Enteropathogens and Chronic Illness in Returning Travelers Ross, Allen G.P; Olds, G. Richard; Cripps, Allan W ...
New England journal of medicine/The New England journal of medicine,
05/2013, Letnik:
368, Številka:
19
Journal Article
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Chronic gastrointestinal illness sometimes develops after international travel. This review covers the diagnosis of the major enteropathogens and provides recommendations for treatment.
In 2011, ...approximately 980 million people traveled internationally.
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More than 522 million people from developed countries traveled overseas; an estimated 50 million to 100 million people traveled to developing countries.
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In 2007, the U.S. Department of Commerce estimated that at least 30 million Americans traveled to developing regions.
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Approximately 8% of travelers to the developing world require medical care during or after travel, and more than a quarter of those who seek medical assistance present with gastrointestinal symptoms.
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Although diarrhea occurs in up to 50% of people who travel to a developing country, it is only one of . . .
Background. There is evidence to support that nutritional deficiency can reduce the body's immune function, thereby decreasing resistance to disease and increasing susceptibility to intestinal ...parasites. Methods. A cross-sectional survey was carried out on 693 school-aged children from 5 schistosomiasis-endemic villages in Northern Samar, the Philippines. Data on dietary intake, nutritional status, and intestinal parasitic infection were collected. Results. The prevalence of stunting, thinness, and wasting was 49.2%, 27.8%, and 59.7% of all children. The proportion of children infected with Schistosoma japonicum (15.6%, P = .03) and hookworm (22.0%, P = .05) were significantly lower among children who met the recommended energy and nutrient intake (RENI) for total calories. The percentage of children infected with Trichuris trichiura was highest among children who did not meet the RENI for energy (74.1%, P = .04), iron (73.4%, P = .01), thiamine (74.0%, P = .00), and riboflavin (73.3%, P = .01). Susceptibility to having 1 or more parasitic infections was significantly associated with poor intake of energy (P = .04), thiamine (P = .02), and riboflavin (P = .01). The proportion of stunted children was significantly higher among children who did not meet the RENI for energy (68.9%, P = .002), protein (54.0%, P = .004), or niacin (30.8%, P = .02) and for those infected with hookworm (31.8%, P = .0002). After adjusting for potential confounders, protein intake less than the RENI (odds ratio OR, 1.48; 95% confidence interval CI, 1.03–2.14), and hookworm infection (OR, 1.77; 95% CI, 1.22–2.55) were the major predictors of stunting. Conclusions. The results support the hypothesis that poor nutrient intake may increase susceptibility to parasitic diseases and together they negatively affect childhood nutritional status.
In this Viewpoint, authors from the International Center for Diarrheal Disease Research in Bangladesh discuss rapid urbanization in low- and middle-income countries and the associated challenges of ...meeting the basic health care needs of growing urban slum populations.
Preventive chemotherapy with 40 mg/kg of praziquantel has been endorsed and advocated by WHO for the global control of schistosomiasis, yet the drug does not prevent reinfection. In this Viewpoint, ...we discuss issues related to this control strategy, which is now implemented in many countries where schistosomiasis is endemic.
Background. In the Philippines, the current national control strategy for schistosomiasis is annual mass drug administration (MDA) with 40 mg/kg of praziquantel in all schistosomiasis-endemic ...villages with a prevalence ≥ 10%. Methods. A cross-sectional survey of schistosomiasis was conducted in 2012 on 18 221 individuals residing in 22 schistosomiasis-endemic villages in the province of Northern Samar. The prevalence of schistosomiasis, intensity of Schistosoma infection, and morbidity of disease were assessed. Results. Despite an active schistosomiasis-control program in Northern Samar for > 30 years, which included a MDA campaign in the last 5 years, the mean prevalence of schistosomiasis among 10 435 evaluated subjects was 27.1% (95% confidence interval CI, 26.3%-28.0%), and the geometric mean intensity of infection among 2832 evaluated subjects was 17.2 eggs per gram of feces (95% CI, 16.4-18.1). Ultrasonography revealed high levels of schistosomiasis-induced morbidity in the schistosomiasis-endemic communities. Left lobe liver enlargement (≥ 70 mm) was evident in 89.3% of subjects. Twenty-five percent of the study population had grade II/III liver parenchyma fibrosis, and 13.3% had splenomegaly (≥ 100 mm). Conclusions. MDA on its own was insufficient to control the prevalence of schistosomiasis, intensity of Schistosoma infection, or morbidity of the disease. Alternative control measures will be needed to complement the existing national MDA program.
Planning for the Next Global Pandemic Ross, Allen G.P; Crowe, Suzanne M; Tyndall, Mark W
International journal of infectious diseases,
09/2015, Letnik:
38, Številka:
C
Journal Article
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Abstract In order to mitigate human and financial losses as a result of future global pandemics, we must plan now. As the Ebola virus pandemic declines, we must reflect on how we have mismanaged this ...recent international crisis and how we can better prepare for the next global pandemic. Of great concern is the increasing frequency of pandemics occurring over the last few decades. Clearly, the window of opportunity to act is closing. This editorial discusses many issues including priority emerging and re-emerging infectious diseases; the challenges of meeting international health regulations; the strengthening of global health systems; global pandemic funding; and the One Health approach to future pandemic planning. We recommend that the global health community unites to urgently address these issues in order to avoid the next humanitarian crisis.
PURPOSE OF REVIEWPreventive chemotherapy is advocated for the global control and elimination of schistosomiasis. Despite the well known short-term benefits of treating patients for schistosomiasis, ...the impact of mass drug administration (MDA) campaigns to control the disease in the long term remains unresolved.
RECENT FINDINGSMany studies have advocated the success of MDA programs in order to attract donor funds for elimination efforts but such successes are often short-lived given the drug does not alter the life cycle of the organism or prevent reinfection. Within a matter of months to years after halting treatment, the prevalence, intensity of infection and morbidity of disease return to baseline levels. Other mitigating factors contribute to the failings of MDA campaigns namelypoverty, poor drug coverage, poor drug compliance, and, in the case of Asiatic schistosomiasis, zoonotic transmission. Genetic and innate and acquired immunologic mechanisms complicate the epidemiologic picture of schistosomiasis globally, and may contribute indirectly to MDA shortcomings. The possibility of drug resistance is an ever present concern because of the sole reliance on one drug, praziquantel.
SUMMARYPreventive chemotherapy is advocated for the global control and elimination of schistosomiasis. The short-term benefits of MDA campaigns are well documented but the long-term benefits are questionable.
A new global strategy for the elimination of schistosomiasis Ross, Allen G.P., M.D., Ph.D; Chau, Thao N., M.P.H; Inobaya, Marianette T., M.Sc ...
International journal of infectious diseases,
01/2017, Letnik:
54, Številka:
C
Journal Article
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Abstract Mass drug administration utilising a single oral dose of 40 mg/kg of praziquantel (PZQ) has been endorsed and advocated by the World Health Organisation (WHO) for the global control and ...elimination of schistosomiasis. However, this strategy is failing primarily because the drugs are not getting to the people who need them the most. The current global coverage is 20%, the drug compliance rate is less than 50%, and the drug efficacy is approximately 50%. Thus in reality, only about 5% of the reservoir human population is actually receiving intermittent chemotherapy. Despite claims that more of the drug will soon be made available the current strategy is inherently flawed and will not lead to disease elimination. We discuss the many practical issues related to this global strategy, and advocate for an integrated control strategy targeting the life cycle and the most at-risk. Moreover, we discuss how an integrated control package for schistosomiasis should fit within a larger integrated health package for rural and remote villages in the developing world. A holistic health system approach is required to achieve sustainable control and ultimately disease elimination.
Schistosomiasis Ross, Allen G.P; Bartley, Paul B; Sleigh, Adrian C ...
The New England journal of medicine,
04/2002, Letnik:
346, Številka:
16
Journal Article
Recenzirano
Schistosomiasis is a parasitic-worm infection that affects about 200 million people in 74 countries. Despite major advances in treatment and control, this tropical disease continues to spread to new ...geographic areas. This review summarizes the manifestations of this disease, its diagnosis, medical treatment, and prophylaxis, and the prospects for a vaccine.
In 1851, Theodor Bilharz described a parasitic infection (bilharzia) that would later be termed schistosomiasis. Currently, 200 million people in 74 countries have this disease; 120 million of them have symptoms, and 20 million have severe illness.
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Schistosomiasis is caused by parasitic trematode worms (schistosomes) that reside in the abdominal veins of their vertebrate definitive hosts. The life cycle of the schistosome is depicted in Figure 1. Schistosomiasis is 1 of the 10 tropical diseases especially targeted for control by the Special Program for Research and Training in Tropical Diseases of the United Nations Development Program, the World Bank, and the . . .
Summary Schistosomiasis is a chronic enteropathogenic disease caused by blood flukes of the genus Schistosoma . The disease afflicts approximately 240 million individuals globally, causing ...approximately 70 million disability-adjusted life years lost. Chronic infections with morbidity and mortality occur as a result of granuloma formation in the intestine, liver, or in the case of Schistosoma haematobium , the bladder. Various methods are utilized to diagnose and evaluate liver fibrosis due to schistosomiasis. Liver biopsy is still considered the gold standard, but it is invasive. Diagnostic imaging has proven to be an invaluable method in assessing hepatic morbidity in the hospital setting, but has practical limitations in the field. The potential of non-invasive biological markers, serum antibodies, cytokines, and circulating host microRNAs to diagnose hepatic fibrosis is presently undergoing evaluation. This review provides an update on the recent advances made with respect to gastrointestinal disease associated with chronic schistosomiasis.
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