 8.6) were increasing. There was stability in the proportion of cases with grade 1 (APC = 1.4; 95%CI ‑0.9 – 3.7) and grade 2 disability (APC = 3.7; 95%CI ‑0.1 – 7.8). Despite the trend towards a reduction in detection, the disease transmission persists in the city. The data also suggest late diagnosis