RESUMO
BACKGROUND: American Cutaneous Leishmaniasis (ACL) shows variable response to therapy, but data on species-specific treatment efficacy is scarce. We describe the clinical characteristics and outcome of patients with ACL imported to a tertiary centre in Germany and determine whether species-specific therapy according to the 2014 "LeishMan" group recommendations is associated with cure. METHODS: A retrospective chart review was conducted at the Charité Institute of International Health in Berlin. We analysed data on PCR-confirmed ACL cases collected between 2000 and 2023. Systemic therapy included liposomal amphotericin B, miltefosine, pentavalent antimony, ketoconazole or itraconazole. Localized therapy included perilesional pentavalent antimony or paromomycin ointment. Cure was defined as re-epithelialization of ulcers or disappearance of papular-nodular lesions after 3 months of treatment. Logistic regression models were used to quantify the effect of species-specific systemic therapy on the outcome. RESULTS: 75 cases were analysed. Most patients were male (62%), median age was 35 years, no patient had a history of immunosuppression. The most common reason for travel was tourism (60%), the most common destination was Costa Rica (28%), the median duration of illness was 8 weeks, and most patients presented with ulcers (87%). Lesions were complex in 43%. The most common Leishmania (L.) species was L. braziliensis (28%), followed by L. panamensis (21%). 51/73 (70%) patients were cured after initial therapy and 17/21 (81%) after secondary therapy. Cure after systemic therapy was more frequent when species-specific treatment recommendations were followed (33/45; 73%), compared to when not followed, (6/17; 35%, P = 0.008). This association was independent of age, sex, previous therapy, complex lesions, and Leishmania species (adjusted OR, 5.06; 95% CI, 1.22-24.16). CONCLUSIONS: ACL is a rare, imported disease in Germany. Complex lesions were common, challenging successful therapy. This study highlights the importance of identifying the parasite species and suggests that a species-specific approach to treatment leads to better outcomes.
Assuntos
Antiprotozoários , Leishmaniose Cutânea , Humanos , Masculino , Feminino , Adulto , Leishmaniose Cutânea/tratamento farmacológico , Leishmaniose Cutânea/epidemiologia , Estudos Retrospectivos , Pessoa de Meia-Idade , Antiprotozoários/uso terapêutico , Adulto Jovem , Berlim/epidemiologia , Adolescente , Resultado do Tratamento , Anfotericina B/uso terapêutico , Viagem , Doenças Transmissíveis Importadas/parasitologia , Doenças Transmissíveis Importadas/epidemiologia , Doenças Transmissíveis Importadas/tratamento farmacológico , Idoso , Leishmania/classificação , Leishmania/efeitos dos fármacos , Leishmania/isolamento & purificação , Criança , Fosforilcolina/análogos & derivadosRESUMO
BACKGROUND: Acute schistosomiasis occurs most often in travelers to endemic regions. The aim of the study is to describe the epidemiological, clinical and parasitological characteristics of patients with schistosomiasis acquired during an international travel. METHODS: Observational retrospective study including all travel-related schistosomiasis cases seen at the International Health Unit Vall d'Hebron-Drassanes (Barcelona, Spain) from 2009 to 2022. Diagnosis of schistosomiasis was defined by the presence of Schistosoma eggs in stools or urine or the positivity of a serological test. We collected demographic, epidemiological, clinical, parasitological, and therapeutic information. RESULTS: 917 cases of schistosomiasis were diagnosed, from whom 96 (10.5 %) were travel-related. Mean age of the patients was 34.9 years, and 53.1 % were women. Median duration of the travel was 72 days, and geographical areas where travelers had contact with fresh water were Africa (82.3 %), Asia (12.5 %), and South America (5.2 %). Twenty (20.8 %) patients reported having had some clinical symptom, being gastrointestinal symptoms the most frequent. Two patients developed the classical Katayama syndrome. In eleven (11.5 %) cases eggs were observed in urine or feces samples, and 85 (88.5 %) cases were diagnosed by a positive serology. Ninety-one (94.8 %) patients received treatment with praziquantel with different therapeutic schemes. The two patients with Katayama syndrome received concomitant treatment with corticosteroids. CONCLUSIONS: Schistosomiasis in travelers represented 10 % of the overall schistosomiasis cases in our center. Increasing the awareness in the pre-travel advice and implementing specific screening in those travelers at risk (long travelers, contact with fresh water) could reduce the incidence and associated morbidity in this group.
Assuntos
Esquistossomose , Viagem , Medicina Tropical , Humanos , Espanha/epidemiologia , Feminino , Masculino , Estudos Retrospectivos , Adulto , Esquistossomose/epidemiologia , Esquistossomose/diagnóstico , Esquistossomose/tratamento farmacológico , Pessoa de Meia-Idade , Praziquantel/uso terapêutico , Doenças Transmissíveis Importadas/epidemiologia , Doenças Transmissíveis Importadas/parasitologia , Doenças Transmissíveis Importadas/diagnóstico , Doenças Transmissíveis Importadas/tratamento farmacológico , Fezes/parasitologia , Animais , Anti-Helmínticos/uso terapêutico , Adulto Jovem , AdolescenteRESUMO
BACKGROUND: Imported malaria parasites with anti-malarial drug resistance (ADR) from Africa is a serious public health challenge in non-malarial regions, including Wuhan, China. It is crucial to assess the ADR status in African Plasmodium falciparum isolates from imported malaria cases, as this will provide valuable information for rational medication and malaria control. METHODS: During 2017-2019, a cross-sectional study was carried out in Wuhan, China. Peripheral blood 3 ml of returned migrant workers from Africa was collected. The target fragments from pfcrt, pfmdr1, and k13 propeller (pfk13) genes were amplified, sequenced, and analysed. RESULTS: In total, 106 samples were collected. Subsequently, 98.11% (104/106), 100% (106/106), and 86.79% (92/106) of these samples were successfully amplified and sequenced for the pfcrt (72-76), pfmdr1, and pfk13 genes, respectively. The prevalence of the pfcrt 76 T, pfmdr1 86Y, and pfmdr1 184F mutations was 9.62, 4.72, and 47.17%, respectively. At codons 72-76, the pfcrt locus displayed three haplotypes, CVMNK (wild-type), CVIET (mutation type), CV M/I N/E K/T (mixed type), with 87.50%, 9.62%, and 2.88% prevalence, respectively. For the pfmdr1 gene, NY (wild type), NF and YF (mutant type), N Y/F, Y Y/F, and N/Y Y/F (mixed type) accounted for 34.91, 43.40, 3.77, 15.09, 0.94, and 1.89% of the haplotypes, respectively. A total of 83 isolates with six unique haplotypes were found in pfcrt and pfmdr1 combined haplotypes, of which NY-CVMNK and NF-CVMNK accounted for 40.96% (34/83) and 43.37% (36/83), respectively. Furthermore, 90 cases were successfully sequenced (84.91%, 90/106) at loci 93, 97, 101, and 145, and 78 cases were successfully sequenced (73.58%, 78/106) at loci 343, 353, and 356 for pfcrt. However, the mutation was observed only in locus 356 with 6.41%. For pfk13, mutations reported in Southeast Asia (at loci 474, 476, 493, 508, 527, 533, 537, 539, 543, 553, 568, 574, 578, and 580) and Africa (at loci 550, 561, 575, 579, and 589) were not observed. CONCLUSIONS: The present data from pfcrt and pfmdr1 demonstrate that anti-malarial drugs including chloroquine, amodiaquine, and mefloquine, remain effective against malaria treatment in Africa. The new mutations in pfcrt related to piperaquine resistance remain at relatively low levels. Another source of concern is the artemether-lumefantrine resistance-related profiles of N86 and 184F of pfmdr1. Although no mutation in pfk13 is detected, molecular surveillance must continue.
Assuntos
Proteínas de Membrana Transportadoras/genética , Proteínas Associadas à Resistência a Múltiplos Medicamentos/genética , Mutação , Plasmodium falciparum/genética , Polimorfismo Genético , Proteínas de Protozoários/genética , África , Antimaláricos/uso terapêutico , China , Doenças Transmissíveis Importadas/tratamento farmacológico , Estudos Transversais , Malária Falciparum/tratamento farmacológico , Proteínas de Membrana Transportadoras/metabolismo , Proteínas Associadas à Resistência a Múltiplos Medicamentos/metabolismo , Mutação/efeitos dos fármacos , Plasmodium falciparum/efeitos dos fármacos , Polimorfismo de Nucleotídeo Único , Proteínas de Protozoários/metabolismoAssuntos
Doenças Transmissíveis Importadas/epidemiologia , Leishmaniose Cutânea/epidemiologia , Anfotericina B/uso terapêutico , Animais , Gluconato de Antimônio e Sódio/uso terapêutico , Antiprotozoários/uso terapêutico , China/epidemiologia , Doenças Transmissíveis Importadas/tratamento farmacológico , Doenças Transmissíveis Importadas/parasitologia , DNA de Cinetoplasto/análise , Humanos , Leishmaniose Cutânea/tratamento farmacológico , Leishmaniose Cutânea/parasitologia , Fosforilcolina/análogos & derivados , Fosforilcolina/uso terapêutico , Psychodidae/parasitologiaRESUMO
BACKGROUND: Species-directed therapy of leishmaniasis has been recommended for travelers since 2014, but little is known about species distribution and treatment practices in non-endemic countries. We aimed to describe leishmaniasis cases in Belgium since species typing became available and evaluate its impact on patient management. METHOD: Retrospective analysis of all patients diagnosed by PCR at our national reference laboratory from 2010 to 2018. Species were typed by Hsp-70 sequencing. RESULTS: We identified 18 visceral leishmaniasis (VL) and 147 (muco)cutaneous leishmaniasis ((M)CL) cases. VL was exclusively due to L. infantum and consistently treated with liposomal amphotericin B, with four observed failures. (M)CL was caused by ten different species. Of 62 cases diagnosed and species typed after 2014 with timing information, 28 (45.2%) were treated before the species result was available. Therapy was not species-directed in 10/32(28.1%) of those treated after species identification. Patients treated according to the guidelines tended to have a favorable outcome more often than those who were not (36/44, 81.8% versus 8/19, 57.9%; p = 0.045). CONCLUSIONS: In contrast to VL, various species caused (M)CL in our setting and species result was often not considered for treatment. Outcome tended to be better however when therapy was species-directed.
Assuntos
Antibacterianos/uso terapêutico , Leishmaniose Cutânea/diagnóstico , Leishmaniose Cutânea/epidemiologia , Leishmaniose Visceral/diagnóstico , Leishmaniose Visceral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bélgica , Criança , Pré-Escolar , Doenças Transmissíveis Importadas/diagnóstico , Doenças Transmissíveis Importadas/tratamento farmacológico , Doenças Transmissíveis Importadas/epidemiologia , DNA Bacteriano , Feminino , Humanos , Leishmania/classificação , Leishmania/isolamento & purificação , Leishmaniose Cutânea/tratamento farmacológico , Leishmaniose Visceral/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Tipagem Molecular , Reação em Cadeia da Polimerase , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Viagem , Resultado do Tratamento , Adulto JovemRESUMO
The demographic features, epidemiology, diagnosis and treatment of two cases with falciparum malaria imported into Suzhou City in 2019 were reported. These findings indicate a risk of imported malaria in visitors besides high prevalence in migrant labors, and much attention should be paid to children that are at a high risk of infections.
Assuntos
Malária Falciparum , Criança , China/epidemiologia , Cidades , Doenças Transmissíveis Importadas/diagnóstico , Doenças Transmissíveis Importadas/tratamento farmacológico , Doenças Transmissíveis Importadas/epidemiologia , Doenças Transmissíveis Importadas/parasitologia , Humanos , Malária Falciparum/diagnóstico , Malária Falciparum/tratamento farmacológico , Malária Falciparum/epidemiologia , Malária Falciparum/prevenção & controle , PrevalênciaRESUMO
BACKGROUND: Plasmodium falciparum malaria (P.f. malaria) is frequently imported to non-endemic countries. Recommendations on outpatient treatment differ largely due to differences in country-level guidelines and even between tropical medicine referral centres within the same country. METHODS: This survey among experts from TropNet or GeoSentinel referral centres for tropical medicine outside malaria endemic areas investigated common practices in P.f. malaria management, selection criteria for outpatient management and diagnostic procedures as a first step for developing a future common and evidence-based approach. RESULTS: A total of 44 referral centres participated. Most of the centres are located in Europe (n = 37). Overall, 27 centres (61%) treat uncomplicated P.f. malaria patients as outpatients, of which eight centres (18%) reported treating ≥75% of patients on an outpatient basis. Seventeen centres (39%) reported treating patients only as inpatients. No single criterion stands out for the decision regarding outpatient treatment, but three groups of factors were identified: (i) clinical criteria including laboratory parameters, clinical condition and tolerance of oral medication; (ii) factors such as patient compliance, reachability by phone and support at home and (iii) patient origin and place of residence as a proxy for possible underlying semi-immunity. The threshold parasitaemia for outpatient treatment varied from 0.1 to 5% with a median of 2%. A median of 0.5% of outpatients were admitted during follow-up. During the last 10 years, 33 complications were reported by nine of the 27 centres and three deaths by one centre. CONCLUSION: This study gives insight into the heterogeneous management of P.f. malaria patients outside endemic regions. Although there is no consensus among experts, the majority of centres includes outpatient treatment in their clinical routine. However, the lack of evidence-based criteria and established safety for this approach shows the need for prospective studies to define and evaluate criteria and practices for safe outpatient management.
Assuntos
Assistência Ambulatorial , Antimaláricos , Doenças Transmissíveis Importadas , Malária Falciparum , Medicina Tropical , Assistência Ambulatorial/estatística & dados numéricos , Antimaláricos/uso terapêutico , Doenças Transmissíveis Importadas/tratamento farmacológico , Europa (Continente) , Humanos , Malária Falciparum/tratamento farmacológico , Malária Falciparum/epidemiologia , Plasmodium falciparum , Estudos Prospectivos , Medicina Tropical/estatística & dados numéricosRESUMO
We reported two cases with community-acquired pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who returned from Wuhan, China in January, 2020. The reported cases highlight non-specific clinical presentations of 2019 novel coronavirus disease (COVID-19) as well as the importance of rapid laboratory-based diagnosis.
Assuntos
Betacoronavirus/isolamento & purificação , Doenças Transmissíveis Importadas/diagnóstico , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Idoso , Antivirais/uso terapêutico , COVID-19 , China , Doenças Transmissíveis Importadas/tratamento farmacológico , Doenças Transmissíveis Importadas/virologia , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/virologia , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/patologia , Feminino , Humanos , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/patologia , SARS-CoV-2 , Taiwan , ViagemRESUMO
Globalization has contributed to the emergence of specific parasitic diseases in novel geographical areas, and in these regions, these infections in travelers and immigrants may cause a considerable burden of disease. Timely diagnosis and treatment of protozoan infections to decrease mortality and prevent associated complications are essential. In this respect, the increased availability of specific DNA-detection procedures has improved the diagnosis of many imported parasitic infections. Travelers and immigrants with associated comorbidities or immunosuppression may pose a special challenge regarding management. An updated review of the main protozoan infections in mobile populations (malaria, Chagas disease, leishmaniasis, enteric protozoan infections) is provided, focusing on the changing epidemiology of these diseases, recent developments in diagnosis and management and the possibility of local transmission of imported infections.
Assuntos
Doenças Transmissíveis Importadas , Emigrantes e Imigrantes , Infecções por Protozoários , Viagem , Amebíase/diagnóstico , Amebíase/tratamento farmacológico , Amebíase/epidemiologia , Amebíase/transmissão , Antiprotozoários/uso terapêutico , Doenças Transmissíveis Importadas/diagnóstico , Doenças Transmissíveis Importadas/tratamento farmacológico , Doenças Transmissíveis Importadas/epidemiologia , Doenças Transmissíveis Importadas/transmissão , Criptosporidiose/diagnóstico , Criptosporidiose/tratamento farmacológico , Criptosporidiose/epidemiologia , Criptosporidiose/transmissão , Ciclosporíase/diagnóstico , Ciclosporíase/tratamento farmacológico , Ciclosporíase/epidemiologia , Ciclosporíase/transmissão , Giardíase/diagnóstico , Giardíase/tratamento farmacológico , Giardíase/epidemiologia , Giardíase/transmissão , Humanos , Leishmaniose/diagnóstico , Leishmaniose/tratamento farmacológico , Leishmaniose/epidemiologia , Leishmaniose/transmissão , Malária/diagnóstico , Malária/tratamento farmacológico , Malária/epidemiologia , Malária/transmissão , Infecções por Protozoários/diagnóstico , Infecções por Protozoários/tratamento farmacológico , Infecções por Protozoários/epidemiologia , Infecções por Protozoários/transmissãoRESUMO
BACKGROUND: Imported loiasis is a rare cause of consultation at the return of stay in central Africa, which often poses difficult diagnostic and therapeutic questions to practitioners especially those who are unaccustomed to tropical medicine. These difficulties can lead to risks for the patients especially if inappropriate treatment is given. Large series of imported loiasis are scarce. METHODS: We retrospectively studied the data including outcome in patients diagnosed with imported loiasis between 1993 and 2013 in the Paris area on the basis of a parasitological diagnosis (microfilaremia > 1/ml and/or serologic tests). We compared sub-Saharan and non sub-Saharan African patients. RESULTS: Of the 177 identified cases, 167 could be analysed. Sex ratio was 1, mean age 41 years and 83% were sub-Saharan Africans. Cameroon was the main country of exposure (62%). Incubation time may be long (up to 18 months). Of the 167 cases, 57% presented with characteristic symptoms (Calabar swellings, creeping dermatitis, eyeworm) whereas 43% were diagnosed fortuitously. Microfilaremia was evidenced in 105 patients (63%), and specific antibodies in 53%. Compared to sub-Saharan Africans, other patients were presenting less frequently with eyeworm migration and microfilaremia whereas they had higher eosinophilia and positive serology. Prevalence of Calabar swellings was not significantly different between the two groups. Cure rates were 52% with ivermectin alone, and 77% with ivermectin followed by diethylcarbamazine. No severe adverse event was reported. CONCLUSIONS: Presentation of imported loiasis varies according to ethnicity. A systematic screening should be recommended in patients with potential exposure in endemic country. Treatment with ivermectin followed by diethylcarbamazine could be a valuable option.
Assuntos
População Negra , Doenças Transmissíveis Importadas/etnologia , Doenças Transmissíveis Importadas/epidemiologia , Loa/imunologia , Loíase/etnologia , Loíase/epidemiologia , Adolescente , Adulto , África do Norte/etnologia , Animais , Criança , Pré-Escolar , Doenças Transmissíveis Importadas/diagnóstico , Doenças Transmissíveis Importadas/tratamento farmacológico , Dietilcarbamazina/uso terapêutico , Feminino , Humanos , Lactente , Recém-Nascido , Ivermectina/uso terapêutico , Loíase/diagnóstico , Loíase/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Paris/epidemiologia , Prevalência , Estudos Retrospectivos , Resultado do Tratamento , Medicina Tropical , Adulto JovemRESUMO
Since the 2007 French guidelines on imported Falciparum malaria, the epidemiology, treatment, and prevention of malaria have changed considerably requiring guidelines for all Plasmodium species to be updated. Over the past decade, the incidence of imported malaria has decreased in all age groups, reflecting the decrease in the incidence of malaria in endemic areas. The rates of severe pediatric cases have increased as in adults, but fatalities are rare. The parasitological diagnosis requires a thick blood smear (or a rapid immunochromatographic test) and a thin blood film. Alternatively, a rapid antigen detection test can be paired with a thin blood film. Thrombocytopenia in children presenting with fever is highly predictive of malaria following travel to a malaria-endemic area and, when detected, malaria should be strongly considered. The first-line treatment of uncomplicated P. falciparum malaria is now an artemisinin-based combination therapy (ACT), either artemether-lumefantrine or artenimol-piperaquine, as recommended by the World Health Organization in endemic areas. Uncomplicated presentations of non-falciparum malaria should be treated either with chloroquine or ACT. The first-line treatment of severe malaria is now intravenous artesunate which is more effective than quinine in endemic areas. Quinine is restricted to cases where artesunate is contraindicated or unavailable. Prevention of malaria in pediatric travelers consists of nocturnal personal protection against mosquitoes (especially insecticide-treated nets) combined with chemoprophylaxis according to the risk level.
Assuntos
Doenças Transmissíveis Importadas/tratamento farmacológico , Doenças Transmissíveis Importadas/prevenção & controle , Malária/prevenção & controle , Antimaláricos/uso terapêutico , Criança , Árvores de Decisões , França , Humanos , Guias de Prática Clínica como Assunto , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Although malaria remains one of the major public health threats in inter-tropical areas, there is limited understanding of imported malaria in children by paediatricians and emergency practitioners in non-endemic countries, often resulting in misdiagnosis and inadequate treatment. Moreover, classical treatments (atovaquone-proguanil, quinine, mefloquine) are limited either by lengthy treatment courses or by side effects. Since 2010, the World Health Organization (WHO) has recommended the use of oral artemisinin-based combination therapy for the treatment of uncomplicated Plasmodium falciparum malaria worldwide. The benefits of artenimol-piperaquine in children have been validated in endemic countries but experience remains limited in cases of imported malaria. METHODS: This prospective observational study in routine paediatric care took place at the Emergency Department, Robert-Debré Hospital (Paris, France) from September 2012 to December 2014. Tolerance and efficacy of artenimol-piperaquine in children presenting with the following inclusion criteria were assessed: P. falciparum positive on thin or thick blood smear; and the absence of WHO-defined features of severity. RESULTS: Among 83 children included in this study, treatment with artenimol-piperaquine was successful in 82 children (98.8%). None of the adverse events were severe and all were considered mild with no significant clinical impact. This also applied to cardiological adverse events despite a significant increase of the mean post-treatment QTc interval. CONCLUSION: Artenimol-piperaquine displays a satisfying efficacy and tolerance profile as a first-line treatment for children with imported uncomplicated falciparum malaria and only necessitates three once-daily oral intakes of the medication. Comparative studies versus artemether-lumefantrine or atovaquone-proguanil would be useful to confirm the results of this study.
Assuntos
Artemisininas/uso terapêutico , Doenças Transmissíveis Importadas/tratamento farmacológico , Malária Falciparum/tratamento farmacológico , Quinolinas/uso terapêutico , Adolescente , Criança , Pré-Escolar , Doenças Transmissíveis Importadas/parasitologia , Quimioterapia Combinada , Serviço Hospitalar de Emergência , Feminino , Humanos , Lactente , Malária Falciparum/diagnóstico , Masculino , Estudos Prospectivos , Resultado do TratamentoRESUMO
In spite of the fact that Plasmodium vivax is the leading causative agent of malaria in our country, imported malaria cases have been reported, recently. In this report, two malaria cases originated from sub-Saharan Africa, and their diagnostic and therapeutic approaches were aimed to be presented. First case, 45-year-old male, who has been working in Republic of Ghana, was admitted to Hacettepe University Hospitals Emergency Service with complaints of fever, sweating and shivering, after returning to Turkey. On admission, his general condition was fine and his physical examination revealed no pathological finding. After his admission, a fever episode occured and his blood tests revealed anemia, trombocytopenia and increased alkaline phosphatase level. Second case, 39-year-old-male admitted to the emergency service with the complaints of fever, shivering and myalgia. His physical examination revealed decreased breath sounds and splenomegaly, his laboratory tests resulted in pansitopenia and elevated liver enzymes. In the thick blood smears of the patients ring formed young trophozoites are detected and in the thin films multiple ring forms demonstrated in one erythrocyte with the absence of mature trophozoites and schizont forms, which were compatible with falciparum malaria. The rapid antigen test (Digamed, Belgium) of the second case found to be positive for both Plasmodium falciparum and P.vivax and this patient followed-up in intensive care unit due to his deterioration of general condition, respiratory distress, hematuria and change of consciousness. Neither cases were commenced on malaria prophylaxis. Both patients have been in countries which chloroquine resistance is commonly seen, they were treated with artemether/lumefantrine as current World Health Organization recommended. Targeting hypnozoites of P.vivax, primaquine was added to the therapy of the second patient. Both patients resulted in cure. In conclusion, while travelling to endemic countries, people should be informed about the importance of malaria prophylaxis and prophylaxis should be commenced immediately and continued appropriately. Additionally, malaria should always be considered in the differential diagnosis of high fever for the patients who admitted to the hospital with a travelling history to these countries.
Assuntos
Antimaláricos , Combinação Arteméter e Lumefantrina , Malária , Primaquina , Adulto , África Subsaariana , Antimaláricos/uso terapêutico , Combinação Arteméter e Lumefantrina/uso terapêutico , Doenças Transmissíveis Importadas/diagnóstico , Doenças Transmissíveis Importadas/tratamento farmacológico , Doenças Transmissíveis Importadas/parasitologia , Doenças Transmissíveis Importadas/prevenção & controle , Humanos , Malária/diagnóstico , Malária/tratamento farmacológico , Malária/parasitologia , Malária/prevenção & controle , Masculino , Pessoa de Meia-Idade , Plasmodium falciparum , Plasmodium vivax , Primaquina/uso terapêutico , Viagem , Resultado do Tratamento , TurquiaRESUMO
OBJECTIVE: To report the diagnosis and treatment of an imported case of schistosomiasis haematobia. METHODS: The patient's medical records were collected, and the clinical features, laboratory diagnosis, epidemiological survey, diagnosis and treatment were analyzed. RESULTS: The patient had arrived to Sudan and Egypt for many times and had a history of contact with the infested water. After returning to China, the patient reported a gross hematuria with unknown causes. Cystoscopy showed neoplasms in the bladder, and pathologic examinations showed chronic granulomatous inflammation with infiltration of plenty of plasma cells, and parasite eggs. Serological test showed positive for the dipstick dye immunoassay, and the microscopic examination of urine sediment revealed Schistosoma haematobium eggs. Following praziquantel treatment for a month, S. haematobium eggs were still detected in the urine. The case was treated with praziquantel again and cured without adverse reactions. CONCLUSIONS: Health education should be strengthened among China-aid-African workers to improve the awareness of self-protection. In addition, the diagnosis and treatment should be improved in medical professionals to achieve a timely definitive diagnosis.
Assuntos
Doenças Transmissíveis Importadas , Praziquantel , Esquistossomose Urinária , Animais , Anti-Helmínticos/uso terapêutico , China , Doenças Transmissíveis Importadas/diagnóstico , Doenças Transmissíveis Importadas/tratamento farmacológico , Doenças Transmissíveis Importadas/urina , Humanos , Praziquantel/uso terapêutico , Schistosoma haematobium , Esquistossomose Urinária/diagnóstico , Esquistossomose Urinária/tratamento farmacológico , Esquistossomose Urinária/urina , Resultado do TratamentoRESUMO
BACKGROUND: Intravenous artesunate (ivA) is the standard treatment for severe malaria. Data systematically evaluating the use of ivA in pediatric patients outside malaria-endemic regions are limited. The aim of this case series was to summarize efficacy and safety of ivA for imported severe malaria in children in Germany. METHODS: Our retrospective case series included pediatric patients with imported severe malaria treated with at least 1 dose of ivA (Artesun, Guilin Pharmaceutical; Shanghai, China) at 4 German tertiary care centers. Severe malaria was defined according to World Health Organization criteria. RESULTS: Between 2010 and 2018, 14 children with a median [interquartile range (IQR)] age of 6 (1;9.5) years were included. All children were of African descent. All but 2 patients had Plasmodium falciparum malaria; 1 child had P. vivax malaria and 1 child had P. falciparum and P. vivax co-infection. Median (IQR) parasitemia at admission in patients with P. falciparum was 9.5% (3;16.5). Patients were treated with 1-10 [median (IQR) 3 (3;4)] doses ivA. All but one patient received a full course of oral antimalarial treatment. Parasite clearance was achieved within 2-4 days, with the exception of 1 patient with prolonged clearance of peripheral parasitemia. Three patients experienced posttreatment hemolysis but none needed blood transfusion. Otherwise ivA was safe and well tolerated. CONCLUSIONS: ivA was highly efficacious in this pediatric cohort. We observed episodes of mild to moderate posttreatment hemolysis in approximately one-third of patients. The legal status and usage of potentially lifesaving ivA should be evaluated in Europe.
Assuntos
Antimaláricos/uso terapêutico , Artesunato/uso terapêutico , Malária Falciparum/tratamento farmacológico , Malária Vivax/tratamento farmacológico , Doença Aguda/terapia , Administração Intravenosa , Adolescente , Antimaláricos/administração & dosagem , Artesunato/administração & dosagem , Criança , Pré-Escolar , Doenças Transmissíveis Importadas/tratamento farmacológico , Doenças Transmissíveis Importadas/parasitologia , Feminino , Alemanha , Humanos , Lactente , Masculino , Parasitemia/tratamento farmacológico , Estudos Retrospectivos , Centros de Atenção TerciáriaAssuntos
Antibacterianos/farmacologia , Doenças Transmissíveis Importadas/diagnóstico , Doenças Transmissíveis Importadas/microbiologia , Farmacorresistência Bacteriana Múltipla , Infecções por Salmonella/diagnóstico , Salmonella typhi/efeitos dos fármacos , Adolescente , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Doenças Transmissíveis Importadas/tratamento farmacológico , Haplótipos , Humanos , Infecções por Salmonella/tratamento farmacológico , Salmonella typhi/genéticaRESUMO
We describe the outcomes of 16 cases of imported loiasis in Italy. Patients had microfilaremia <20,000/mL and were treated with high-dose albendazole for 28 days and a single dose of ivermectin. This combination might be an effective treatment option in nonendemic areas, when diethylcarbamazine, the drug of choice, is not available.
Assuntos
Albendazol/administração & dosagem , Antiprotozoários/administração & dosagem , Doenças Transmissíveis Importadas/tratamento farmacológico , Doenças Transmissíveis Importadas/parasitologia , Ivermectina/administração & dosagem , Loíase/tratamento farmacológico , Adolescente , Adulto , Idoso , Biomarcadores , Quimioterapia Combinada , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Itália , Loíase/parasitologia , Masculino , Pessoa de Meia-Idade , Avaliação de Sintomas , Resultado do Tratamento , Adulto JovemRESUMO
Background: The referral and treatment outcomes of tuberculosis (TB) patients referred from Japan to the Philippines have not yet been systematically reported. This study aimed to describe the cross-border referral process for TB patients referred from Japan to the Philippines. Methods: This is a retrospective descriptive review of the referral process between the two countries. The data on the pathways of Filipino patients with TB or latent TB infection initially treated in Japan from 2009 to mid-2018 were summarized. We calculated the proportion of the referred-and-accessed and that of the successfully treated in the health facilities in the Philippines. The Chi-square test or Fisher's exact test was applied to test significant differences between categorical data. Results: Among the 36 Filipino TB patients referred, 83.3% (30 patients) were successful in accessing any of the health facilities. Among these, 28 patients confirmed that they had started TB treatment in the Philippines. Age groups (P = 0.17), gender (P = 0.76), planned place of residence (P = 0.44), bacteriological results (P = 0.81), and TB patient types (P = 0.96) did not show any significant differences in the referred-and-access rate. The treatment success rate among the 23 TB patients (excluding five patients who were still receiving treatment as of writing) was 91.3%. However, only three out of five multidrug-resistant TB patients successfully started treatment. Conclusions: The current cross-border TB patient referral mechanism between Japan and the Philippines indicated successful results. However, it needs to be enhanced by strengthening the mechanism to track referral outcomes systemically.
Assuntos
Continuidade da Assistência ao Paciente/estatística & dados numéricos , Encaminhamento e Consulta , Viagem , Tuberculose/tratamento farmacológico , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Doenças Transmissíveis Importadas/tratamento farmacológico , Doenças Transmissíveis Importadas/microbiologia , Continuidade da Assistência ao Paciente/normas , Feminino , Humanos , Lactente , Japão , Masculino , Pessoa de Meia-Idade , Filipinas , Estudos Retrospectivos , Resultado do Tratamento , Tuberculose/diagnóstico , Adulto JovemRESUMO
OBJECTIVE: To perform epidemiological survey and laboratory diagnosis of a Plasmodium ovale malaria case imported into Hefei City, so as to provide scientific evidence for the prevention and control of imported malaria in the future. METHODS: The epidemiological history and clinical data of the imported malaria case were collected and analyzed. RESULTS: The patient returned to China from Mozambique, and was admitted to the hospital due to repeated fever several months after returning to China. Rapid diagnostic test (RDT) suggested non-P. falciparum infection, and microscopy displayed normal or slightly swelled malaria parasite-infected erythrocytes, unapparent serrated changes, increased cytoplasm in large trophozoite with irregular morphology, and almost no vacuoles. qPCR assay revealed P. ovale infection. CONCLUSIONS: Clinical medical professionals should improve their awareness of malaria diagnosis in people with a history of living or working in overseas malaria-epidemic areas, and early and rational administration of antimalarials should be given promptly to prevent the spread of malaria epidemics.