Lipophosphoglycans (LPG) of Leishmania spp. are known to alter innate immune responses and be cri... more Lipophosphoglycans (LPG) of Leishmania spp. are known to alter innate immune responses and be critical for parasite binding to the vector gut wall. LPG displays various oligosaccharides capping the terminal and branch apexes. However, it is unknown how these capping oligosaccharides serve as immunomodulators in the absence of a conjugated protein. Several oligosaccharides including dimannose and trimannose, were synthesized and covalently linked to latex beads to study their effect in a Leishmania infection model. In vitro incubation of activated J774 or bone marrow derived macrophages with di- and tri-mannose resulted in differential modulation of IL-12p40, a key cytokine to control intracellular pathogens by driving a Th1 response. Co-inoculation of trimannose and L. major into the footpad of C57BL/6 mice increased IL-12p40 and IFN-γ production 48 hours post-infection, a significantly Th1 skewed response. Noticeably at 14 days post-infection, L. major infected, trimannose treated mice had significantly decreased lesion size and decreased parasite load compared to infected untreated, controls. Cytokines from draining lymph node supernatants measured via Luminex at 14 days post infection showed decreased IL-12p40 and IL-10 secretion and increased IFN-γ in the co-inoculated mice. In vitro, the effects of trimannose were mediated by macrophage TLR and mannose receptors as well as T cell proliferation. Leishmania-derived trimannose represents a novel immunomodulator that provides early Th1 skewed cytokine production to control parasite load and alter the course of infection.
Canine leishmaniosis (CanL) is a zoonotic disease caused by protozoan Leishmania infantum. Dogs w... more Canine leishmaniosis (CanL) is a zoonotic disease caused by protozoan Leishmania infantum. Dogs with CanL are often coinfected with tick-borne bacterial pathogens, including Borrelia burgdorferi in the United States. These coinfections have been causally associated with hastened disease progression and mortality. However, the specific cellular mechanisms of how coinfections affect microbicidal responses against L. infantum are unknown. We hypothesized that B. burgdorferi coinfection impacts host macrophage effector functions, prompting L. infantum intracellular survival. In vitro experiments demonstrated that exposure to B. burgdorferi spirochetes significantly increased L. infantum parasite burden and pro-inflammatory responses in DH82 canine macrophage cells. Induction of cell death and generation of mitochondrial ROS were significantly decreased in coinfected DH82 cells compared to uninfected and L. infantum-infected cells. Ex vivo stimulation of PBMCs from L. infantum-seronegati...
Lyme disease (LD) due toBorrelia burgdorferiis the most prevalent vector-borne disease in the Uni... more Lyme disease (LD) due toBorrelia burgdorferiis the most prevalent vector-borne disease in the United States. There is a poor understanding of how immunity contributes to bacterial control, pathology, or both during LD.
Lyme disease, caused by Borrelia burgdorferi sensu stricto and most commonly transmitted by Ixode... more Lyme disease, caused by Borrelia burgdorferi sensu stricto and most commonly transmitted by Ixodes scapularis Say (Ixodida: Ixodidae), is the most common tick-borne disease in Maryland. Because B. burgdorferi s.s. is maintained in enzootic cycles among wild mice (Peromyscus spp) and Ixodes spp ticks, differing patterns of parasitism of ticks on mice could impact the infection prevalence with B. burgdorferi. We determined the infection prevalence of Peromyscus spp as well as questing and partially engorged nymphal ticks collected at six sites on private land in five counties in Maryland from May to August 2020. Questing nymph infection prevalence (NIP) was 14%. We trapped 1258 mice and collected 554 ticks and 413 ear tissue samples. The prevalence of infested Peromyscus spp varied based on host age and sex, with older and male mice more likely to be infested. We detected a significant difference amongst the proportion of attached Ixodes and the location of trapping. Similarly, the pr...
The effectiveness of the two-dose COVID-19 vaccines has made reentry to in-person teaching, learn... more The effectiveness of the two-dose COVID-19 vaccines has made reentry to in-person teaching, learning, and performing possible, despite singers’ special vulnerabilities to SARS-CoV-2 due to the virus’ airborne transmission route and the high-aerosol generating nature of singing. A number of factors may complicate a return to pre-pandemic conditions. This article provides resources to help teachers, singers, and collaborative pianists safely and ethically navigate a return to in-person singing by considering the following: effectiveness of vaccination and mask use; an update on aerosol risk; environmental risk factors and mitigation; the intersection of the privacy laws FERPA and HIPAA and vaccine hesitancy, and the psychological risks of reentry following the pandemic.
While many Bayesian state-space models for infectious disease processes focus on population infec... more While many Bayesian state-space models for infectious disease processes focus on population infection dynamics (e.g., compartmental models), in this work we examine the evolution of infection processes and the complexities of the immune responses within the host using these techniques. We present a joint Bayesian state-space model to better understand how the immune system contributes to the control ofLeishmania infantuminfections over the disease course. We use longitudinal molecular diagnostic and clinical data of a cohort of dogs to describe population progression rates and present evidence for important drivers of clinical disease. Among these results, we find evidence for the importance of co-infection in disease progression. We also show that as dogs progress through the infection, parasite load is influenced by their age, ectoparasiticide treatment status, and serology. Furthermore, we present evidence that pathogen load information from an earlier point in time influences it...
Canine brucellosis is a reportable zoonotic disease that can lead to canine reproductive losses a... more Canine brucellosis is a reportable zoonotic disease that can lead to canine reproductive losses and human infection through contact with infected urine or other genitourinary secretions. Although many locations require testing and euthanasia of positive dogs, current diagnosis is limited by the time required for seroconversion, for example, presence of B. canis-specific antibodies. The goal of this study was to determine the diagnostic ability of Brucella canis-specific quantitative polymerase chain reaction (qPCR) assay to detect B. canis in field samples prior to serological positivity for faster diagnosis and prevention of transmission within kennels or in households. Two kennels, one of which was located in the owner's home, were sampled following observation of suggestive clinical signs and positive serology of at least one dog. Specimens obtained were comparatively analysed via serology and qPCR analysis. 107 dogs were analysed for B. canis infection via qPCR: 105 via whole-blood samples, 65 via vaginal swab, six via urine and seven via genitourinary tract tissue taken at necropsy. Forty-five dogs were found to be infected with canine brucellosis via qPCR, of which 22 (48.89%) were seropositive. A statistically significant number (P = 0.0228) of qPCR-positive dogs, 5/25 (20.00%), seroconverted within a 30-day interval after initial serologic testing. As compared to serology, qPCR analysis of DNA from vaginal swabs had a sensitivity of 92.31% and specificity of 51.92%, and qPCR analysis of DNA from whole-blood samples had a sensitivity of 16.67% and specificity of 100%. B. canis outer membrane protein 25 DNA qPCR from non-invasive vaginal swab and urine samples provided early detection of B. canis infection in dogs prior to detection of antibodies. This assay provides a critical tool to decrease zoonotic spread of canine brucellosis, its associated clinical presentation(s), and emotional and economic repercussions.
IMPORTANCE Children aged 6 months through 4 years have become eligible for COVID-19 vaccination, ... more IMPORTANCE Children aged 6 months through 4 years have become eligible for COVID-19 vaccination, but little is known about parental intentions regarding, concerns about, or facilitators to COVID-19 vaccination for this age group. OBJECTIVES To evaluate parental intentions, concerns, and facilitators for COVID-19 vaccination for children aged 6 months through 4 years and to help inform the US Centers for Disease Control and Prevention Advisory Committee on Immunization Practices' deliberations and recommendations for COVID-19 vaccination for children aged 6 months through 4 years. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study fielded an online survey from February 2 to 10, 2022, among a nonprobability sample of US parents of children aged 6 months through 4 years who were recruited through Qualtrics using quota-based sampling for respondent gender, race and ethnicity, and child age group. MAIN OUTCOMES AND MEASURES COVID-19 vaccination intentions, time to COVID-19 vaccination, COVID-19 vaccination concerns and facilitators, and trusted COVID-19 vaccination locations for children aged 6 months through 4 years. RESULTS The final weighted sample of 2031 participants (73.5% participation rate) had more respondents who identified as male (985; weighted percentage, 54.8%) or White (696; weighted percentage, 66.2%), were aged 25 to 49 years (1628; weighted percentage, 85.6%), had at least a bachelor's degree (711; weighted percentage, 40.0%), lived in a metropolitan area (1743; weighted percentage, 82.9%) or the South (961; weighted percentage, 43.4%), or received at least 1 dose of a COVID-19 vaccine (1205; weighted percentage, 59.8%). Half of respondents (645; weighted percentage, 45.6%) indicated that they "definitely" or "probably" will vaccinate their child aged 6 months through 4 years once they became eligible. However, only one-fifth (396; weighted percentage, 19.0%) indicated they would get a COVID-19 vaccine for their child in this age group within 3 months of them becoming eligible for vaccination. Vaccine safety and efficacy were parents' top concerns, and receiving more information about safety and efficacy were the top facilitators to COVID-19 vaccination for this age group. A doctor's office or clinic and local pharmacy were the most trusted COVID-19 vaccination locations for this age group. CONCLUSIONS AND RELEVANCE These results suggest that only a minority of parents of children in this age group are eager to vaccinate their children within the first few months of eligibility, with widespread concerns about COVID-19 vaccination for this age group. Thus, considerable efforts to increase parental COVID-19 vaccine confidence for children aged 6 months through 4 years may be needed to maximize COVID-19 vaccination for this age group in the United States.
Leishmaniasis on the Indian subcontinent is thought to have an anthroponotic transmission cycle. ... more Leishmaniasis on the Indian subcontinent is thought to have an anthroponotic transmission cycle. There is no direct evidence that a mammalian host other than humans can be infected with Leishmania donovani and transmit infection to the sand fly vector. The aim of the present study was to evaluate the impact of sand fly feeding on other domestic species and provide clinical evidence regarding possible non-human reservoirs through experimental sand fly feeding on cows, water buffalo goats and rodents. We performed xenodiagnosis using colonized Phlebotomus argentipes sand flies to feed on animals residing in villages with active Leishmania transmission based on current human cases. Xenodiagnoses on mammals within the endemic area were performed and blood-fed flies were analyzed for the presence of Leishmania via qPCR 48hrs after feeding. Blood samples were also collected from these mammals for qPCR and serology. Although we found evidence of Leishmania infection within some domestic ma...
Purpose of Review Leishmaniasis is a leading cause of parasitic death, with incidence rising from... more Purpose of Review Leishmaniasis is a leading cause of parasitic death, with incidence rising from decreased resources to administer insecticide and anti-leishmanial treatments due to the COVID-19 pandemic. Leishmaniasis is nonendemic in the United States (U.S.), but enzootic canine populations and potentially competent vectors warrant monitoring of autochthonous disease as a fluctuating climate facilitates vector expansion. Recent studies concerning sand fly distribution and vector capacity were assessed for implications of autochthonous transmission within the U.S. Recent Findings Climate change and insecticide resistance provide challenges in sand fly control. While most Leishmaniainfected dogs in the U.S. were infected via vertical transmission or were imported, autochthonous vector-borne cases were reported. Autochthonous vector-borne human cases have been reported in four states. Further vaccine research could contribute to infection control. Summary Both cutaneous and visceral leishmaniasis cases in the U.S. are increasingly reported. Prevention measures including vector control and responsible animal breeding are critical to halt this zoonotic disease.
Influenza typically causes mild infection but can lead to severe outcomes for those with compromi... more Influenza typically causes mild infection but can lead to severe outcomes for those with compromised lung health. Flooding, a seasonal problem in Iowa, can expose many Iowans to molds and allergens shown to alter lung inflammation, leading to asthma attacks and decreased viral clearance. Based on this, the hypothesis for this research was that there would be geographically specific positive associations in locations with flooding with influenza diagnosis. An ecological study was performed using influenza diagnoses and positive influenza polymerase chain reaction tests from a de-identified large private insurance database and Iowa State Hygienic Lab. After adjustment for multiple confounding factors, Poisson regression analysis resulted in a consistent 1% associated increase in influenza diagnoses per day above flood stage (95% confidence interval: 1.00–1.04). This relationship remained after removal of the 2009–2010 influenza pandemic year. There was no associated risk between flood...
<p>Endemic regions for (A) <i>T</i>. <i>cruzi</i> and (B) <i>... more <p>Endemic regions for (A) <i>T</i>. <i>cruzi</i> and (B) <i>L</i>. <i>infantum</i> are shaded. Gray dots represent at least one report of human congenital infection with (A) <i>T</i>. <i>cruzi</i> or (B) <i>L</i>. <i>infantum</i>. Black squares represent at least one report of (B) canine congenital infection with <i>L</i>. <i>infantum</i>. Maps created with ArcMap, Version 10.2 (Esri). See <a href="http://www.plospathogens.org/article/info:doi/10.1371/journal.ppat.1005302#ppat.1005302.s001" target="_blank">S1 File</a> for case and location references.</p
Lipophosphoglycans (LPG) of Leishmania spp. are known to alter innate immune responses and be cri... more Lipophosphoglycans (LPG) of Leishmania spp. are known to alter innate immune responses and be critical for parasite binding to the vector gut wall. LPG displays various oligosaccharides capping the terminal and branch apexes. However, it is unknown how these capping oligosaccharides serve as immunomodulators in the absence of a conjugated protein. Several oligosaccharides including dimannose and trimannose, were synthesized and covalently linked to latex beads to study their effect in a Leishmania infection model. In vitro incubation of activated J774 or bone marrow derived macrophages with di- and tri-mannose resulted in differential modulation of IL-12p40, a key cytokine to control intracellular pathogens by driving a Th1 response. Co-inoculation of trimannose and L. major into the footpad of C57BL/6 mice increased IL-12p40 and IFN-γ production 48 hours post-infection, a significantly Th1 skewed response. Noticeably at 14 days post-infection, L. major infected, trimannose treated mice had significantly decreased lesion size and decreased parasite load compared to infected untreated, controls. Cytokines from draining lymph node supernatants measured via Luminex at 14 days post infection showed decreased IL-12p40 and IL-10 secretion and increased IFN-γ in the co-inoculated mice. In vitro, the effects of trimannose were mediated by macrophage TLR and mannose receptors as well as T cell proliferation. Leishmania-derived trimannose represents a novel immunomodulator that provides early Th1 skewed cytokine production to control parasite load and alter the course of infection.
Canine leishmaniosis (CanL) is a zoonotic disease caused by protozoan Leishmania infantum. Dogs w... more Canine leishmaniosis (CanL) is a zoonotic disease caused by protozoan Leishmania infantum. Dogs with CanL are often coinfected with tick-borne bacterial pathogens, including Borrelia burgdorferi in the United States. These coinfections have been causally associated with hastened disease progression and mortality. However, the specific cellular mechanisms of how coinfections affect microbicidal responses against L. infantum are unknown. We hypothesized that B. burgdorferi coinfection impacts host macrophage effector functions, prompting L. infantum intracellular survival. In vitro experiments demonstrated that exposure to B. burgdorferi spirochetes significantly increased L. infantum parasite burden and pro-inflammatory responses in DH82 canine macrophage cells. Induction of cell death and generation of mitochondrial ROS were significantly decreased in coinfected DH82 cells compared to uninfected and L. infantum-infected cells. Ex vivo stimulation of PBMCs from L. infantum-seronegati...
Lyme disease (LD) due toBorrelia burgdorferiis the most prevalent vector-borne disease in the Uni... more Lyme disease (LD) due toBorrelia burgdorferiis the most prevalent vector-borne disease in the United States. There is a poor understanding of how immunity contributes to bacterial control, pathology, or both during LD.
Lyme disease, caused by Borrelia burgdorferi sensu stricto and most commonly transmitted by Ixode... more Lyme disease, caused by Borrelia burgdorferi sensu stricto and most commonly transmitted by Ixodes scapularis Say (Ixodida: Ixodidae), is the most common tick-borne disease in Maryland. Because B. burgdorferi s.s. is maintained in enzootic cycles among wild mice (Peromyscus spp) and Ixodes spp ticks, differing patterns of parasitism of ticks on mice could impact the infection prevalence with B. burgdorferi. We determined the infection prevalence of Peromyscus spp as well as questing and partially engorged nymphal ticks collected at six sites on private land in five counties in Maryland from May to August 2020. Questing nymph infection prevalence (NIP) was 14%. We trapped 1258 mice and collected 554 ticks and 413 ear tissue samples. The prevalence of infested Peromyscus spp varied based on host age and sex, with older and male mice more likely to be infested. We detected a significant difference amongst the proportion of attached Ixodes and the location of trapping. Similarly, the pr...
The effectiveness of the two-dose COVID-19 vaccines has made reentry to in-person teaching, learn... more The effectiveness of the two-dose COVID-19 vaccines has made reentry to in-person teaching, learning, and performing possible, despite singers’ special vulnerabilities to SARS-CoV-2 due to the virus’ airborne transmission route and the high-aerosol generating nature of singing. A number of factors may complicate a return to pre-pandemic conditions. This article provides resources to help teachers, singers, and collaborative pianists safely and ethically navigate a return to in-person singing by considering the following: effectiveness of vaccination and mask use; an update on aerosol risk; environmental risk factors and mitigation; the intersection of the privacy laws FERPA and HIPAA and vaccine hesitancy, and the psychological risks of reentry following the pandemic.
While many Bayesian state-space models for infectious disease processes focus on population infec... more While many Bayesian state-space models for infectious disease processes focus on population infection dynamics (e.g., compartmental models), in this work we examine the evolution of infection processes and the complexities of the immune responses within the host using these techniques. We present a joint Bayesian state-space model to better understand how the immune system contributes to the control ofLeishmania infantuminfections over the disease course. We use longitudinal molecular diagnostic and clinical data of a cohort of dogs to describe population progression rates and present evidence for important drivers of clinical disease. Among these results, we find evidence for the importance of co-infection in disease progression. We also show that as dogs progress through the infection, parasite load is influenced by their age, ectoparasiticide treatment status, and serology. Furthermore, we present evidence that pathogen load information from an earlier point in time influences it...
Canine brucellosis is a reportable zoonotic disease that can lead to canine reproductive losses a... more Canine brucellosis is a reportable zoonotic disease that can lead to canine reproductive losses and human infection through contact with infected urine or other genitourinary secretions. Although many locations require testing and euthanasia of positive dogs, current diagnosis is limited by the time required for seroconversion, for example, presence of B. canis-specific antibodies. The goal of this study was to determine the diagnostic ability of Brucella canis-specific quantitative polymerase chain reaction (qPCR) assay to detect B. canis in field samples prior to serological positivity for faster diagnosis and prevention of transmission within kennels or in households. Two kennels, one of which was located in the owner&#39;s home, were sampled following observation of suggestive clinical signs and positive serology of at least one dog. Specimens obtained were comparatively analysed via serology and qPCR analysis. 107 dogs were analysed for B. canis infection via qPCR: 105 via whole-blood samples, 65 via vaginal swab, six via urine and seven via genitourinary tract tissue taken at necropsy. Forty-five dogs were found to be infected with canine brucellosis via qPCR, of which 22 (48.89%) were seropositive. A statistically significant number (P = 0.0228) of qPCR-positive dogs, 5/25 (20.00%), seroconverted within a 30-day interval after initial serologic testing. As compared to serology, qPCR analysis of DNA from vaginal swabs had a sensitivity of 92.31% and specificity of 51.92%, and qPCR analysis of DNA from whole-blood samples had a sensitivity of 16.67% and specificity of 100%. B. canis outer membrane protein 25 DNA qPCR from non-invasive vaginal swab and urine samples provided early detection of B. canis infection in dogs prior to detection of antibodies. This assay provides a critical tool to decrease zoonotic spread of canine brucellosis, its associated clinical presentation(s), and emotional and economic repercussions.
IMPORTANCE Children aged 6 months through 4 years have become eligible for COVID-19 vaccination, ... more IMPORTANCE Children aged 6 months through 4 years have become eligible for COVID-19 vaccination, but little is known about parental intentions regarding, concerns about, or facilitators to COVID-19 vaccination for this age group. OBJECTIVES To evaluate parental intentions, concerns, and facilitators for COVID-19 vaccination for children aged 6 months through 4 years and to help inform the US Centers for Disease Control and Prevention Advisory Committee on Immunization Practices' deliberations and recommendations for COVID-19 vaccination for children aged 6 months through 4 years. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study fielded an online survey from February 2 to 10, 2022, among a nonprobability sample of US parents of children aged 6 months through 4 years who were recruited through Qualtrics using quota-based sampling for respondent gender, race and ethnicity, and child age group. MAIN OUTCOMES AND MEASURES COVID-19 vaccination intentions, time to COVID-19 vaccination, COVID-19 vaccination concerns and facilitators, and trusted COVID-19 vaccination locations for children aged 6 months through 4 years. RESULTS The final weighted sample of 2031 participants (73.5% participation rate) had more respondents who identified as male (985; weighted percentage, 54.8%) or White (696; weighted percentage, 66.2%), were aged 25 to 49 years (1628; weighted percentage, 85.6%), had at least a bachelor's degree (711; weighted percentage, 40.0%), lived in a metropolitan area (1743; weighted percentage, 82.9%) or the South (961; weighted percentage, 43.4%), or received at least 1 dose of a COVID-19 vaccine (1205; weighted percentage, 59.8%). Half of respondents (645; weighted percentage, 45.6%) indicated that they "definitely" or "probably" will vaccinate their child aged 6 months through 4 years once they became eligible. However, only one-fifth (396; weighted percentage, 19.0%) indicated they would get a COVID-19 vaccine for their child in this age group within 3 months of them becoming eligible for vaccination. Vaccine safety and efficacy were parents' top concerns, and receiving more information about safety and efficacy were the top facilitators to COVID-19 vaccination for this age group. A doctor's office or clinic and local pharmacy were the most trusted COVID-19 vaccination locations for this age group. CONCLUSIONS AND RELEVANCE These results suggest that only a minority of parents of children in this age group are eager to vaccinate their children within the first few months of eligibility, with widespread concerns about COVID-19 vaccination for this age group. Thus, considerable efforts to increase parental COVID-19 vaccine confidence for children aged 6 months through 4 years may be needed to maximize COVID-19 vaccination for this age group in the United States.
Leishmaniasis on the Indian subcontinent is thought to have an anthroponotic transmission cycle. ... more Leishmaniasis on the Indian subcontinent is thought to have an anthroponotic transmission cycle. There is no direct evidence that a mammalian host other than humans can be infected with Leishmania donovani and transmit infection to the sand fly vector. The aim of the present study was to evaluate the impact of sand fly feeding on other domestic species and provide clinical evidence regarding possible non-human reservoirs through experimental sand fly feeding on cows, water buffalo goats and rodents. We performed xenodiagnosis using colonized Phlebotomus argentipes sand flies to feed on animals residing in villages with active Leishmania transmission based on current human cases. Xenodiagnoses on mammals within the endemic area were performed and blood-fed flies were analyzed for the presence of Leishmania via qPCR 48hrs after feeding. Blood samples were also collected from these mammals for qPCR and serology. Although we found evidence of Leishmania infection within some domestic ma...
Purpose of Review Leishmaniasis is a leading cause of parasitic death, with incidence rising from... more Purpose of Review Leishmaniasis is a leading cause of parasitic death, with incidence rising from decreased resources to administer insecticide and anti-leishmanial treatments due to the COVID-19 pandemic. Leishmaniasis is nonendemic in the United States (U.S.), but enzootic canine populations and potentially competent vectors warrant monitoring of autochthonous disease as a fluctuating climate facilitates vector expansion. Recent studies concerning sand fly distribution and vector capacity were assessed for implications of autochthonous transmission within the U.S. Recent Findings Climate change and insecticide resistance provide challenges in sand fly control. While most Leishmaniainfected dogs in the U.S. were infected via vertical transmission or were imported, autochthonous vector-borne cases were reported. Autochthonous vector-borne human cases have been reported in four states. Further vaccine research could contribute to infection control. Summary Both cutaneous and visceral leishmaniasis cases in the U.S. are increasingly reported. Prevention measures including vector control and responsible animal breeding are critical to halt this zoonotic disease.
Influenza typically causes mild infection but can lead to severe outcomes for those with compromi... more Influenza typically causes mild infection but can lead to severe outcomes for those with compromised lung health. Flooding, a seasonal problem in Iowa, can expose many Iowans to molds and allergens shown to alter lung inflammation, leading to asthma attacks and decreased viral clearance. Based on this, the hypothesis for this research was that there would be geographically specific positive associations in locations with flooding with influenza diagnosis. An ecological study was performed using influenza diagnoses and positive influenza polymerase chain reaction tests from a de-identified large private insurance database and Iowa State Hygienic Lab. After adjustment for multiple confounding factors, Poisson regression analysis resulted in a consistent 1% associated increase in influenza diagnoses per day above flood stage (95% confidence interval: 1.00–1.04). This relationship remained after removal of the 2009–2010 influenza pandemic year. There was no associated risk between flood...
<p>Endemic regions for (A) <i>T</i>. <i>cruzi</i> and (B) <i>... more <p>Endemic regions for (A) <i>T</i>. <i>cruzi</i> and (B) <i>L</i>. <i>infantum</i> are shaded. Gray dots represent at least one report of human congenital infection with (A) <i>T</i>. <i>cruzi</i> or (B) <i>L</i>. <i>infantum</i>. Black squares represent at least one report of (B) canine congenital infection with <i>L</i>. <i>infantum</i>. Maps created with ArcMap, Version 10.2 (Esri). See <a href="http://www.plospathogens.org/article/info:doi/10.1371/journal.ppat.1005302#ppat.1005302.s001" target="_blank">S1 File</a> for case and location references.</p
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