Natural variables separate the endemic areas of Clonorchis sinensis and Opisthorchis viverrini along a continuous,straight zone in Southeast Asia

Background Clonorchiasis and opisthorchiasis,caused by the liver flukes Clonorchis sinensis and Opisthorchis viverrini respectively,represent significant neglected tropical diseases(NTDs)in Asia.The co-existence of these pathogens in overlapping regions complicates effective disease control strategies.This study aimed to clarify the distribution and interaction of these diseases within Southeast Asia.Methods We systematically collated occurrence records of human clonorchiasis(n=1809)and opisthorchiasis(n=731)across the Southeast Asia countries.Utilizing species distribution models incorporating environmental and climatic data,coupled machine learning algorithms with boosted regression trees,we predicted and distinguished endemic areas for each fluke species.Machine learning techniques,including geospatial analysis,were employed to delineate the boundaries between these flukes.Results Our analysis revealed that the endemic range of C.sinensis and O.viverrini in Southeast Asia primarily spans across part of China,Vietnam,Thailand,Laos,and Cambodia.During the period from 2000 to 2018,we identified C.sinensis infections in 84 distinct locations,predominantly in southern China(Guangxi Zhuang Autonomous Region)and northern Vietnam.In a stark contrast,O.viverrini was more widely distributed,with infections documented in 721 locations across Thailand,Laos,Cambodia,and Vietnam.Critical environmental determinants were quantitatively analyzed,revealing annual mean temperatures ranging between 14 and 20°C in clonorchiasis-endemic areas and 24-30°C in opisthorchiasis regions(P<0.05).The machine learning model effectively mapped a distinct demarcation zone,demonstrating a clear separation between the endemic areas of these two liver flukes with AUC from 0.9 to1.The study in Vietnam delineates the coexistence and geographical boundaries of C.sinensis and O.viverrini,revealing distinct endemic zones and a transitional area where both liver fluke species overlap.Conclusions Our findings highlight the critical role of specific climatic and environmental factors in influencing the geographical distribution of C.sinensis and O.viverrini.This spatial delineation offers valuable insights for integrated surveillance and control strategies,particularly in regions with sympatric transmission.The results underscore the need for tailored interventions,considering regional epidemiological variations.Future collaborations integrating eco-epidemiology,molecular epidemiology,and parasitology are essential to further elucidate the complex interplay of liver fluke distributions in Asia.

Fish sharing as a risk factor for Opisthorchis viverrini infection:evidence from two villages in north-eastern Thailand

Background:Foodborne trematodiasis(FBT)is a significant global health problem,with the liver flukes Opisthorchis viverrini,O.felineus,and Clonorchis sinensis contributing to half of the global burden of FBT.North-eastern Thailand where O.viverrini is endemic and un-cooked fish dishes remain an integral part of the food culture has the highest reported incidence of opisthorchiasis,including associated cholangiocarcinoma.Both food sharing and eating practices are potentially important factors in FTB,suggesting an important role for the social ecology of disease transmission in these rural communities.Methods:Two rural Thai-Lao villages that were part of a 12-village project in Northeastern Thailand were selected for detailed investigation of O.viverrini infection risk associated with sharing of raw fish dishes among households.The project included screening individuals for infection and cholangiocarcinoma,a household questionnaire,and offering treatment options for positive individuals.Social network mapping was used to construct raw fish dish-sharing networks and create a proxy variable capturing variability in the degree of food sharing(DFS),measured as the number of different households with which each household shared fish dishes.Measures of associations between DFS,O.viverrini infection,the frequency of raw fish consumption,and the number of raw fish dishes consumed were generated using binary logistic regression,proportional odds ordinal logistic regression,and Poisson regression.Results:The results showed that the probability that a household has members infected with O.viverrini increased by~7%(P<0.01)for each additional household included in its network.Moreover,the frequency and number of types of raw fish dishes consumed increased significantly as the DFS increased.Of the two villages,that with the highest infection prevalence(48%versus 34.6%)had significantly higher social connectivity overall(P<0.001).Conclusions:Our findings suggest that the social ecology of human settlements may be key to understanding the transmission dynamics of some FBT.In the case of O.viverrini in Thai-Lao communities,for which food sharing is a traditional practice supporting social cohesion,food sharing network mapping should be incorporated into community-based interventions.These should encourage fish dish preparation methods that minimize infection risk by targeting households with high DFS values.

Efficacy of the combination of modern medicine and traditional Chinese medicine in pulmonary fibrosis arising as a sequelae in convalescent COVID-19 patients: a randomized multicenter trial

Background:The coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)has led to a significant number of mortalities worldwide.COVID-19 poses a serious threat to human life.The clinical manifestations of COVID-19 are diverse and severe and 20%of infected patients are reported to be in a critical condition.A loss in lung function and pulmonary fibrosis are the main manifestations of patients with the severe form of the disease.The lung function is affected,even after recovery,thereby greatly affecting the psychology and well-being of patients,and significantly reducing their quality of life.

Association between helminth infections and diabetes mellitus in adults from the Lao People’s Democratic Republic:a crosssectional study

Background:As a result of epidemiological transition,the health systems of low-and middle-income countries are increasingly faced with a dual disease burden of infectious diseases and emerging non-communicable diseases.Little is known about the mutual influence of these two disease groups.The aim of this study was to investigate the cooccurrence of helminth infections and diabetes mellitus in adults in Lao People’s Democratic Republic(Lao PDR).Methods:We conducted a cross-sectional study among 1600 randomly selected adults aged 35 and older from four different socio-economical and ecological provinces.Information on socio-demographics,risk factors and health conditions was obtained from personal interviews.Clinical assessments including anthropometry(height,weight,waist and hip circumference)and blood pressure measurements were also conducted.Diabetes was classified based on selfreported diagnoses and a point-of-care glycated haemoglobin(HbA1c)test from finger prick blood samples.Stool samples for helminth diagnosis were examined with formalin-ether concentration technique for intestinal parasitic infections.The independent associations of helminth infections with diabetic status and HbA1c were assessed using multiple regression analyses.Results:The prevalence of pre-diabetes and diabetes was 37.3%and 22.8%,respectively.Fifty-six percent of diabetic cases were undiagnosed and 85%of diagnosed diabetic cases had poor glycemic control.Participants from rural areas and from southern parts of the country had higher infection rates,with Opisthorchis viverrini,being the most common helminth infection(30.5%).We found a positive association between Taenia spp.infections and HbA1c(β=0.117;95%CI:0.042-0.200)and diabetes mellitus risk(OR=2.98;95%CI:1.10-8.05).No other helminth species was associated with glycated hemoglobin.Conclusions:Hyperglycaemia and diabetic rates in Lao PDR are alarmingly high,but consistent with other high rates in the region.Given the high rates of under-diagnosis and poorly-controlled glycaemia in diabetes mellitus patients,routine diabetes screening and treatment is essential for the local healthcare system.Large longitudinal cohorts integrating biomarkers are warranted in the search of causal diabetes mellitus risk factors in the region.Common intestinal helminth infections,including O.viverrini,are unlikely to explain the high diabetes mellitus rates observed.