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Characterization of tungiasis infection and morbidity using thermography in Kenya revealed higher disease burden during COVID-19 school closures

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Infectious Diseases of Poverty 2023年第2期12卷 120-121页

作者： Lynne Elson Abneel K.Matharu Naomi Riithi Paul Ouma Francis Mutebi Hermann Feldmeier Jürgen Krücken ulrike fillinger KEMRI-Wellcome Trust Research Programme Kilifi Kenya Centre for Tropical Medicine and Global Health Nuffield Department of Medicine University of Oxford Oxford UK International Centre of Insect Physiology and Ecology Human Health Theme Nairobi Kenya College of Veterinary Medicine Animal Resources and Biosecurity Makerere University Kampala Uganda Institute of Microbiology Infectious Diseases and Immunology Charité University Medicine Berlin Germany Institute for Parasitology and Tropical Veterinary Medicine Freie Universität Berlin Berlin Germany

Background Tungiasis is a neglected tropical skin disease caused by the sand flea Tunga penetrans.Female fleas penetrate the skin,particularly at the feet,and cause severe inflammation.This study aimed to characterize disease burden in two highly affected regions in Kenya,to test the use of thermography to detect tungiasis-associated inflammation and to create a new two-level classification of disease severity suitable for mapping,targeting,and monitoring interventions.Methods From February 2020 to April 2021,3532 pupils age 8–14 years were quasi-randomly selected in 35 public primary schools and examined for tungiasis and associated symptoms.Of the infected pupils,266 were quasi-randomly selected and their households visited,where an additional 1138 family members were examined.Inflammation was assessed using infra-red thermography.A Clinical score was created combining the number of locations on the feet with acute and chronic symptoms and infra-red hotspots.Results The overall prevalence of tungiasis among all the school pupils who were randomly selected during survey rounds 1 and 3 was 9.3%[95%confidence interval(CI):8.4–10.3].Based on mixed effects logistic models,the odds of infection with tungiasis among school pupils was three times higher in Kwale(coastal Kenya)than in Siaya[western Kenya;adjusted odds ratio(aOR)=0.36,95%CI:0.18–0.74];three times higher in males than in females(aOR=3.0,95%CI:2.32–3.91)and three times lower among pupils sleeping in a house with a concrete floor(aOR=0.32,95%CI:0.24–0.44).The odds of finding an infected person among the household population during surveys before the COVID-19 pandemic was a third(aOR=0.32,95%CI:0.19–0.53)of that when schools were closed due to COVID-19 restrictions and approximately half(aOR=0.44,95%CI:0.29–0.68)in surveys done after school re-opening(round 3).Infection intensity was positively correlated with inflammation as measured by thermography(Spearman’s rho=0.68,P<0.001)and with the clinical score(rho=0.86,P<0.001).Based on the two-level classificati

关键词： Tungiasis Neglected tropical diseases Thermography Morbidity Child COVID-19 Kenya

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Neurocognitive and mental health outcomes in children with tungiasis:a cross-sectional study in rural Kenya and Uganda

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Infectious Diseases of Poverty 2023年第6期12卷 98-98页

作者： Berrick Otieno Lynne Elson Abneel K.Matharu Naomi Riithi Esther Chongwo Khamis Katana Carophine Nasambu Francis Mutebi Herman Feldmeier Jürgen Krücken ulrike fillinger Amina Abubakar Kenya Medical Research Institute (KEMRI)-Wellcome Trust Programme Hospital Road Kilifi Kenya Centre for Tropical Medicine and Global Health Nuffield Department of Medicine University of Oxford Oxford UK International Centre of Insect Physiology and Ecology (ICIE) Human Health Theme Nairobi Kenya Institute for Parasitology and Tropical Veterinary Medicine Freie Universität Berlin Berlin Germany Institute for Human Development Aga Khan University Nairobi Kenya School of Veterinary Medicine and Animal Resources College of Veterinary Medicine Animal Resources and Biosecurity Makerere University Kampala Uganda Charité University Medicine Berlin Germany

Background Tungiasis,a neglected tropical parasitosis,disproportionately afects children.Few empirical studies have reported neurocognitive and mental health outcomes of children with ectoparasitic skin diseases like tungiasis.Pathophysiology of tungiasis suggests it could detrimentally afect cognition and behaviour.This study pioneered the investigation of neurocognitive and mental health outcomes in children with tungiasis.Methods This was a multi-site cross-sectional study including 454 quasi-randomly sampled school-children aged 8-14 from 48 randomly selected schools in two counties in Kenya and a district in Uganda.The participants were stratifed into infected and uninfected based on the presence of tungiasis.The infected were further classifed into mild and severe infection groups based on the intensity of the infection.Adapted,validated,and standardized measures of cognition and mental health such as Raven Matrices and Child Behaviour Checklist were used to collect data.Statistical tests including a multilevel,generalized mixed-efects linear models with family link set to identity were used to compare the scores of uninfected and infected children and to identify other potential risk factors for neurocognitive and behavioural outcomes.Results When adjusted for covariates,mild infection was associated with lower scores in literacy[adjustedβ(aβ)=−8.9;95%confdence interval(CI)−17.2,−0.6],language(aβ=−1.7;95%CI−3.2,−0.3),cognitive fexibility(aβ=−6.1;95%CI−10.4,−1.7)and working memory(aβ=−0.3;95%CI−0.6,−0.1).Severe infection was associated with lower scores in literacy(aβ=−11.0;95%CI−19.3,−2.8),response inhibition,(aβ=−2.2;95%CI−4.2,−0.2),fne motor control(aβ=−0.7;95%CI−1.1,−0.4)and numeracy(aβ=−3;95%CI−5.5,−0.4).Conclusions This study provides frst evidence that tungiasis is associated with poor neurocognitive functioning in children.Since tungiasis is a chronic disease with frequent reinfections,such negative efects may potentially impair their development and life achievements.

关键词： Tungiasis Tunga penetrans Neglected tropical disease Neurocognition Mental health School-aged children Africa

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National prevalence and risk factors for tungiasis in Kenya

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Infectious Diseases of Poverty 2023年第5期12卷 97-97页

作者： Lynne Elson Christopher Kamau Sammy Koech Christopher Muthama George Gachomba Erastus Sinoti Elwyn Chondo Eliud Mburu Miriam Wakio Jimmy Lore Marta Maia Ifedayo Adetifa Benedict Orindi Phillip Bejon ulrike fillinger Kenya Medical Research Institute-Wellcome Trust Research Programme Kilifi Kenya Nuffield Department of Medicine University of Oxford Oxford UK Department of Health Muranga Kenya Department of Health Kericho Kenya Department of Health Makueni Kenya Department of Health Nakuru Kenya Department of Health Samburu Kenya Department of Health Kilifi Kenya Department of Health Kajiado Kenya Department of Health Taita Taveta Kenya Department of Health Turkana Kenya London School of Hygiene and Tropical Medicine London UK International Centre for Insect Physiology and Ecology (Icipe) Nairobi Kenya

Background Tungiasis is a highly neglected tropical skin disease caused by the sand flea,Tunga penetrans,the female of which burrows into the skin,causing pain and itching.The disease occurs throughout South America and sub-Saharan Africa but there are few systematic data on national disease burdens.The tungiasis research community is keen to develop survey methods to fill this gap.Here we used a school-based,thorough examination method to determine the prevalence and risk factors for tungiasis in Kenya.Methods We conducted the first nationally representative survey of tungiasis,including nine counties covering the major ecological zones of Kenya.A stratified multistage random sampling was used to select 22 primary schools from each of the nine counties and to select up to 114 pupils aged 8 to 14 years in each school.Pupils were examined thoroughly for tungiasis.Two surveys were conducted,the first between May and July 2021 and the second between October 2021 and April 2023 when pupils were also interviewed for risk factors.Mixed effect logistic regression models were used to test associations of independent variables with tungiasis using the school as a random effect.Results The overall prevalence of tungiasis in the first survey was 1.35%[95%confidence interval(CI):1.15-1.59%],and 0.89%in the second survey.The prevalence ranged from 0.08%(95%CI:0.01-0.59%)in Taita Taveta county to 3.24%(95%CI:2.35-4.44%)in Kajiado county.Tungiasis infection was associated with county of residence,male sex[adjusted odds ratio(aOR)=2.01,95%CI:1.52-2.67],and lower age(aOR=0.81,95%CI:0.75-0.88).For the first time we demonstrate an association with attending public schools rather than private schools(aOR=5.62,95%CI:1.20-26.22)and lower socioeconomic status(aOR=0.10,95%CI:0.03-0.33).Using a rapid screening method of the top of feet only,would have missed 62.9%of all cases,78.9%of mild cases and 20.0%of severe cases.Conclusions Tungiasis is widely but heterogeneously distributed across Kenya.School-based surveys offer an efficient str

关键词： Tungiasis Neglected tropical diseases Prevalence Disease burden Kenya

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冠状动脉搭桥术中输注红细胞增加术后低心排心力衰竭的风险

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世界核心医学期刊文摘（心脏病学分册） 2007年第1期3卷 19-19页

作者： Surgenor S.D. DeFoe G.R. fillinger M.P. 朱启明 Dartmouth-Hitchcock Medical Center 1 Medical Center Dr Lebanon NH 03756 United StatesDr

背景:体外循环(CPB)中的血液稀释性贫血与冠状动脉搭桥术(CABG)术中死亡率增高有关。术中输注红细胞(RBC)对治疗贫血的影响尚不清楚。作者评估了CPB中贫血、RBC输注与低心排心力衰竭(LOF)风险的关系。方法和结果:资料来自于新英格兰北部... 详细信息

背景:体外循环(CPB)中的血液稀释性贫血与冠状动脉搭桥术(CABG)术中死亡率增高有关。术中输注红细胞(RBC)对治疗贫血的影响尚不清楚。作者评估了CPB中贫血、RBC输注与低心排心力衰竭(LOF)风险的关系。方法和结果:资料来自于新英格兰北部1996—2004年8004例单一CABG病例,术后出血或输血≥3U者除外。

关键词：冠状动脉搭桥术稀释性正性肌力药物新英格兰贫血者

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