RESUMEN
Screening for depression may identify persons for HIV prevention services and to ensure linkage to care for ART and mental health. We assessed factors associated with depressive symptoms using multiple logistic regression among 15- to 29-year-old gay, bisexual or other men who have sex with men (MSM) and transgender women who have sex with men (TGW) attending HIV prevention clinics at Silom Community Clinic or Bangrak Hospital in Bangkok or Rainbow Clinic in Nakhon Sawan, Thailand. We defined depressive symptoms as a self-report of feelings of sadness that impacted daily life in the past one month. Among 192 MSM, 51 TGW, and 11 gender-questioning persons screened: 12.6% met the criteria for depression; 5.9% had new HIV diagnosis. Independently associated factors which increase the risk of depressive symptoms included: studying in a private school (AOR 7.17); experiencing any type of bullying (AOR 2.8); having a partner with HIV (AOR 4.1); and learning about the study from sources other than a friend (AOR 4.2). Given many youths had depressive symptoms, screening for depression and connection to mental health services would be beneficial in sexual health settings to meet the needs of HIV-vulnerable youth.
Asunto(s)
Depresión , Infecciones por VIH , Homosexualidad Masculina , Personas Transgénero , Humanos , Masculino , Tailandia/epidemiología , Adolescente , Infecciones por VIH/psicología , Infecciones por VIH/epidemiología , Personas Transgénero/psicología , Personas Transgénero/estadística & datos numéricos , Femenino , Adulto Joven , Depresión/epidemiología , Depresión/psicología , Adulto , Homosexualidad Masculina/psicología , Homosexualidad Masculina/estadística & datos numéricos , Minorías Sexuales y de Género/psicología , Factores de Riesgo , Parejas Sexuales/psicologíaRESUMEN
BACKGROUND: The first HPV vaccines licensed targeted two HPV types responsible for most cervical cancers. A 9-valent vaccine (9vHPV), targeting 5 additional types, was introduced in 2016 and is currently the only HPV vaccine available in the United States. Previous studies demonstrated high rates of HPV infection in Alaska Native (AN) women. We sought to measure prevalence of high risk HPV types in AN women undergoing colposcopy and to determine those preventable by vaccination. METHODS: For this cross-sectional study, we recruited women who were undergoing colposcopy for clinical indications at Alaska Native Medical Center to obtain cervical brush biopsy samples. Specimens were shipped to Atlanta, Georgia for DNA extraction, HPV detection, and typing using L1 PCR with type-specific hybridization to detect 37 HPV types. RESULTS: Four hundred eighty eight specimens from 489 women were tested. At least one HPV type was found in 458 (94%) specimens. Of 458 participants who were HPV positive, 332 (72%) had two or more types. At least one type targeted by 9vHPV was detected in 95% of participants with CIN 3 (21/22), 82% with CIN 2 (37/45), and 65% with CIN 1 (119/184). (p < 0.001) HPV 16 or 18 were detected in 77% (17/22) with CIN 3, 53% (24/45) with CIN 2, and 36% (67/184) with CIN 1. (p < 0.001). CONCLUSIONS: A substantial proportion of AN women attending colposcopy clinic had evidence of HPV 16/18 infection, as well as other high risk types targeted by 9vHPV. At least one 9vHPV type was detected in 62% of the participants overall, and 95% of participants with CIN3. AN women are expected to benefit from vaccination against HPV 16/18, and will have greater benefit from 9vHPV. Information from this study could be used to develop public health strategies to increase vaccine uptake, or to track HPV genotype prevalence over time.
RESUMEN
We describe incident human immunodeficiency virus (HIV) and syphilis trends in men who have sex with men (MSM) and transgender women (TGW) presenting for HIV voluntary counseling and testing (VCT) services and sexually transmitted infection (STI) management at the Silom Community Clinic, Bangkok, Thailand. Clients underwent rapid HIV testing and syphilis rapid plasma reagin (RPR) testing. For incidence analysis, we included clients with >1 follow-up visit. Initial negative HIV with subsequent positive HIV defined incident HIV infection; incident syphilis infection was defined as negative RPR followed by positive RPR (titer ≥1:8) and confirmatory anti- Treponema pallidum antibodies. Calculation of incidence using Poisson regression assumed a uniform probability distribution throughout the seroconversion interval. From 15 September 2005 to 31 December 2015, we tested 10,158 clients for HIV and 10,324 for syphilis. Overall, 7109 clients tested HIV-seronegative and contributed 7157 person-years (PY). Three-hundred forty-seven incident HIV infections resulted in an incidence rate of 4.8 per 100 PY (95% confidence interval [CI] 4.4-5.4). We found an inverted U-shape trend of HIV incidence over time with a peak of 6.4 per 100 PY in quarter 2/2011 ( p < 0.01) (Poisson with RCS function, p = 0.001). Overall, 8713 clients tested seronegative for syphilis and contributed 8623 PY. The incidence of syphilis infection was 4.4 per 100 PY (95% CI 3.9-4.8). Despite an apparent decline in HIV incidence among MSM and TGW attending VCT services, syphilis incidence rose and remained high. Evaluating temporal trends of HIV and syphilis incidence provides an opportunity to evaluate epidemic trajectories and target limited program funding. We recommend focused HIV and STI prevention interventions for MSM in Bangkok.
Asunto(s)
Infecciones por VIH/epidemiología , Homosexualidad Masculina/estadística & datos numéricos , Profilaxis Pre-Exposición , Sífilis/epidemiología , Personas Transgénero/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/prevención & control , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Factores de Riesgo , Asunción de Riesgos , Enfermedades de Transmisión Sexual/epidemiología , Sífilis/diagnóstico , Sífilis/prevención & control , Tailandia/epidemiología , Transexualidad , Adulto JovenRESUMEN
Membrane filtration, multiple tube fermentation (the standard methods) and Colilert are techniques available for assessing drinking water quality, but there are no published comparisons of Colilert to standard methods in a developing country laboratory. We reviewed the published literature on Colilert and standard methods and conducted a study to compare Colilert with membrane filtration for the detection and enumeration of total coliforms and fecal coliforms (Escherichia coli bacteria) using 35 stored drinking water samples from households in Abidjan, Côte d'lvoire. Our study results are consistent with previous published studies conducted in developed countries. Results from Colilert and membrane filtration correlated for both total coliforms (r2 = 0.81) and E. coli (r2 = 0.93). Colilert is an acceptable method to measure the presence and quantity of coliforms in water samples in a developing country setting.
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Microbiología del Agua , Abastecimiento de Agua/análisis , Côte d'Ivoire , Países en Desarrollo , Enterobacteriaceae , Escherichia coli , Heces/microbiología , Filtración/métodos , Contaminación del Agua/análisis , Abastecimiento de Agua/normasRESUMEN
Of 4,196 patients undergoing coronary angiography, 297 (7 percent) had left main coronary arterial narrowing. In 188 (4.5 percent) the narrowing was greater than or equal to 70 percent and in 109 (3 percent) it was between 50 and 69 percent. Three patients (1 percent) died at cardiac catheterization. Saphenous vein bypass graft surgery was performed in 267 patients with an operative mortality of 7 percent: in 179 patients the left main coronary narrowing was greater than or equal to 70 percent (operative mortality 9 percent), and in 88 between 50 and 69 percent (mortality rate 2 percent). There was an average of 2.6 grafts per patient. The course of these patients was followed up for 4 3/4 years. At 1 year there was a 92.2 percent survival rate. The rate of survival at 2, 3 and 4 3/4 years, was 91, 89 and 86 percent, respectively. After saphenous vein bypass graft surgery, 75 percent of patients are angina-free and 22.4 percent are in improved condition. Grafts were studied in 51 patients and 85 percent of 128 grafts were found to be patent. It appears that there is improvement in survival and a reduction of symptoms after saphenous vein bypass graft surgery in patients with left main coronary arterial narrowing.
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Puente de Arteria Coronaria/mortalidad , Enfermedad Coronaria/cirugía , Adulto , Anciano , Angiografía Coronaria , Enfermedad Coronaria/mortalidad , Enfermedad Coronaria/patología , Vasos Coronarios/patología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Arterias Mamarias/cirugía , Persona de Mediana Edad , Vena Safena/trasplanteRESUMEN
Liver abscesses are the most common manifestation of extraintestinal infection by Entamoeba histolytica. Involvement of other sites, including the peritoneum, pericardium, brain, or genitourinary tract, is unusual. We describe a case of inguinal necrotizing lymphadenitis caused by E histolytica. Our patient responded well to surgical drainage, metronidazole, and paramomycin therapy. A literature review of genitourinary and other uncommon sites of E histolytica infection is included.
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Entamoeba histolytica , Entamebiasis/complicaciones , Linfadenitis/microbiología , Adulto , Animales , Antiinfecciosos/uso terapéutico , Entamebiasis/tratamiento farmacológico , Ingle , Humanos , Inmunohistoquímica , Linfadenitis/tratamiento farmacológico , Linfadenitis/patología , Masculino , Metronidazol/uso terapéuticoRESUMEN
A patient with staphylococcal endocarditis of unknown valvular location and resistant to antibiotic therapy was studied in order to localize the site of infection prior to cardiac surger. The injection of contrast material into the right atrium visualized tricuspid vegetations which were confirmed at surgery. In such situations, forward angiographic studies constitute a safe, simple, and potentially diagnostic procedure which avoids the hazards of advancing a catheter across an infected valve.
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Angiografía , Endocarditis Bacteriana/diagnóstico por imagen , Atrios Cardíacos/diagnóstico por imagen , Infecciones Estafilocócicas/diagnóstico por imagen , Válvula Tricúspide/diagnóstico por imagen , Adulto , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Humanos , MasculinoRESUMEN
We analysed 528 genital self-collected swabs (SCS) from 67 HIV-1 and herpes simplex virus type-2 (HSV-2) co-infected women collected during the placebo month of a randomized crossover clinical trial of suppressive acyclovir in Chiang Rai, Thailand. In this first longitudinal study of HIV-1 and HSV-2 co-infected women using genital SCS specimens, we found frequent mucosal HIV-1 shedding. Overall, 372 (70%) swabs had detectable HIV-1 RNA with median HIV-1 viral load of 2.61 log(10) copies/swab. We found no statistically significant association between detectable HIV-1 RNA and HSV-2 DNA in the same SCS specimen (adjusted odds ratio [aOR] 1.40; 95% confidence intervals [CI], 0.78-2.60, P = 0.25). Only baseline HIV-1 plasma viral load was independently associated with genital HIV-1 RNA shedding (aOR, 7.6; 95% CI, 3.3-17.2, P < 0.0001). SCS may be useful for future HIV-1 and HSV-2 studies because this method allows for frequent genital sampling, and inclusion of genital sites other than the cervix.
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Genitales Femeninos/virología , Infecciones por VIH/virología , VIH-1/fisiología , Herpes Genital/virología , Herpesvirus Humano 2/fisiología , Esparcimiento de Virus , Adulto , Coinfección , Femenino , Infecciones por VIH/complicaciones , Herpes Genital/complicaciones , Humanos , Estudios Longitudinales , Persona de Mediana Edad , Reacción en Cadena en Tiempo Real de la Polimerasa , Tailandia , Adulto JovenAsunto(s)
Enfermedad Coronaria/fisiopatología , Corazón/fisiopatología , Adulto , Anciano , Angiocardiografía , Cateterismo Cardíaco , Gasto Cardíaco , Volumen Cardíaco , Cinerradiografía , Angiografía Coronaria , Enfermedad Coronaria/diagnóstico por imagen , Femenino , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Boidae , Conjuntiva/lesiones , Lesiones de la Cornea , Lesiones Oculares Penetrantes/etiología , Párpados/lesiones , Mordeduras de Serpientes/complicaciones , Adolescente , Animales , Antibacterianos , Córnea/patología , Córnea/cirugía , Quimioterapia Combinada/uso terapéutico , Lesiones Oculares Penetrantes/tratamiento farmacológico , Lesiones Oculares Penetrantes/cirugía , Humanos , Masculino , Agudeza VisualRESUMEN
We used molecular subtyping to investigate an outbreak of listeriosis involving residents of 24 US states. We defined a case as infection with Listeria monocytogenes serotype 4b yielding one of several closely related patterns when subtyped by pulsed-field gel electrophoresis. Patients infected with strains yielding different patterns were used as controls. A total of 108 cases were identified with 14 associated deaths and four miscarriages or stillbirths. A case-control study implicated meat frankfurters as the likely source of infection (OR 17.3, 95% CI 2.4-160). The outbreak ended abruptly following a manufacturer-issued recall, and the outbreak strain was later detected in low levels in the recalled product. A second strain was recovered at higher levels but was not associated with human illness. Our findings suggest that L. monocytogenes strains vary widely in virulence and confirm that large outbreaks can occur even when only low levels of contamination are detected in sampled food. Standardized molecular subtyping and coordinated, multi-jurisdiction investigations can greatly facilitate detection and control of listeriosis outbreaks.
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Brotes de Enfermedades , Contaminación de Alimentos , Enfermedades Transmitidas por los Alimentos/epidemiología , Enfermedades Transmitidas por los Alimentos/microbiología , Listeria monocytogenes/aislamiento & purificación , Listeriosis/epidemiología , Listeriosis/microbiología , Carne/microbiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Niño , Preescolar , Electroforesis en Gel de Campo Pulsado , Femenino , Microbiología de Alimentos , Humanos , Masculino , Persona de Mediana Edad , Embarazo , Estados Unidos/epidemiologíaRESUMEN
Streptomyces species are most widely known for their production of antimicrobial substances and, apart from mycetoma, have rarely been reported as a cause of infection. We describe a patient with early human immunodeficiency virus infection who presented with fever, cough, and nodular pulmonary infiltrates. Open lung biopsy revealed necrotic tissue and a sulfur granule; aerobic bacterial cultures yielded Streptomyces species. The patient was treated successfully with clarithromycin for 6 months. We review the clinical presentation and treatment of invasive streptomyces infections.
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Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Infecciones por Actinomycetales/diagnóstico , Neumonía Bacteriana/microbiología , Streptomyces/aislamiento & purificación , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Infecciones por Actinomycetales/tratamiento farmacológico , Adulto , Antibacterianos/uso terapéutico , Claritromicina/uso terapéutico , Humanos , Masculino , Neumonía Bacteriana/tratamiento farmacológicoRESUMEN
From 1969 through December 31, 1981, a total of 232 patients with an ejection fraction of 0.2 or less (normal 0.67) had myocardial revascularization. The in-hospital mortality in these patients decreased from 25 deaths in 82 patients (30%) from 1969 through 1972 to 10 deaths in 150 patients (7%) from 1973 through December 31, 1981. There was a 24% five-year survival for patients in congestive heart failure at the time of operation, a 40% survival at five years for patients successfully treated for failure before operation and a 60% five-year survival for those patients who had never been in failure. These results would appear to be better than those with cardiac transplantation, with neither the restrictions for operation nor the long-term immunotherapy required with cardiac transplantation.
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Enfermedad Coronaria/cirugía , Revascularización Miocárdica , Adulto , Anciano , Humanos , Persona de Mediana Edad , Revascularización Miocárdica/mortalidad , Pronóstico , Estudios Retrospectivos , Volumen SistólicoRESUMEN
During the past 5 years, 45 patients were operated on for mitral insufficiency due to coronary artery disease. Preoperatively, 33 had angina; 24 were in NYHA Class IV; and 21 were in Class III. The ejection fraction ranged from 0.1 to 0.7 (mean 0.40). The degree of mitral regurgitation ranged from Grade II/VI to Grade V/VI. Mitral repair was performed in 38 (84%) and replacement in seven (16%). At surgery, a ruptured papillary muscle or torn chordae tendineae with a dilated annulus were found in 21 patients and a dilated annulus only in 24. Seventy-six vein grafts and eight internal mammary anastomoses were performed. There were three hospital deaths (7%). Postoperative follow-up of 36 long-term survivors revealed symptomatic improvement in all but one patient. Twenty patients were in NYHA Class I, 15 in Class II, and one in Class III. In eight patients restudied, 17 of 18 vein grafts were patent (94%). Mitral regurgitation decreased from a mean of 2.7 to a mean of 0.6 (P less than 0.001). Average improvement in ejection fraction was 0.14, significant at P less than 0.01. Actuarial studies revealed an 80% survival rate at 5 years.
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Enfermedad Coronaria/complicaciones , Insuficiencia de la Válvula Mitral/etiología , Válvula Mitral/cirugía , Revascularización Miocárdica , Anciano , Enfermedad Coronaria/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/cirugíaRESUMEN
Sixty-nine patients over age 35 with severe valvular aortic stenosis were investigated for concomitant coronary artery disease. Forty (57.9%) had clinical angina pectoris. Sixteen (23.2%) had significant coronary occlusive disease by arteriography. Of those with angina, 13 patients (32.5) had significant coronary arterial obstruction, while in the pain-free group only (10.3%) had occlusive coronary disease. It is concluded that patients with severe aortic stenosis who are free of angina have only a small, but definite, chance of having significant coronary disease.
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Angina de Pecho/complicaciones , Estenosis de la Válvula Aórtica/complicaciones , Enfermedad Coronaria/complicaciones , Anciano , Angiocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores Sexuales , Estadística como AsuntoRESUMEN
OBJECTIVE: To survey knowledge, attitudes, and practices regarding water use and infant feeding in the Koumassi District of Abidjan, Côte d'Ivoire, and to evaluate the microbiologic quality of source and stored drinking water. DESIGN: Random-cluster household survey. METHODS: We randomly selected 20 clusters, each comprising six households with at least 1 child aged < or =3 years. In each household, we administered a questionnaire and collected source and stored drinking water samples and tested these for chlorine levels and for total coliform and fecal bacteria count ( Escherichia coli ). RESULTS: Municipal water was used for drinking in 112 (93%) of 120 households, and in 99 (83%), it was stored for later use. By 1 month of age, 97 (90%) of 108 infants given drinking water were given stored water for drinking. In 8 (66%) of 12 households where children were receiving artificial feeding, formula was prepared from municipal water without additional treatment. Stored water had lower levels of free chlorine than source water (median of 0.05 versus 0.2 mg/dl; p <.001), and E. coli was detected in 36 (41%) of 87 stored water samples and 1 (1%) of 108 source water samples ( p <.001). CONCLUSIONS: In the Koumassi District of Abidjan, where municipal water is widely available and of good quality, drinking water is stored in most households, is often contaminated with E. coli, and is given to children at a young age. If replacement feeding is to be more widely used to prevent postnatal transmission of HIV-1, communities using stored water need interventions to make stored water safer.
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Encuestas Epidemiológicas , Alimentos Infantiles/normas , Microbiología del Agua/normas , Abastecimiento de Agua/normas , Cloro/análisis , Recuento de Colonia Microbiana , Côte d'Ivoire/epidemiología , Diarrea/epidemiología , Diarrea/etiología , Escherichia coli/aislamiento & purificación , Composición Familiar , Infecciones por VIH/prevención & control , Humanos , Recién Nacido , Encuestas y CuestionariosRESUMEN
BACKGROUND: The emergence of resistance to antimicrobial agents within the salmonellae is a worldwide problem that has been associated with the use of antibiotics in livestock. Resistance to ceftriaxone and the fluoroquinolones, which are used to treat invasive salmonella infections, is rare in the United States. We analyzed the molecular characteristics of a ceftriaxone-resistant strain of Salmonella enterica serotype typhimurium isolated from a 12-year-old boy with fever, abdominal pain, and diarrhea. METHODS: We used pulsed-field gel electrophoresis and analysis of plasmids and beta-lactamases to compare the ceftriaxone-resistant S. enterica serotype typhimurium from the child with four isolates of this strain obtained from cattle during a local outbreak of salmonellosis. RESULTS: The ceftriaxone-resistant isolate from the child was indistinguishable from one of the isolates from cattle, which was also resistant to ceftriaxone. Both ceftriaxone-resistant isolates were resistant to 13 antimicrobial agents; all but one of the resistance determinants were on a conjugative plasmid of 160 kb that encoded the functional group 1 beta-lactamase CMY-2. Both ceftriaxone-resistant isolates were closely related to the three other salmonella isolates obtained from cattle, all of which were susceptible to ceftriaxone. CONCLUSIONS: This study provides additional evidence that antibiotic-resistant strains of salmonella in the United States evolve primarily in livestock. Resistance to ceftriaxone, the drug of choice for invasive salmonella disease, is a public health concern, especially with respect to children, since fluoroquinolones, which can also be used to treat this disease, are not approved for use in children.
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Bovinos/microbiología , Ceftriaxona , Resistencia a las Cefalosporinas , Cefalosporinas , Diarrea/microbiología , Infecciones por Salmonella/transmisión , Salmonella enterica/clasificación , Animales , Antibacterianos/administración & dosificación , Tipificación de Bacteriófagos , Ceftriaxona/uso terapéutico , Cefalosporinas/uso terapéutico , Niño , Electroforesis en Gel de Campo Pulsado , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Plásmidos/genética , Infecciones por Salmonella/tratamiento farmacológico , Infecciones por Salmonella/microbiología , Salmonella enterica/genética , Salmonella enterica/aislamiento & purificación , Serotipificación , Drogas Veterinarias , beta-Lactamasas/genética , beta-Lactamasas/aislamiento & purificaciónRESUMEN
CONTEXT: Ceftriaxone, an expanded-spectrum cephalosporin, is an antimicrobial agent commonly used to treat severe Salmonella infections, especially in children. Ceftriaxone-resistant Salmonella infections have recently been reported in the United States, but the extent of the problem is unknown. OBJECTIVES: To summarize national surveillance data for ceftriaxone-resistant Salmonella infections in the United States and to describe mechanisms of resistance. DESIGN AND SETTING: Case series and laboratory evaluation of human isolates submitted to the Centers for Disease Control and Prevention from 17 state and community health departments participating in the National Antimicrobial Resistance Monitoring System (NARMS) for enteric bacteria between 1996 and 1998. PATIENTS: Patients with ceftriaxone-resistant Salmonella infections between 1996 and 1998 were interviewed and isolates with decreased ceftriaxone susceptibility were further characterized. MAIN OUTCOME MEASURES: Exposures and illness outcomes, mechanisms of resistance. RESULTS: The prevalence of ceftriaxone-resistant Salmonella was 0.1% (1 of 1326) in 1996, 0.4% (5 of 1301) in 1997, and 0.5% (7 of 1466) in 1998. Ten (77%) of the 13 patients with ceftriaxone-resistant infections were aged 18 years or younger. The patients lived in 8 states (California, Colorado, Kansas, Massachusetts, Maryland, Minnesota, New York, and Oregon). Nine (82%) of 11 patients interviewed did not take antimicrobial agents and 10 (91%) did not travel outside the United States before illness onset. Twelve of the 15 Salmonella isolates with ceftriaxone minimum inhibitory concentrations of 16 microg/mL or higher were serotype Typhimurium but these isolates had different pulsed-field gel electrophoresis patterns. Thirteen of these 15 isolates collected between 1996 and 1998 were positive for a 631-base pair polymerase chain reaction product obtained by using primers specific for the ampC gene of Citrobacter freundii. CONCLUSIONS: Domestically acquired ceftriaxone-resistant Salmonella has emerged in the United States. Most ceftriaxone-resistant Salmonella isolates had similar AmpC plasmid-mediated resistance.