Image and diagnosis. Cutaneous larva migrans (CLM).
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Animals↗
Biomedical subjects
J F Lindo
Publications and source records attributed to J F Lindo.
Pathogenic Acanthamoeba strains from water sources in Jamaica, West Indies.
In 2004, samples of tap water and of river and sea water associated with human activities were collected in Jamaica, West Indies, and checked for free-living Acanthamoeba. The morphologies of the cysts and trophozoites observed and the results of PCR-based amplifications with a genus-specific primer pair were used to identify the Acanthamoeba isolates. The potential of each isolate as a human pathogen was then evaluated using thermotolerance and osmotolerance assays and two PCR-based assays for Acanthamoeba pathogenesis. Acanthamoeba were identified in 36.1%, 26.4% and 49.6% of the tap-, river- and sea-water samples collected, respectively. Pathogenic potential was shown by 60.0% of the Acanthamoeba strains isolated from tap water, 68.4% of the strains from river water, and 40.4% of the seawater strains. Sequencing of ribosomal DNA revealed the T1, T2, T4, T5, T7, T9 and T11 genotypes. Isolates of the T4 genotype were collected from tap, rain and sea water and, as expected, exhibited the most pathogenic traits; most were osmotolerant, thermotolerant and expressing extracellular serine protease. This is the first study of the occurrence and distribution of Acanthamoeba in water in the West Indies, and the results confirm the presence of potentially pathogenic strains in Jamaica.
Acanthamoeba↗
Fatal autochthonous eosinophilic meningitis in a Jamaican child caused by Angiostrongylus cantonensis.
A fatal case of infection with Angiostrongylus cantonensis is reported in a 14-month-old Jamaican boy. Although infection with Angiostrongylus was not considered initially, sections of multiple worms were observed in the brain and lungs at autopsy and confirmed the infection. This is the first reported fatality due to this infection in the Western Hemisphere, and follows shortly after an outbreak of eosinophilic meningitis among a group of travelers to Jamaica. The source of infection in this case could not be determined.
Angiostrongylus cantonensis↗
Failure to detect Angiostrongylus cantonensis in rats in Barbados.
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Angiostrongylus cantonensis↗
Intestinal parasites among young children in the interior of Guyana.
Intestinal parasites contribute greatly to morbidity in developing countries. While there have been several studies of the problem in the Caribbean, including the implementation of control programmes, this has not been done for Guyana. The aim of this study was to determine the prevalence of intestinal parasites among young children in a town located in the interior of Guyana. Eighty-five children under the age of 12 years were studied prospectively for intestinal parasites in Mahdia, Guyana. Stool samples were transported in formalin to the Department of Microbiology, The University of the West Indies, Jamaica, for analysis using the formalin-ether concentration and Ziehl-Neelsen techniques. Data on age and gender of the children were recorded on field data sheets. At least one intestinal parasite was detected in 43.5% (37/85) of the children studied and multiple parasitic infections were recorded in 21.2% (18/85). The most common intestinal helminth parasite was hookworm (28.2%; 24/85), followed by Ascaris lumbricoides (18.8%; 16/85) and then Trichuris trichuria (14.1%; 12/85). Among the protozoan infections Giardia lamblia was detected in 10.5% (9/85) of the study population while Entamoeba histolytica appeared rarely. All stool samples were negative for Cryptosporidium and other intestinal Coccidia. There was no predilection for gender with any of the parasites. The pattern of distribution of worms in this area of Guyana was unlike that seen in other studies. Hookworm infection was the most common among the children and a large proportion had multiple infections. The study established the occurrence and prevalence of a number of intestinal parasites in the population of Guyana. This sets the stage for the design and implementation of more detailed epidemiological studies.
Child↗
Investigations of the epidemiology of infections with hepatitis A virus in Jamaica.
Between January 1995 and August 1998, a study was conducted to elucidate the epidemiology of hepatitis A virus (HAV) in Jamaica. Participants were recruited from six sites across the island. The potential risk factors for transmission which were studied included age of the individual, gender, residence (urban v. rural area), sanitary facilities (flush toilet v. pit) and source of domestic water (indoor plumbing v. other). There were 128 male subjects and 211 female, aged 3-90 years. The mean ages of the males and females were 24.9 and 25.6 years, respectively. The seroprevalence of HAV in the study population, estimated by ELISA, was 59.9%. Logistic regression indicated that age (P < 0.001) and source of domestic water (P = 0.006) were the major contributors to exposure to HAV. The rate of exposure to the virus was seen to increase with age. By the age of 10 years, 30% of children had been exposed, and almost 100% of the oldest subjects were seropositive. Rates of exposure to HAV were higher among households which had external sources of water, including standpipes, rivers and tanks, than those with indoor plumbing. Although the seroprevalence of HAV in Jamaica is similar to that seen in developing countries, the age-related pattern of exposure mirrors the pattern seen in developed countries.
Adolescent↗
Dialysis adequacy at two haemodialysis units in Jamaica.
A prospective study on adequacy of dialysis was conducted at the haemodialysis units of Kingston Public Hospital (KPH) and the University Hospital of the West Indies (UHWI). Dialysis adequacy was better at KPH and morbidity, as measured by patient admission days, was increased at UHWI. Diabetics had a lower mean serum albumin and urea reduction ratio (URR) than non-diabetics. Multiple regression analyses revealed that age of patient (F = 5.30; p = 0.0241) and hospital (F = 7.85; p = 0.007) were the variables significantly associated with serum albumin level when the effect of other variables was controlled (F = 2.12; p = 0.34). Similar analyses showed that the hospital at which dialysis was done was the only factor which accounted for significantly higher URR, with KPH having higher rates (F = 13; p = 0.006). The differences between hospitals necessitate further investigations, explanations and intervention strategies. The study provides opportunities for improving patient care and for dialysis health care professionals to assess clinical performance measures and reduce variation between dialysis centres.
Adolescent↗
A sonographic study of kidney dimensions in a sample of healthy Jamaicans.
A sonographic study of 49 randomly selected healthy adult Jamaicans was conducted to establish a guide for renal dimensions in the population. The mean length of the right kidney was 9.7 +/- 0.7 cm and the left 10 +/- 0.7 cm. The left kidney was longer than the right in the overall group and in males. There was no difference in width between right or left kidneys in the group as a whole or within either gender. There was a significant association between the weight of males and width of their kidneys; however, this association was not seen in females. The lone association between weight of participants and renal length occurred in females and only with respect to the left kidney. Lengths and widths of kidneys were not associated with height in either gender. Renal surface area (RSA) was similar between the genders and also between right and left kidneys. Similarly, there was no significant association between renal length and body surface area (BSA) overall or within the genders. Renal index (RI) which is more reliable at assessing renal parenchymal mass than renal length alone was 20.92 and 22.86 for the right and left kidneys, respectively, in males. Similarly, RI for the right and left kidneys in females was 23.76 and 25.54, respectively.
Adolescent↗
Dengue in Guyana.
There have been dramatic increases in dengue fever (DF) and dengue haemorrhagic fever in South America. Guyana has reported less than five cases per year for most of the past decade. We evaluated patients in a clinic in Georgetown, Guyana, over 2 days and found evidence of 50 cases of dengue infection.
Adolescent↗
L3 antigen-specific antibody isotype responses in human strongyloidiasis: correlations with larval output.
Autoinfective strongyloidiasis is potentially fatal, yet the majority of infected individuals harbour asymptomatic and chronic infections. The role of humoral responses in modulating autoinfection was assessed by examining antibody isotype responses to filariform larval antigens amongst chronically infected ex-Far East Prisoners of War (exFEPOWs) with longstanding (> 30 years) infection. Serum immunoglobulin (Ig)G1, IgG4, IgE and IgA responses to whole Strongyloides stercoralis L3 extracts and their constituent antigenic components were characterized by ELISA and quantitative immunoblotting. Comparison of two groups of S. stercoralis infected exFEPOWs with and without detectable larvae in stool demonstrated novel trends. Significantly enhanced recognition of six immunodominant antigenic components by IgA was associated with undetectable larval output, as was enhanced IgE recognition of several components. Additionally, IgE and IgG4 exhibited parallel antigen recognition patterns. These findings are consistent with roles for IgA in modulating larval output, for IgE in regulating autoinfection, and for IgG4 in blocking IgE-mediated responses in human strongyloidiasis.
Animals↗
Seroepidemiology of Helicobacter pylori infection in a Jamaican community.
We researched epidemiologic associations between environmental and demographic factors and prevalence of Helicobacter pylori infection in a suburban Jamaican community. Using a clustered sampling technique, 22 domestic yards enclosing 60 separate households were randomly selected from a local community. All household members (n = 346) were invited to participate following informed consent; the overall compliance rate was 58.9%. A commercial enzyme immunoassay (HMáCAP) was used to detect IgG antibodies raised against H. pylori. Environmental and demographic information was obtained by questionnaire. The seroprevalence of H. pylori was 69.9% (n = 202). Analysis of the independent variables revealed three major components: Component 1 described, collectively, good personal hygiene and sanitation, indoor water supply and absence of straying animals in the peridomestic area; Component 2 included older age, good personal hygiene and large yard size; Component 3 the presence of domestic animals (cats and dogs) and, again, large yard size. These three complexes explained 42.2% of the variability in the data set. Logistic regression showed that Components 2 and 3 were independently associated with H. pylori seropositivity, indicating that a combination of demographic, environmental and zoonotic factors is involved in the spread of H. pylori infections at the tropical community level.
Adolescent↗
Rubella susceptibility in Jamaican women, 1996.
The 1995 rubella outbreak in Jamaica indicated a need to survey the susceptibility rate in Jamaican antenatal women at risk. In this 1996 study, 389 women in the reproductive age group were investigated for rubella antibodies. In the public sector urban group (A), rubella susceptibility was 20.2%, while in a private sector urban clinic (B) practising routine rubella surveillance and recommending postpartum immunization in seronegatives, the susceptibility rate was 13.8%. The latter rate was significantly lower than that in the rural group (C) (35.9%; p < 0.001). The overall susceptibility rate was 21.3%. Rubella susceptibility has improved overall in women of childbearing age compared with levels in the prevaccine year of 1968. A significant thrust in rubella prevention will still be required before the next rubella epidemic in order to reduce the risk of congenital rubella syndrome.
Adolescent↗
Immunomodulatory effects of concurrent HTLV-I infection in strongyloidiasis.
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Adjuvants, Immunologic↗
Evaluation of the OptiMAL test for rapid diagnosis of Plasmodium vivax and Plasmodium falciparum malaria.
The development of rapid and specific diagnostic tests to identify individuals infected with malaria is of paramount importance in efforts to control the severe public health impact of this disease. This study evaluated the ability of a newly developed rapid malaria diagnostic test, OptiMAL (Flow Inc., Portland, Oreg.), to detect Plasmodium vivax and Plasmodium falciparum malaria during an outbreak in Honduras. OptiMAL is a rapid (10-min) malaria detection test which utilizes a dipstick coated with monoclonal antibodies against the intracellular metabolic enzyme parasite lactate dehydrogenase (pLDH). Differentiation of malaria parasites is based on antigenic differences between the pLDH isoforms. Since pLDH is produced only by live Plasmodium parasites, this test has the ability to differentiate live from dead organisms. Results from the OptiMAL test were compared to those obtained by reading 100 fields of traditional Giemsa-stained thick-smear blood films. Whole-blood samples were obtained from 202 patients suspected of having malaria. A total of 96 samples (48%) were positive by blood films, while 91 (45%) were positive by the OptiMAL test. The blood films indicated that 82% (79 of 96) of the patients were positive for P. vivax and 18% (17 of 96) were infected with P. falciparum. The OptiMAL test showed that 81% (74 of 91) were positive for P. vivax and 19% (17 of 91) were positive for P. falciparum. These results demonstrated that the OptiMAL test had sensitivities of 94 and 88% and specificities of 100 and 99%, respectively, when compared to traditional blood films for the detection of P. vivax and P. falciparum malaria. Blood samples not identified by OptiMAL as malaria positive normally contained parasites at concentrations of less than 100/microl of blood. Samples found to contain P. falciparum were further tested by two other commercially available rapid malaria diagnostic tests, ParaSight-F (Becton Dickinson, Cockeysville, Md.) and ICT Malaria P.f. (ICT Diagnostics, Sydney, Australia), both of which detect only P. falciparum. Only 11 of the 17 (65%) P. falciparum-positive blood samples were identified by the ICT and ParaSight-F tests. Thus, OptiMAL correctly identified P. falciparum malaria parasites in patient blood samples more often than did the other two commercially available diagnostic tests and showed an excellent correlation with traditional blood films in the identification of both P. vivax malaria and P. falciparum malaria. We conclude that the OptiMAL test is an effective tool for the rapid diagnosis of malaria.
Humans↗
Increased prevalence of Plasmodium falciparum malaria in Honduras, Central America.
We report on our investigation of a malaria outbreak in Honduras, Central America, in January 1997. We tested 202 patients with fever and chills using thin and thick blood film microscopy. Sixteen patients lived in the city and the rest lived in rural areas. A total of 95 samples (47%) were positive for malaria parasites. Seventy-nine percent (63/80) of the rural patients were infected with Plasmodium vivax and 21% (17/80) were infected with P. falciparum. In the urban area, all 15 infected patients had P. vivax malaria and none showed evidence of P. falciparum. Since previous reports indicate that falciparum malaria accounts for only 2% of the overall malaria infections in Honduras, the results reported here suggest that there is a dramatic increase in falciparum malaria in the area of Honduras investigated in this study.
Disease Outbreaks↗
Intestinal parasitic infections in human immunodeficiency virus (HIV)-positive and HIV-negative individuals in San Pedro Sula, Honduras.
Honduras has at least five-times more human immunodeficiency virus (HIV)-infected individuals than any other country in Central America. The relationship between HIV status and the presence of intestinal parasites in this part of the world is unknown. This study presents the results from a prospective, comparative study for the presence of parasites in 52 HIV-positive and 48 HIV-negative persons in San Pedro Sula, Honduras. Infection with HIV was determined by microagglutination and confirmed by Western blot analysis. Parasites were detected in stools using formalin-ether concentration, and Kinyoun and trichrome staining. Age, sex, and clinical state of HIV infection were recorded for each study participant. Our results indicate that Cryptosporidium parvum and Strongyloides stercoralis, which are intracellular or live in the mucosa, were found exclusively in persons infected with HIV. In comparison, the prevalence of the extracellular parasites Giardia lamblia, Ascaris lumbricoides, and Trichuris trichiura was significantly higher (P < 0.05) in persons who were HIV-negative. Trichuris worms are in contact with the gut epithelium and less so with the mucosa, whereas Strongyloides lives within the gut mucosa. It is possible that changes in the gut epithelium due to HIV infection do not affect the mucosa and therefore would not affect Strongyloides. We conclude that infection with HIV may selectively deter the establishment of certain intestinal parasites. This may be due to the fact that HIV-induced enteropathy does not favor the establishment of extracellular parasites. Intracellular and mucosal dwelling organisms, however, may benefit from pathologic changes and reduced local immune responses induced by the virus, which, in turn, may lead to higher prevalence among HIV-infected individuals.
Adolescent↗
Epidemiology of giardiasis and cryptosporidiosis in Jamaica.
We report the findings of a cross-sectional epidemiologic study of Giardia lamblia and Cryptosporidum infections in Jamaica. Three hundred twenty eight stool samples from patients less than one to 81 years of age were examined using formalin-ether concentration for G. lamblia, Zeihl-Neelsen staining for Cryptosporidium, and the Prospect rapid enzyme immunoassay (EIA; Alexon, Sunnyvale, CA) for parasite diagnosis. The Prospect Giardia rapid assay detected 17 cases of G. lamblia infection compared with six by formalin-ether concentration. However, the Prospect Cryptosporidum EIA did not increase the rate of detection of Cryptosporidum when compared with Zeihl-Neelsen staining. Cryptosporidum infections were most frequently diagnosed in children less than five years old and prevalence decreased with age. In contrast, the prevalence of giardiasis increased as children became older. There were no associations between the infections and stool consistency, clinical manifestations, or sex of the individuals. The contribution of the parasites to childhood morbidity will depend on accurate laboratory diagnosis.
Adolescent↗
The age-prevalence profile of abdominal obesity among patients in a diabetes referral clinic in Jamaica.
Generalised obesity is a major risk factor for cardiovascular disease, diabetes, hypertension and premature death, but abdominal or central obesity is even more closely related to these. Diabetes causes accelerated atherosclerosis and this results in peripheral vascular and ischaemic heart disease and stroke, major causes of death in diabetics in the Caribbean. Diabetics who have abdominal obesity are therefore at increased risk for these events. 485 patients attending the Diabetes Referral Clinic at the University Hospital of the West Indies, Jamaica, were evaluated for abdominal obesity based on the ratio between their waist and hip measurements. There was an increase in the numbers of diabetics with increasing age. Abdominal obesity was significantly more prevalent among females (90%) than among males (34.9%) (mean 2 = 142; p < 0.0001), and massive obesity was detected in 31.1% of females. However, the prevalence of abdominal obesity among males and females was not significantly age-related. Given the high prevalence of obesity in this clinic population, more precise studies of abdominal obesity associated morbidity in diabetics should be undertaken.
Abdomen↗