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PURPOSE OF REVIEW: Neurocysticercosis (NCC) is still a significant contributor to neurological disease in vast regions of the world, and increasingly diagnosed in nonendemic countries because of travel and immigration from endemic settings. There is a need for clinicians in endemic and nonendemic regions to understand the complexities of its diagnosis and management. RECENT FINDINGS: Recent information on the performance and use of available imaging and immunodiagnostic tools as well as antiparasitic and anti-inflammatory therapeutic regimes were assessed. SUMMARY: Imaging and serology data should be assessed in the context of the specific type of NCC to improve diagnostic precision. In terms of therapeutic approaches, more controlled data is required on the efficacy and safety of combined antiparasitic therapy, and antiseizure and anti-inflammatory regimes should be optimized to minimize perilesional damage and reduce the risk of epilepsy.
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PURPOSE OF REVIEW: Cystic echinococcosis is a zoonotic infection frequently involving the liver. Treatment options, including surgery, are decided based on the staging of the disease. RECENT FINDINGS: Ultrasound is the cornerstone for diagnosis, staging, and follow-up of cystic echinococcosis. MRI can help to evaluate for cystobiliary complications and planning of the surgery. The two main surgical approaches for cystic echinococcosis include a radical approach, which entails a partial hepatectomy and total pericystectomy, and a conservative approach or endocystectomy. Recent data suggest a conservative approach is well tolerated with acceptable morbidity and no mortality. Recurrences in centers with experience are rare. Data on laparoscopic surgery is emerging, but long-term follow-up still needs to be improved. SUMMARY: Surgical treatment options should be carefully evaluated according to the cystic echinococcosis disease staging. A multidisciplinary approach, including diagnostic and interventional radiology, abdominal and liver surgery, and infectious diseases, results in better outcomes.
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Equinococose Hepática , Equinococose , Humanos , Equinococose Hepática/diagnóstico por imagem , Equinococose Hepática/cirurgia , Equinococose/diagnóstico por imagem , Equinococose/cirurgia , Hepatectomia/métodos , Estudos RetrospectivosRESUMO
PURPOSE OF REVIEW: The present review focuses on parasitic infections of the central nervous system (CNS) that can affect the international traveler. RECENT FINDINGS: The epidemiology of imported parasitic infections is changing and clinicians are treating increasing numbers of returned travelers with parasitic infections in the CNS with which they are not familiar. SUMMARY: The epidemiology, life cycle, clinical manifestations, diagnosis, and treatment of parasites that affect the CNS will be discussed.
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Infecções Parasitárias do Sistema Nervoso Central/diagnóstico , Viagem , Infecções Parasitárias do Sistema Nervoso Central/parasitologia , Infecções Parasitárias do Sistema Nervoso Central/patologia , Helmintíase/complicações , Humanos , Malária Falciparum/complicaçõesRESUMO
PURPOSE OF REVIEW: There is unprecedented movement of people across international borders and parasitic infections, previously restricted to endemic regions, are now encountered in nonendemic areas of the world. RECENT FINDINGS: Migrants may import parasitic infections acquired in their countries of origin. Increasingly, clinicians in nonendemic regions are faced with patients with neglected diseases such as Chagas disease, malaria and strongyloidiasis. There are gaps in knowledge among physicians in nonendemic regions, which lead to missed opportunities for preventive strategies and early treatment. Both primary care and infectious disease physicians should have a broad knowledge of common parasitic infections to improve health outcomes and decrease healthcare disparities through early identification and treatment of disease encountered in migrants. SUMMARY: Migrant health is still a young field in medicine; clinicians should be aware of diseases seen in migrants, and access both educational and clinical resources, including experts in tropical medicine, in order to reduce health disparities among migrants. Collaboration between primary care and infectious disease/tropical medicine experts should be strengthened.
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Doença de Chagas , Doenças Parasitárias , Migrantes , Medicina Tropical , Humanos , Doenças NegligenciadasRESUMO
PURPOSE OF REVIEW: Neurocysticercosis is the most common helminthic infection of the central nervous system caused by the larval stage of the pork tapeworm, Taenia solium. Endemic regions include Latin American countries, sub-Saharan Africa, and large regions of Asia, including the Indian subcontinent and is a global health problem. Seizures are the most common manifestation and approximately 30% of adult-onset seizures in endemic regions are attributable to NCC. Calcifications because of neurocysticercosis is the most common finding on imaging in endemic regions and are important seizure foci contributing to the burden of epilepsy. RECENT FINDINGS: After treatment with antiparasitics for multiple viable parenchymal disease, approximately 38% of cysts that resolved after 6 months of therapy will result in residual calcifications, which represents a significant burden of residual disease. Calcified disease has been referred to as 'inactive disease', but there is accumulating evidence to suggest that calcified granulomas are actually dynamic and substantially contribute to the development and maintenance of seizures. SUMMARY: Calcified parenchymal neurocysticercosis contributes significantly to the development and maintenance of seizures in endemic regions. Understanding the pathogenesis of the role of calcified NCC in seizure development and risk factors for development of calcifications after treatment is critical to decreasing the burden of symptomatic disease in endemic regions.
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Encéfalo/patologia , Calcinose/epidemiologia , Neurocisticercose/epidemiologia , Adulto , Animais , Antiparasitários/uso terapêutico , Encéfalo/diagnóstico por imagem , Encéfalo/parasitologia , Calcinose/diagnóstico por imagem , Calcinose/etiologia , Saúde Global , Humanos , Neurocisticercose/tratamento farmacológico , Neurocisticercose/parasitologia , Fatores de Risco , Convulsões/epidemiologia , Convulsões/etiologia , Taenia solium/isolamento & purificação , Tomografia Computadorizada por Raios X/métodosRESUMO
A 39-year-old female presented with a 5-day history of left inferonasal periocular swelling and associated intermittent itching. Ophthalmologic examination demonstrated a 4 × 8 mm subcutaneous painless mass localized anterior to the medial left lower orbital rim. An excision of the mass was performed, and pathology revealed Dirofilaria. The patient improved over the 3 months of postoperative follow-up. Although several human cases of pulmonary dirofilariasis have been reported in the United States, periocular dirofilariasis has been rarely reported in the United States. The case report is in compliance with the Health Insurance Portability and Accountability Act.
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Dirofilaria repens/isolamento & purificação , Dirofilariose/diagnóstico , Infecções Oculares Parasitárias/diagnóstico , Doenças Orbitárias/diagnóstico , Adulto , Animais , Diagnóstico Diferencial , Dirofilariose/cirurgia , Infecções Oculares Parasitárias/cirurgia , Feminino , Humanos , New York , Doenças Orbitárias/cirurgiaAssuntos
Neurocisticercose , Doenças dos Suínos , Taenia solium , Animais , Humanos , Neurocisticercose/diagnóstico por imagem , SuínosAssuntos
Doenças Transmissíveis Importadas/epidemiologia , Viagem , Medicina Tropical , Mudança Climática , Resistência Microbiana a Medicamentos , Emigração e Imigração , Saúde Global , Humanos , Neurocisticercose/epidemiologia , Tifo por Ácaros/epidemiologia , Clima Tropical , Febre Tifoide/epidemiologiaRESUMO
BACKGROUND: US residents make 60 million international trips annually. Family practice providers need to be aware of travel-associated diseases affecting this growing mobile population. OBJECTIVE: To describe demographics, travel characteristics and clinical diagnoses of US residents who present ill after international travel. METHODS: Descriptive analysis of travel-associated morbidity and mortality among US travellers seeking care at 1 of the 22 US practices and clinics participating in the GeoSentinel Global Surveillance Network from January 2000 to December 2012. RESULTS: Of the 9624 ill US travellers included in the analysis, 3656 (38%) were tourist travellers, 2379 (25%) missionary/volunteer/research/aid workers (MVRA), 1580 (16%) travellers visiting friends and relatives (VFRs), 1394 (15%) business travellers and 593 (6%) student travellers. Median (interquartile range) travel duration was 20 days (10-60 days). Pre-travel advice was sought by 45%. Hospitalization was required by 7%. Compared with other groups of travellers, ill MVRA travellers returned from longer trips (median duration 61 days), while VFR travellers disproportionately required higher rates of inpatient care (24%) and less frequently had received pre-travel medical advice (20%). Illnesses of the gastrointestinal tract were the most common (58%), followed by systemic febrile illnesses (18%) and dermatologic disorders (17%). Three deaths were reported. Diagnoses varied according to the purpose of travel and region of exposure. CONCLUSIONS: Returning ill US international travellers present with a broad spectrum of travel-associated diseases. Destination and reason for travel may help primary health care providers to generate an accurate differential diagnosis for the most common disorders and for those that may be life-threatening.
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Doenças Transmissíveis/epidemiologia , Vigilância de Evento Sentinela , Viagem/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Recém-Nascido , Internacionalidade , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto JovemAssuntos
Doenças Transmissíveis , Neurocisticercose , Medicina Tropical , Humanos , Higiene , Estados UnidosRESUMO
BACKGROUND: The continued increase in global migration compels clinicians to be aware of specific health problems faced by refugees, immigrants, and migrants (RIM). This analysis aimed to characterize RIM evaluated at GeoSentinel sites, their migration history, and infectious diseases detected through screening and diagnostic workups. METHODS: A case report form was used to collect data on demographics, migration route, infectious diseases screened, test results, and primary infectious disease diagnosis for RIM patients seen at GeoSentinel sites. Descriptive statistics were performed. RESULTS: Between October 2016 and November 2018, 5,319 RIM patients were evaluated at GeoSentinel sites in 19 countries. Africa was the region of birth for 2,436 patients (46 %), followed by the Americas (1,644, 31 %), and Asia (1,098, 21 %). Tuberculosis (TB) was the most common infection screened and reported as positive (853/2,273, 38 % positive by any method). TB, strongyloidiasis, and hepatitis B surface antigen positivity were observed across all migration administrative categories and regions of birth. Chagas disease was reported only among RIM patients from the Americas (393/394, 100 %) and schistosomiasis predominantly in those from Africa (480/510, 94 %). TB infection (694/5,319, 13 %) and Chagas disease (524/5,319, 10 %) were the leading primary infectious disease diagnoses. CONCLUSIONS: Several infections of long latency (e.g. TB, hepatitis B, and strongyloidiasis) with potential for long-term sequelae were seen among RIM patients across all migration administrative categories and regions of origin. Obtaining detailed epidemiologic information from RIM patients is critical to optimize detection of diseases of individual and public health importance, particularly those with long latency periods.
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Doença de Chagas , Emigrantes e Imigrantes , Hepatite B , Refugiados , Estrongiloidíase , Migrantes , Tuberculose , HumanosRESUMO
Parasites in the genus Blastocystis comprise several subtypes (genotypes) and have a worldwide distribution. In some surveys, these are the most common parasites found in human stool specimens. An emerging literature suggests that the pathogenicity of Blastocystis is related to specific subtypes and parasite burden, although even individuals with small numbers of cysts may be symptomatic. Some data suggest an association between infection with Blastocystis and irritable bowel syndrome. However, there are few clinical studies demonstrating a direct relationship between the presence of this parasite and disease, few animal models to explore this relationship, and no consensus as to appropriate treatment. We recommend that asymptomatic individuals with few cysts not be treated. However, those who have gastrointestinal or dermatologic signs and symptoms and many cysts in stool specimens may require treatment. Metronidazole is the drug of choice. Additional studies are required to determine pathogenicity and appropriate therapy.
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Antiprotozoários/uso terapêutico , Infecções por Blastocystis/tratamento farmacológico , Blastocystis/patogenicidade , Animais , Doenças Assintomáticas , Infecções por Blastocystis/parasitologia , Infecções por Blastocystis/patologia , Modelos Animais de Doenças , HumanosAssuntos
Encefalopatias/diagnóstico , Quarto Ventrículo/parasitologia , Neurocisticercose/diagnóstico , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Encefalopatias/complicações , Encefalopatias/parasitologia , Cistos do Sistema Nervoso Central/diagnóstico , Vértebras Cervicais/patologia , Diagnóstico Diferencial , Diplopia/etiologia , Feminino , Quarto Ventrículo/patologia , Cefaleia/etiologia , Humanos , Hidrocefalia/complicações , Hidrocefalia/diagnóstico , Hipertensão/complicações , Hipertensão/diagnóstico , Hipertensão Intracraniana/diagnóstico , Vértebras Lombares/patologia , Imageamento por Ressonância Magnética , Neurocisticercose/complicações , Neurocisticercose/patologia , Papiledema/etiologia , RadiografiaRESUMO
BACKGROUND: Coronavirus disease 2019 (COVID-19) is associated with a coagulopathy favouring thrombosis over bleeding that imparts a poor prognosis. Clot in transit (CIT) is considered a rare entity and the most severe form of venous thromboembolism (VTE), carrying a higher mortality than isolated pulmonary embolism (PE). The incidence of this phenomenon in patients with COVID-19 infection is unknown and likely under-recognized. CASE SUMMARY: During the peak of the COVID-19 pandemic in New York City, a 70-year-old Hispanic female presented with syncope due to a saddle PE further complicated by a highly mobile CIT. Polymerase chain reaction was positive for COVID-19 infection, however, there was no evidence of lung parenchymal involvement or hyper-inflammation. Based on consensus from a multidisciplinary team, aspiration thrombectomy was attempted to treat this extreme case of VTE, however, the patient died during the procedure. DISCUSSION: This case raises awareness to the most catastrophic form of VTE, presenting in an early phase of COVID-19 infection without the typical hyper-inflammation and severe lung injury associated with development of COVID-related coagulopathy. It also serves to inform on the critical role echocardiography has in the comprehensive evaluation and re-evaluation of hospitalized patients with COVID-19, and the importance of a multidisciplinary organized approach in clinical decision-making for this complex and poorly understood disease and its sequelae.
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BACKGROUND: Chagas disease, caused by the parasite Trypanosoma cruzi, once considered a disease confined to Mexico, Central America, and South America, is now an emerging global public health problem. An estimated 300 000 immigrants in the United States are chronically infected with T. cruzi. However, awareness of Chagas disease among the medical community in the United States is poor. METHODS: We review our experience managing 60 patients with Chagas disease in hospitals throughout the New York City metropolitan area and describe screening, clinical manifestations, EKG findings, imaging, and treatment. RESULTS: The most common country of origin of our patients was El Salvador (n = 24, 40%), and the most common detection method was by routine blood donor screening (n = 21, 35%). Nearly half of the patients were asymptomatic (n = 29, 48%). Twenty-seven patients were treated with either benznidazole or nifurtimox, of whom 7 did not complete therapy due to side effects or were lost to follow-up. Ten patients had advanced heart failure requiring device implantation or organ transplantation. CONCLUSIONS: Based on our experience, we recommend that targeted screening be used to identify at-risk, asymptomatic patients before progression to clinical disease. Evaluation should include an electrocardiogram, echocardiogram, and chest x-ray, as well as gastrointestinal imaging if relevant symptoms are present. Patients should be treated if appropriate, but providers should be aware of adverse effects that may prevent patients from completing treatment.
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Patients in the acute care setting often require referrals for post-hospital care. Before 2003, charts were copied manually and faxed to each nursing home separately, which was labor intensive, created delays, depended on legible notes, and did not ensure patient confidentiality. Social workers at our institution, in collaboration with 21 area nursing homes, successfully developed a program to streamline this process by using the electronic medical record and computer-assisted faxing. The patient's medical record (history/physical, nursing notes, pharmacy record, and therapy notes) was able to be transmitted quickly. This technology-assisted referral system had positive and successful outcomes, such as decreased length of stay, which resulted in an estimated cost savings of $2,008,512 per year.
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Correio Eletrônico/organização & administração , Alta do Paciente , Encaminhamento e Consulta/organização & administração , Serviço Hospitalar de Assistência Social/organização & administração , Humanos , Sistemas de Informação , Sistemas Computadorizados de Registros Médicos , Casas de Saúde/organização & administração , Telefac-SímileRESUMO
Neurocysticercosis is an infection of the central nervous system by the larval stage of the pork tapeworm Taenia solium. The combination of modern diagnostic tests, use of antiparasitic drugs, improved anti-inflammatory treatments, and minimally invasive neurosurgery has improved outcomes in patients with neurocysticercosis. This parasitic infection is complex in both the clinical presentation and the treatment approach, which depends on the number of cysts, location in the brain, stage of degeneration, and host inflammatory response. Therapeutic interventions for each location are different; therefore, principles for managing parenchymal disease cannot be applied to extraparenchymal disease and should be individualized.