Many parasitic infections have different presenting features in endemic individuals (ENDs) and immunologically naive temporary residents (TRs). Temporary residents with loiasis often display acute ...symptoms and hypereosinophilia, in contrast to a parasite-induced subclinical state in chronically infected ENDs. Few studies have examined differences in ENDs and TRs infected with the related filarial parasite
. We identified 40 TRs and 36 ENDs with imported onchocerciasis at the National Institutes of Health between 1976 and 2016. All study subjects received an extensive pretreatment medical history, physical examination, and laboratory investigations. We performed additional parasite-specific serologic testing on stored patient sera. Asymptomatic infection occurred in 12.5% of TRs and no ENDs (
= 0.06). Papular dermatitis was more common in TRs (47.5% versus 2.7%,
< 0.001), whereas more pigmentation changes occurred in ENDs (41.7% versus 15%,
= 0.01). Only endemic patients reported visual disturbance (13% versus 0%,
= 0.03). One TR (3.3%) had onchocercal eye disease, compared with 22.6% of ENDs (
= 0.053). Absolute eosinophil counts (AECs) were similar in ENDs and TRs (
= 0.5), and one-third of subjects had a normal AEC. Endemic individuals had higher filarial-specific IgG4 and were more likely to be positive for IgG4 antibodies to
-16. Temporary residents and ENDs with imported
infection presented with different dermatologic manifestations; ocular involvement occurred almost exclusively in ENDs. Unlike
, clinical differences appear not to be eosinophil-mediated and may reflect chronicity, intensity of infection, or the presence of
in
.
PURPOSE OF REVIEWWith increasing international travel and mass global population migration, clinicians in nonendemic countries must be familiar with imported neglected tropical diseases including ...onchocerciasis, which is commonly known as ‘river blindness’.
RECENT FINDINGSImported onchocerciasis manifests differently in travelers compared with migrants from endemic areas and is likely underdiagnosed in both groups. Recent clinical studies confirm that eosinophilia is not a sensitive marker for Onchocerca volvulus, with one-third of patients having a normal eosinophil count. Novel diagnostics measuring antibodies to multiple recombinant O. volvulus antigens maintain a high sensitivity while improving specificity compared with conventional pan-filarial serologic testing. A 6-week course of doxycycline has macrofilaricidal activity through Wolbachia depletion and may be useful in nonendemic areas in addition to standard serial ivermectin.
SUMMARYRecent studies characterizing distinct clinical presentations in travelers and migrants may enable clinicians to better recognize imported onchocerciasis. Although novel diagnostics have improved specificity, most remain restricted to tropical disease reference laboratories and to date there is no marker of cure. Prolonged doxycycline treatment may reduce the need for serial ivermectin, though more potent short-course macrofilaricidal drugs are being developed.
Background
Standard dapsone and clofazimine-containing multidrug therapy (MDT) for leprosy is limited by drug tolerability, which poses treatment adherence barriers. Although ofloxacin-based regimens ...are promising alternatives, current efficacy and safety data are limited, particularly outside of endemic areas. We evaluated treatment outcomes in patients with leprosy receiving ofloxacin-containing MDT (OMDT) at our center.
Methods
We performed a retrospective chart review of patients treated for leprosy at our center over an 8-year period (2011-2019). Primary outcomes evaluated were clinical cure rate, occurrence of leprosy reactions, antibiotic-related adverse events, and treatment adherence. Analyses were descriptive; however, data were stratified by age, sex, spectrum of disease, region of origin, and treatment regimen, and odds ratios were reported to assess associations with adverse outcomes.
Results
Over the enrolment period, 26 patients were treated with OMDT (n = 19 multibacillary, n = 7 paucibacillary), and none were treated with clofazimine-based standard MDT. At the time of analysis, 23 patients (88%) had completed their course of treatment, and all were clinically cured, while 3 (12%) were still on treatment. Eighteen patients (69%) experienced either ENL (n = 7, 27%), type 1 reactions (n = 7, 27%), or both (n = 4, 15%). No patients stopped ofloxacin due to adverse drug effects, and there were no cases of allergic hypersensitivity, tendinopathy or rupture, or C. difficile colitis.
Conclusions
We demonstrate a high cure rate and tolerability of OMDT in this small case series over an 8-year period, suggesting its viability as an alternative to standard clofazimine-containing MDT.
Brucella melitensis was identified in an aspirate obtained from a patient's hip joint during a procedure at a hospital in Canada. We conducted an investigation into possible exposures among hospital ...workers; 1 worker who assisted with the procedure tested positive for B. melitensis. Aerosol-generating procedures performed outside the laboratory may facilitate transmission of this bacterium.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Imported cutaneous leishmaniasis (CL) is a growing problem with increasing global travel to endemic areas. Returned travellers seeking care encounter significant barriers to treatment, including ...diagnostic delays and difficult access to anti-leishmanial drugs. Treatment recommendations in non-endemic settings are a moving target, reflecting recent developments in
Leishmania
diagnostics and therapeutics. Accumulating experience with molecular-based species identification has enabled species-directed therapy. Clinicians are reevaluating more toxic traditional regimens in light of newly approved therapeutic agents and emerging data on local cutaneous treatments. Referral centers are implementing treatment decision algorithms designed to maximize efficacy while minimizing adverse events. Although management strategies continue to evolve, treatment of CL in non-endemic settings remains controversial. Persistent reliance on expert opinion reflects lack of research focused on travellers and limited randomized controlled trial evidence. We herein review the current epidemiology of cutaneous leishmaniasis in travellers and species-specific evidence for available therapies.
Entamoeba histolytica Showler, Adrienne J; Boggild, Andrea K
Canadian Medical Association journal (CMAJ),
09/2013, Letnik:
185, Številka:
12
Journal Article
Recenzirano
Odprti dostop
Stool microscopy reports typically state "Entamoeba histolytica/dispar present." Although morphologically identical to E. histolytica, E. dispar is a nonpathogenic intestinal amoeba. False-negative ...result rates for stool microscopy approach 40%, but decrease to 5%-15% with 3 or more specimens examined.1 Testing to confirm E. histolytica by polymerase chain reaction or enzyme immunoassay should be done on a separate, fresh and unpreserved specimen.5 In developed countries, the prevalence of E. histolytica/E. dispar is 2.4% among immigrants, 4% among travellers and 27% among men who have sex with men.4 Most cases represent E. dispar colonization; in 1 Canadian study, only 4.6% of cases involved E. histolytica.4 Entamoeba histolytica is a nationally and provincially notifiable disease; E. dispar is a harmless commensal with no public health implications. Colonization of the stool with E. dispar suggests potential exposure to other pathogens with fecal-oral transmission but does not cause diarrhea. 4. Pillai DR, Keystone JS, Sheppard DC, et al. Entamoeba histolytica and Entamoeba dispar, epidemiology and comparison of diagnostic methods in a setting of non-endemicity. Clin Infect Dis 1999;29: 1315-8.
Due to its implication in severe pregnancy complications including the devastating microcephaly of CZS, and fetal loss in approximately 5% of cases during pregnancy 3,4,6, accuracy and precision of ...both diagnostic assays and testing algorithms are essential to understanding the epidemiologic scope of this emerging infectious disease, minimizing associated morbidity, and strategically targeting control efforts. Given the overlapping nature of ZIKV with other febrile illnesses in travellers, and suboptimal performance of each test in isolation, a combination of serologic- and PCR-based testing of serum, urine, and other potential specimens including amniotic fluid and CSF is recommended to confirm ZIKV infection. In the absence of a single, sensitive and specific “gold standard” ZIKV diagnostic that performs optimally across specimen types and over the period of acute and convalescent infection, clinicians must maintain a high index of suspicion, despite negative testing, when the consequences of infection may be severe.Disclosures The authors have no disclosures.Author contribution All authors contributed to literature review, and critical analysis and revision of the manuscript.
Fever and rash in a woman returning from the Caribbean Showler, Adrienne J; Chowdhury, Fahad; Bogoch, Isaac I
Canadian Medical Association journal (CMAJ),
2014-May-13, 2014-05-13, 20140513, Letnik:
186, Številka:
8
Journal Article
Recenzirano
Odprti dostop
Physicians should consider dengue in febrile patients presenting within two weeks of return from an endemic area, although a shorter incubation period of five to seven days is most typical.3 Common ...concurrent symptoms during the initial febrile phase include retro-orbital headache, myalgia, vomiting and an early, nonspecific macular rash.3 In the immediate period around defervescence, known as the critical phase, patients are at risk of hemorrhage and complications related to increased vascular permeability. A distinct rash characterized by diffuse erythema with islands of sparing (areas of uninvolved skin) typically appears just before recovery. Leukopenia, thrombocytopenia and transaminitis frequently occur. Combined symptoms and laboratory findings are more highly predictive of dengue infection, which is 71 times more likely in travellers with both fever and rash and 230 times more likely in those with fever, rash and leukopenia.3 In any returning traveller who is ill, it is essential to initially rule out severe and potentially lifethreatening infections requiring specific treatment, including malaria, typhoid fever, bacterial sepsis, influenza and rickettsial disease.3 Chikungunya virus has been isolated recently in the Caribbean and should also be considered in returning travellers with fever.4 Serologic testing for dengue lacks sensitivity in the acute setting, with only 50% of patients having detectable IgM antibodies on day 4 of illness.5 A fourfold rise in convalescent IgG titres measured more than 14 days after symptom onset retroactively confirms dengue infection but rarely influences management be - cause patients have already recovered. If available, enzyme-linked immunoassays or polymerase chain reaction assays targeting the viral NS1 antigen or its nucleic acids are helpful for the diagnosis of dengue in the early febrile period.5 The best prevention for dengue is to avoid mosquito bites. Wearing long-sleeved clothing and using a repellant that contains at least 30% DEET (diethyltoluamide) is the most effective way to elude day-biting Aedes mosquitoes. Prior dengue infection confers lifelong immunity to the infecting serotype, but only transient immunity to other viral serotypes. More than one of the four dengue serotypes may cocirculate within an endemic area, and reinfection with a different serotype increases the risk for clinically severe dengue.5 No effective dengue vaccine is currently available; however, this is an active area of research.8
Strongyloidiasis is a common infection in Canadian migrants that can cause life-threatening hyperinfection in immunosuppressed hosts. We designed and implemented a safety tool to guide management of ...patients with
in order to prevent adverse outcomes. Methods: Patients treated at our centre for strongyloidiasis from January 1, 2013 to December 31, 2015 were identified through our ivermectin access log. Patients were categorized into pre-implementation and post-implementation groups. A retrospective chart review for predefined variables was conducted.
Of 37 patients with strongyloidiasis, 26 were in the pre-implementation group and 11 were in the post-implementation group. Documented seroreversion (positive to negative) occurred in 42.1% of patients pre-implementation and 62.5% of patients post-implementation (
= 0.420). Documented stool clearance occurred in 80.0% of patients pre-implementation and 100.0% of patients post-implementation (
= 1.000). More patients were screened for HTLV-1 coinfection post-implementation (80.0%) versus pre-implementation (30.8%) (
= 0.011). Loss to follow-up after treatment occurred in 23.1% of patients pre-implementation and 20.0% of patients post-implementation (
= 1.000).
The safety tool may be useful in the treatment of patients with strongyloidiasis to improve documentation of patient outcomes and standardize care. Future research should include a powered prospective study.
Parasitic infections are an important cause of illness among returned travelers, and can lead to considerable morbidity and, in some cases, mortality. The complexity of parasitic life cycles and ...geographic specificities can present diagnostic challenges, particularly in non-endemic settings to which most travelers return for care. Clinical manifestations reflect the diverse taxonomy and pathogenesis of parasites, and appropriate diagnosis and management therefore necessitate a high index of suspicion of parasitic illnesses. Much of our knowledge surrounding management of parasitic infections in travelers is extrapolated from evidence derived in endemic populations, or is based on expert opinion and case series. We herein provide an overview of parasitic diseases of short-term travelers, and summarize current therapeutic strategies for each illness.
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