Economic Analysis of the Impact of Overseas and Domestic Treatment and Screening Options for Intestinal Helminth Infection among US-Bound Refugees from Asia.

BACKGROUND: Many U.S.-bound refugees travel from countries where intestinal parasites (hookworm, Trichuris trichuria, Ascaris lumbricoides, and Strongyloides stercoralis) are endemic. These infections are rare in the United States and may be underdiagnosed or misdiagnosed, leading to potentially serious consequences. This evaluation examined the costs and benefits of combinations of overseas presumptive treatment of parasitic diseases vs. domestic screening/treating vs. no program. METHODS: An economic decision tree model terminating in Markov processes was developed to estimate the cost and health impacts of four interventions on an annual cohort of 27,700 U.S.-bound Asian refugees: 1) "No Program," 2) U.S. "Domestic Screening and Treatment," 3) "Overseas Albendazole and Ivermectin" presumptive treatment, and 4) "Overseas Albendazole and Domestic Screening for Strongyloides". Markov transition state models were used to estimate long-term effects of parasitic infections. Health outcome measures (four parasites) included outpatient cases, hospitalizations, deaths, life years, and quality-adjusted life years (QALYs). RESULTS: The "No Program" option is the least expensive ($165,923 per cohort) and least effective option (145 outpatient cases, 4.0 hospitalizations, and 0.67 deaths discounted over a 60-year period for a one-year cohort). The "Overseas Albendazole and Ivermectin" option ($418,824) is less expensive than "Domestic Screening and Treatment" ($3,832,572) or "Overseas Albendazole and Domestic Screening for Strongyloides" ($2,182,483). According to the model outcomes, the most effective treatment option is "Overseas Albendazole and Ivermectin," which reduces outpatient cases, deaths and hospitalization by around 80% at an estimated net cost of $458,718 per death averted, or $2,219/$24,036 per QALY/life year gained relative to "No Program". DISCUSSION: Overseas presumptive treatment for U.S.-bound refugees is a cost-effective intervention that is less expensive and at least as effective as domestic screening and treatment programs. The addition of ivermectin to albendazole reduces the prevalence of chronic strongyloidiasis and the probability of rare, but potentially fatal, disseminated strongyloidiasis.

18F-FDG PET/CT in a case of parasite infection mimicking lung and breast malignancy.

A 51-year-old woman with dyspnea on exertion, fever, pleural effusion, and pericardial thickening underwent F-FDG PET/CT, which revealed focal hypermetabolic lesions in the right lung and left breast. The histopathology of the lesions was compatible with infiltration of inflammatory cells. Blood eosinophil counts were elevated, and enzyme-linked immunoassays were positive for antibodies to several parasites. After antiparasite medication, blood eosinophil counts were normalized, and PET/CT demonstrated complete disappearance of abnormal FDG accumulation in the lung and breast.

CT features of intraperitoneal manifestations of parasitic infestation.

OBJECTIVE: The purpose of this study was to evaluate the CT features of intraperitoneal manifestations with parasitic infestation in nine patients. CONCLUSION: The CT features of intraperitoneal manifestations of parasitic infestation were single or multiple multiseptated cystic masses in the peritoneal cavity, hazy omental infiltration, or both. Recognizing these features is important to establish an early diagnosis that leads to rapid treatment and helps avoid unnecessary surgery.

[Interventional radiology of the digestive system]. / La radiologia interventistica nell'apparato digerente.

The authors report on the use of interventional radiology modalities in the treatment of some gastrointestinal diseases (intussusception, stenosis, hemorrhage, etc). The results are compared with literature data relative to both interventional radiology and conventional therapeutic procedures. In our series, hydrostatic reduction of ileocolic intussusception was successful in 60% of cases. Transluminal dilatation with a balloon catheter was attempted in 108 patients with alimentary tract stenosis and was successful in 93. Hemorrhage and ischemia can be treated by means of transcatheter therapy (vasopressin, embolization) and percutaneous angioplasty. Percutaneous gastrostomy appears to be an effective alternative to surgical gastrostomy. Tapeworm infections can be cured by intraduodenal injection of "Gastrografin" (Schering). The success achieved in the different applications is such as to suggest a wider use of interventional radiology procedures, for they offer a more favorable cost/benefit ratio and often yield better results than conventional techniques.

Radiological manifestations of parasitic disease.

Parasitic diseases are very common on a worldwide basis. In certain cases radiological features are of importance both for primary diagnosis and for detection of complications of infestation. This review concentrates on parasitic diseases of radiological interest.

The role of CT in the evaluation of patients with intracranial CNS infectious-inflammatory disorders.

Infections of the CNS may be caused by diverse etiologies. These include bacteria, viruses, mycoses, protozoa, helminths. In these CNS infections there is a breakdown in the blood-brain barrier. The most common clinical forms of intracranial CNS infections include meningitis, cerebritis-abscess formation, and dural infections. These conditions may be complicated by infarction, hydrocephalus, brain atrophy unless the CNS infection in detected early. The introduction of CT has markedly enhanced our ability to diagnose early and initiate therapy rapidly. In most disorders early diagnosis has caused a dramatic decrease in mortality and morbidity. Since the introduction of CT, clinical outcome in patients with cerebritis-brain abscess has markedly changed. In this paper the role of CT in the evaluation of intracranial CNS infection will be reviewed.

[Parasitic calcifications: elements for diagnostic (author's transl)]. / Diagnostic des calcifications parasitaires (à l'exclusion des calcifications fongiques et des protozoaires)

Among the radiologic calcifications, those of parasitic etiology are rather commonly found. They are heterotopic dystrophic calcifications, their late apparition in the evolution of the parasitic disease is not subordinate to any metabolic dysfunction. The authors describe the morphologic and the topographic criteria of different parasitic calcifications except the fungic ones and protozoaire. Moreover they state for each parasite some epidemiological, biological and clinical facts which can be helpful for the diagnosis.