Triatomines: Trypanosomatids, Bacteria, and Viruses Potential Vectors?

Triatominae bugs are the vectors of Chagas disease, a major concern to public health especially in Latin America, where vector-borne Chagas disease has undergone resurgence due mainly to diminished triatomine control in many endemic municipalities. Although the majority of Triatominae species occurs in the Americas, species belonging to the genus Linshcosteus occur in India, and species belonging to the Triatoma rubrofasciata complex have been also identified in Africa, the Middle East, South-East Asia, and in the Western Pacific. Not all of Triatominae species have been found to be infected with Trypanosoma cruzi, but the possibility of establishing vector transmission to areas where Chagas disease was previously non-endemic has increased with global population mobility. Additionally, the worldwide distribution of triatomines is concerning, as they are able to enter in contact and harbor other pathogens, leading us to wonder if they would have competence and capacity to transmit them to humans during the bite or after successful blood feeding, spreading other infectious diseases. In this review, we searched the literature for infectious agents transmitted to humans by Triatominae. There are reports suggesting that triatomines may be competent vectors for pathogens such as Serratia marcescens, Bartonella, and Mycobacterium leprae, and that triatomine infection with other microrganisms may interfere with triatomine-T. cruzi interactions, altering their competence and possibly their capacity to transmit Chagas disease.

A scoping review on the field validation and implementation of rapid diagnostic tests for vector-borne and other infectious diseases of poverty in urban areas.

BACKGROUND: Health personnel face challenges in diagnosing vector-borne and other diseases of poverty in urban settings. There is a need to know what rapid diagnostic technologies are available, have been properly assessed, and are being implemented to improve control of these diseases in the urban context. This paper characterizes evidence on the field validation and implementation in urban areas of rapid diagnostics for vector-borne diseases and other diseases of poverty. MAIN BODY: A scoping review was conducted. Peer-reviewed and grey literature were searched using terms describing the targeted infectious diseases, diagnostics evaluations, rapid tests, and urban setting. The review was limited to studies published between 2000 and 2016 in English, Spanish, French, and Portuguese. Inclusion and exclusion criteria were refined post hoc to identify relevant literature regardless of study design and geography. A total of 179 documents of the 7806 initially screened were included in the analysis. Malaria (n = 100) and tuberculosis (n = 47) accounted for the majority of studies that reported diagnostics performance, impact, and implementation outcomes. Fewer studies, assessing mainly performance, were identified for visceral leishmaniasis (n = 9), filariasis and leptospirosis (each n = 5), enteric fever and schistosomiasis (each n = 3), dengue and leprosy (each n = 2), and Chagas disease, human African trypanosomiasis, and cholera (each n = 1). Reported sensitivity of rapid tests was variable depending on several factors. Overall, specificities were high (> 80%), except for schistosomiasis and cholera. Impact and implementation outcomes, mainly acceptability and cost, followed by adoption, feasibility, and sustainability of rapid tests are being evaluated in the field. Challenges to implementing rapid tests range from cultural to technical and administrative issues. CONCLUSIONS: Rapid diagnostic tests for vector-borne and other diseases of poverty are being used in the urban context with demonstrated impact on case detection. However, most evidence comes from malaria rapid diagnostics, with variable results. While rapid tests for tuberculosis and visceral leishmaniasis require further implementation studies, more evidence on performance of current tests or development of new alternatives is needed for dengue, Chagas disease, filariasis, leptospirosis, enteric fever, human African trypanosomiasis, schistosomiasis and cholera.

Capacidad de respuesta y desafíos del sistema de salud cubano frente a las enfermedades transmisibles / Response capacity and challenges of the Cuban health system against communicable diseases / Capacidade de resposta e desafios do sistema de saúde cubano contra doenças transmissíveis

RESUMEN En el presente artículo se identifican rasgos distintivos y esenciales en las transformaciones del sistema de salud cubano que han permitido la erradicación y disminución de las tasas de incidencia de algunas enfermedades transmisibles a niveles inferiores a 0,1 por 100 000 habitantes. Los resultados obtenidos son consecuencia de la importancia otorgada a la prevención y control de estas enfermedades, así como a los riesgos y daños potenciales. La estructura y funcionamiento del subsistema de higiene y epidemiología y sus interrelaciones con el resto del sistema a partir de los diferentes modelos de prestación de servicios han constituido escenarios de integración permanentes para la toma de decisiones. Se eliminaron enfermedades como la poliomielitis, paludismo, difteria, tosferina, rubéola, parotiditis, meningitis posparotiditis, sarampión, fiebre amarilla, cólera, formas graves de la tuberculosis, rabia humana transmitida por caninos, leishmaniasis, enfermedad de Chagas, la transmisión vertical del virus de inmunodeficiencia humana, sífilis congénita y formas clínicas como el tétanos neonatal y el síndrome de rubéola congénita. Se hace énfasis en algunas enfermedades transmisibles y, en especial, en la respuesta social desarrollada contra la tuberculosis, la lepra, el sida y las enfermedades transmitidas por vectores. Se demuestra que el contexto sanitario actual revela aún desafíos para la sostenibilidad de los logros alcanzados en el país. Garantizar el mantenimiento de la cobertura universal con acceso de la población cubana a los servicios de salud será siempre un principio de la salud pública cubana.

ABSTRACT This article presents distinctive and essential features in the transformations of the Cuban health system that have allowed the eradication and reduction of the incidence rates of some communicable diseases at levels lower than 0.1 per 100 000 inhabitants. The results obtained are a consequence of the importance given to the prevention and control, as well as to the risks and potential damages, of these diseases. The structure and functioning of the hygiene and epidemiology subsystem and its interrelations with the rest of the system, based on the different models of service provision, have been permanent integration scenarios for decision making. Diseases such as poliomyelitis, malaria, diphtheria, whooping cough, rubella, mumps, post-mumps meningitis, measles, yellow fever, cholera, severe forms of tuberculosis, human rabies transmitted by canines, leishmaniasis, Chagas disease, vertical transmission of HIV, congenital syphilis and clinical forms such as neonatal tetanus and congenital rubella syndrome were eliminated. Some communicable diseases are analyzed in more detail and, in particular, the social response developed against tuberculosis, leprosy, AIDS and vector-borne diseases. However, the current health context presents challenges for the sustainability of the achievements made in the country. Assuring the maintenance of universal coverage with access of the Cuban population to health services will always be a principle of Cuban public health.

RESUMO No presente artigo se identificam características específicas e essenciais nas transformações do sistema de saúde cubano que permitiram a erradicação e redução das taxas de incidência de algumas doenças transmissíveis a níveis inferiores a 0,1 por 100 000 habitantes. Os resultados obtidos são uma conseqüência da importância dada à prevenção e controle dessas doenças, bem como aos riscos e danos potenciais. A estrutura e o funcionamento do subsistema de higiene e epidemiologia e suas inter-relações com o resto do sistema, com base nos diferentes modelos de prestação de serviços, constituíram cenários de integração permanente para a tomada de decisões. Foram eliminadas doenças como a poliomielite, malária, difteria, coqueluche, rubéola, parotidite, meningite pós-parotidite, sarampo, febre amarela, cólera, formas graves de tuberculose, raiva humana transmitida por cães, leishmaniose, doença de Chagas, a transmissão vertical do vírus da imunodeficiência humana, sífilis congênita e formas clínicas como o tétano neonatal e a síndrome da rubéola congênita. É dada ênfase a algumas doenças transmissíveis e, em particular, à resposta social desenvolvida contra a tuberculose, a hanseniasis, a AIDS e as doenças transmitidas por vetores. Mostra-se que o atual contexto de saúde revela desafios para a sustentabilidade das realizações no país. Garantir a manutenção da cobertura universal com acesso da população cubana aos serviços de saúde sempre será um princípio da saúde pública cubana.

A clausura enferma: petições para a saída do Convento da Ajuda no Rio de Janeiro para tratamento de doenças contagiosas, c. 1750-1780 / Disease in the cloisters: requests to leave Convento da Ajuda, Rio de Janeiro, for the treatment of contagious diseases, c. 1750-1780

Resumo O artigo discute os pedidos de freiras do Convento da Ajuda para deixar a clausura a fim de curar doenças contagiosas. O padecimento dessas doenças era considerado uma das poucas exceções para permitir a saída das freiras. As ordens femininas guardavam estritamente a clausura, condição necessária para manter o recato de virgens consagradas a Cristo. A documentação contém detalhes sobre as causas e as formas de transmissão das doenças, bem como sobre os tipos de tratamento para combatê-las. Por fim, os processos esclarecem os procedimentos adotados fora da clausura para as freiras não colocarem em risco o recolhimento e a honra, quando iam buscar em locais distantes o tratamento adequado para aquelas doenças.

Abstract This article discusses the requests submitted by nuns from Convento da Ajuda (Ajuda Convent) to leave their life of enclosure to receive treatment for contagious diseases. Disease was one of the few cases in which nuns were granted permission to leave. The female orders were strictly cloistered in order to preserve their purity as virgins consecrated to Christ. Extant documents detail the causes of the diseases, the ways they were transmitted, and the treatments used to fight them. These processes shed light on the procedures adopted outside the cloisters so that the nuns did not jeopardize their reclusion and honor when they went to distant places in search of treatment.

[Disease in the cloisters: requests to leave Convento da Ajuda, Rio de Janeiro, for the treatment of contagious diseases, c.1750-1780]. / A clausura enferma: petições para a saída do Convento da Ajuda no Rio de Janeiro para tratamento de doenças contagiosas, c.1750-1780.

This article discusses the requests submitted by nuns from Convento da Ajuda (Ajuda Convent) to leave their life of enclosure to receive treatment for contagious diseases. Disease was one of the few cases in which nuns were granted permission to leave. The female orders were strictly cloistered in order to preserve their purity as virgins consecrated to Christ. Extant documents detail the causes of the diseases, the ways they were transmitted, and the treatments used to fight them. These processes shed light on the procedures adopted outside the cloisters so that the nuns did not jeopardize their reclusion and honor when they went to distant places in search of treatment.

The armadillo as an animal model and reservoir host for Mycobacterium leprae.

Apart from humans, armadillos are the only known natural hosts of Mycobacterium leprae. They are well developed as hosts for in vivo propagation of M leprae and are advancing as models for studying the pathogenesis of leprosy and translational research. Armadillos are immunologically intact. They exhibit the full Ridley-Jopling spectrum of histopathologic responses to M leprae and uniquely manifest extensive neurological involvement that closely recapitulates human leprosy. In addition, free-ranging armadillos in some regions are known to harbor a naturally occurring infection with M leprae, and zoonotic transmission between armadillos and humans has been implicated in a large number of new case presentations. We review the role of the armadillo as a model for leprosy and reservoir for human infection.

Tuberculosis and leprosy in Italy: new skeletal evidence.

Tuberculosis (TB) and leprosy are infections caused by Mycobacteria. This paper documents new skeletal evidence in Italy from the Iron Age site of Corvaro (Central Italy; 5th century BCE) and the Roman site of Palombara (Central Italy; 4th-5th century CE), and briefly reviews the extant evidence for these infections in Italy. The skeletal evidence for TB in Italy is more ancient than for leprosy, and is more common. The oldest evidence for both mycobacterial diseases is in the North of Italy, but this could be by chance, even if biomolecular models suggest a land route from the East to central Europe, especially for leprosy.

Health concerns of Micronesian peoples.

Several states in the United States have been experiencing an influx of migrants from an area of the world that most people have only heard of when learning about the atomic bomb and World War II. This area is the former U.S. Trust Territory of Pacific Islands now called the Freely Associated States. At the end of World War II, the United States took possession of many of these islands and in 1948, the United States formally took over administration of the Marshalls, the Carolines, Palau, and the Northern Marianas islands. Collectively this area is known as Micronesia. Micronesians come from areas that have high prevalence of several communicable diseases and there is growing concern that Micronesian immigrants may enable the spread of infectious disease to the United States from Asia. Data concerning Hansen's disease and tuberculosis support this claim. According to data from the Hawai'i State Department of Health, a 5-year trend examining new cases of tuberculosis in Hawai'i identified that 65 out of 77 new cases came from the Freely Associated States of Micronesia. Presented is an overview of the health concerns and health status of the people from the Federated States of Micronesia.

A qualitative exploration of social contact patterns relevant to airborne infectious diseases in northwest Bangladesh.

In South Asia, the burden of infectious diseases is high. Socioeconomically and culturally-defined social interaction patterns are considered to be an important determinant in the spread of diseases that are transmitted through person-to-person contact. Understanding of the contact patterns in this region can be helpful to develop more effective control measures. Focus group discussions were used in exploring social contact patterns in northwest Bangladesh. The patterns were assessed for perceived relevance to the spread of airborne infectious diseases, with special focus on diseases, like leprosy and tuberculosis, in which the role of social determinants is well-recognized. Highly-relevant social contact patterns inside the home and the neighbourhood, across age and sex groups, were reported in all group discussions. Outside the home, women and girls reported relevant contacts limited to the close neighbourhood while men mentioned high relevant contacts beyond. This implies that, in theory, infectious diseases can easily be transmitted across age and sex groups in and around the home. Adult men might play a role in the transmission of airborne infectious diseases from outside this confined area since only this group reported highly-relevant social contacts beyond the home. This concept needs further exploration but control programmes in the South Asian region could benefit from considering differences in social contact patterns by gender for risk assessments and planning of preventive interventions.

Prevalence of infectious diseases of immigrant workers receiving health examinations at Rajavithi Hospital.

BACKGROUND: There are rapidly increasing numbers of immigrant workers coming for jobs in Thailand. These immigrant workers often harbor some serious communicable diseases. OBJECTIVE: To describe the prevalence of infectious diseases in these immigrant workers. MATERIAL AND METHOD: This is a retrospective study of immigrant workers who presented for check-ups needed for work permits at Rajavithi Hospital during 1 January 2008 to 31 December 2010. They were examined for serious infectious disease including pulmonary TB, elephantiasis, leprosy, syphilis and malaria. Their health status was analyzed. RESULTS: A total of 102,090 immigrant workers were examined. The majority of cases were female (58.4%) and 94.3% of the population was under the age of 40. Workers from Burma constituted the most cases, (78.9%), followed by workers from Laos (14.0%) and Cambodia (7.0%). The prevalence of infectious diseases in all workers was 1,612.3 cases per 100,000 population. Patients with pulmonary TB, elephantiasis, leprosy, syphilis and malaria were 1,112.7, 7.8, 4.9, 465.3 and 21.5 cases per 100,000 population respectively. The prevalence of TB in Burmese, Lao and Cambodian workers was 1,119.3, 885.9 and 1,493.2 cases per 100,000 population respectively. The prevalence of syphilis in Burmese, Lao and Cambodian workers was 467.8, 258.1 and 851.2 cases per 100,000 population respectively. CONCLUSION: Immigrant workers with infectious diseases were 1,612.3 cases per 100,000 population. Those harboring these serious transmitted diseases may be an important factor in these diseases becoming widespread in Thailand.

Noble goals, unforeseen consequences: control of tropical diseases in colonial Central Africa and the iatrogenic transmission of blood-borne viruses.

BACKGROUND: In southern Cameroon, 40-50% of individuals born before 1945 have antibodies against hepatitis C virus (HCV), suggesting massive iatrogenic transmission of at least one blood-borne virus in the region of the world where SIV(cpz) emerged into HIV-1. OBJECTIVE: To estimate the potential role of disease control programs that used intravenous (IV) drugs in the transmission of blood-borne viruses, especially HCV. Methods We reviewed, for 1921-1959, records of health services in Cameroun, Oubangui-Chari, Gabon and Moyen-Congo. We calculated the incidence of diseases whose treatment required the administration of IV drugs, and compared these with previously published data on HCV prevalence. RESULTS: Several IV drugs were used against African trypanosomiasis, leprosy, yaws and syphilis. However, yaws was the only disease whose incidence was high enough so that up to half of some birth cohorts could have acquired HCV. Yaws incidence varied dramatically between regions, and was often >200 per 1000 per year in southern Cameroon, where extremely high HCV prevalence was found. Yaws incidence peaked between 1935 and 1955, a period which coincided with the emergence of HCV and HIV. CONCLUSION: Age, geographical and temporal distributions of yaws suggest that the HCV epidemic in Cameroon was driven by campaigns against yaws (and, secondarily, syphilis) using arsenicals and other metallic drugs. The same interventions may have exponentially amplified other blood-borne viruses, including SIV(cpz)/HIV-1.

[Medicine and health in the Democratic Republic of Congo: from Independence to the Third Republic]. / Médecine et santé en République Démocratique du Congo: de l'Indépendance à la 3e République.

The birth and mortality rates in the Democratic Republic of Congo (DRC), a former Belgian colony, are high, i.e., 48.9/1000 and 17/1000 respectively. The DRC also has one of the highest maternal death rates in the world, i.e., 1289/100,000 live births. Health conditions have not improved since independence. Access to drinking water is limited, living conditions are poor, and food availability in households is low. The mean health services utilization rate in the DRC is estimated to be 0.15 visits/inhabitant/year. The incidence of transmissible diseases is rising. This increase is observed even for illnesses that were under control before independence such as sleeping sickness, onchocerciasis, leprosy, and tuberculosis. One the main causes of mortality and morbidity in the population is malaria that is responsible for the deaths of 150,000 to 250,000 children under the age of 5 every year. The HIV prevalence rate is 4.5% with 1.19 million persons with AIDS and 930,000 orphans whose parents died of AIDS. Other potentially epidemic diseases including bubonic plaque and Ebola hemorrhagic fever are serious threats. Non-transmissible diseases are also on the rise including diabetes, systemic arterial hypertension, cancer and neglected diseases such as sickle cell anemia. To meet these challenges, the country's health authorities have established a program called the Strategy for Reinforcement of the Health System (SRHS). One goal of the SRHS is to develop health zones in order to improve access to quality health care for the whole population.

Combating tropical infectious diseases: report of the Disease Control Priorities in Developing Countries Project.

Infectious diseases are responsible for >25% of the global disease toll. The new Disease Control Priorities in Developing Countries Project (DCPP) aims to decrease the burden of these diseases by producing science-based analyses from demographic, epidemiologic, disease intervention, and economic evidence for the purpose of defining disease priorities and implementing control measures. The DCPP recently reviewed selected tropical infectious diseases, examined successful control experiences, and defined unsettled patient treatment, prevention, and research issues. Disease elimination programs against American trypanosomiasis (Chagas disease), onchocerciasis, lymphatic filariasis, leprosy, trachoma, and measles are succeeding. Dengue, leishmaniasis, African trypanosomiasis, malaria, diarrheal diseases, helminthic infections, and tuberculosis have reemerged because of inadequate interventions and control strategies and the breakdown of health delivery systems. Application of technologies must be cost-effective and intensified research is essential if these and other scourges are to be controlled or eliminated in the 21st century.

Diseases in European historical populations and their effects on individuals and society.

Traditionally, populations are considered "historical" when first written evidences appear. Cultural development with all it's features--agricultural innovations and as a consequence--population growth, social specialisation and stratification, and finally--urbanisation trigger new environmental conditions, among them also in epidemiological situation, that have the feedback effects on the population and the individual. At this time only qualitative evaluations on many of questions can be presented. This paper is an attempt to synthesize available data on the following specific topics related to Medieval/Early Modern European population welfare: nutritional intake, malnutrition and famine; great epidemics and their consequences; spreading of specific infectious diseases (tuberculosis, syphilis, leprosy), which also had a great social resonance in those times, professional diseases. Considerations on their impact on demographical situation (life expectancy, birth rate), life quality and physical development and body build of an individual are also presented. Finally, possibilities for directional selection and impact on modern genetic diversity in Europe are discussed.

The European-American exchange.

The European-American exchange of infectious diseases was responsible for the demographic havoc of the native population in the New World after 1492. Prior to this date medical writers describe the presence in Spain of viral diseases like influenza, parotitis, smallpox, measles, poliomyelitis, and rabies; there were also rickettsiasis, diphtheria, salmonellosis, plague, tubercolosis, leprosy, malaria, scabies and tinea. In America, before European arrivals, there were no records of human viral diseases, though there were records of rickettsiasis, treponematosis--pinta, yaws and syphilis--leihsmaniasis, amibiasis and perhaps leprosy. With the discovery of America in 1492, Columbus's sailors were contaminated by yaws and spread this disease into Europe. In 1493 influenza, as a zoonosis, was introduced into Santo Domingo and was responsible for the annihilation of the natives of the Antilles in less than a quarter of a century; in 1518 smallpox was also introduced in Santo Domingo and then to the American continent by negro slaves: by the same means measles were introduced in 1531. The previous existence or introduction of other infectious diseases in America is also discussed.

Latent and chronic infections imported from Southeast Asia.

This review is intended to remind physicians of exotic infections with latency of at least one year that could cause illness in refugees or US citizens exposed in Southeast Asia. Tuberculosis, melioidosis, and leprosy are the major chronic infections of bacterial origin. Intestinal protozoa, roundworms, and flatworms are considered with regard to pathogenic, potential and duration of infection. Malaria, filariasis, and schistosomiasis may be seen on occasion. Paragonimiasis and Chinese liver fluke infections are more common and may simulate other less exotic diseases.