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1.
BMC Res Notes ; 12(1): 387, 2019 Jul 09.
Artículo en Inglés | MEDLINE | ID: mdl-31288833

RESUMEN

OBJECTIVE: Murine typhus has been increasingly reported on Reunion island, Indian ocean, following documentation of eight autochthonous infections in 2012-2013. We conducted a serosurvey to assess the magnitude of the seroprevalence of rickettsioses in the population. Two hundred and forty-one stored frozen sera taken from the 2009 Copanflu-RUN cohort were analysed using an immunofluorescence assay allowing to distinguish typhus group (TGR) and spotted fever group Rickesttsiae (SFGR). Seropositivity was defined for a dilution titre of Rickettsia IgG antibodies ≥ 1:64. Seroprevalence was weighted to account for the discrepancy between the Copanflu-RUN subset and the general population, as to infer prevalence at community level. Prevalence proportion ratios (PPR) were measured using log-binomial models. RESULTS: The weighted seroprevalences of typhus group rickettsioses and spotted fever group rickettsioses were of 12.71% (95% CI 8.84-16.58%) and 17.68% (95% CI 13.25-22.11%), respectively. Pooled together, data suggested that a fifth of the population had been exposed at least to one Rickettsia group. Youths (< 20 years) were less likely seropositive than adults (adjusted PPR 0.13, 95% CI 0.01-0.91). People living in the western dryer part of the island were more exposed (adjusted PPR 2.53, 95% CI 1.07-5.97). Rickettsioses are endemic on Reunion island and circulated before their first identification as murine typhus in year 2011. Surprisingly, since isolation of Rickettsia africae from Amblyomma variegatum in year 2004 or isolation of Rickettsia felis from Amblyomma loculosum, no autochthonous cases of African tick-bite fever or flea-borne spotted fever has yet been diagnosed.


Asunto(s)
Rickettsia/inmunología , Rickettsiosis Exantemáticas/diagnóstico , Tifus Epidémico Transmitido por Piojos/diagnóstico , Adolescente , Adulto , Animales , Anticuerpos Antibacterianos/sangre , Anticuerpos Antibacterianos/inmunología , Femenino , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina G/inmunología , Masculino , Persona de Mediana Edad , Reunión/epidemiología , Rickettsia/fisiología , Estudios Seroepidemiológicos , Rickettsiosis Exantemáticas/epidemiología , Rickettsiosis Exantemáticas/microbiología , Tifus Epidémico Transmitido por Piojos/epidemiología , Tifus Epidémico Transmitido por Piojos/microbiología , Adulto Joven
3.
Trials ; 18(1): 450, 2017 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-28969659

RESUMEN

BACKGROUND: Undifferentiated febrile illness (UFI) includes typhoid and typhus fevers and generally designates fever without any localizing signs. UFI is a great therapeutic challenge in countries like Nepal because of the lack of available point-of-care, rapid diagnostic tests. Often patients are empirically treated as presumed enteric fever. Due to the development of high-level resistance to traditionally used fluoroquinolones against enteric fever, azithromycin is now commonly used to treat enteric fever/UFI. The re-emergence of susceptibility of Salmonella typhi to co-trimoxazole makes it a promising oral treatment for UFIs in general. We present a protocol of a randomized controlled trial of azithromycin versus co-trimoxazole for the treatment of UFI. METHODS/DESIGN: This is a parallel-group, double-blind, 1:1, randomized controlled trial of co-trimoxazole versus azithromycin for the treatment of UFI in Nepal. Participants will be patients aged 2 to 65 years, presenting with fever without clear focus for at least 4 days, complying with other study criteria and willing to provide written informed consent. Patients will be randomized either to azithromycin 20 mg/kg/day (maximum 1000 mg/day) in a single daily dose and an identical placebo or co-trimoxazole 60 mg/kg/day (maximum 3000 mg/day) in two divided doses for 7 days. Patients will be followed up with twice-daily telephone calls for 7 days or for at least 48 h after they become afebrile, whichever is later; by home visits on days 2 and 4 of treatment; and by hospital visits on days 7, 14, 28 and 63. The endpoints will be fever clearance time, treatment failure, time to treatment failure, and adverse events. The estimated sample size is 330. The primary analysis population will be all the randomized population and subanalysis will be repeated on patients with blood culture-confirmed enteric fever and culture-negative patients. DISCUSSION: Both azithromycin and co-trimoxazole are available in Nepal and are extensively used in the treatment of UFI. Therefore, it is important to know the better orally administered antimicrobial to treat enteric fever and other UFIs especially against the background of fluoroquinolone-resistant enteric fever. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02773407 . Registered on 5 May 2016.


Asunto(s)
Antibacterianos/administración & dosificación , Azitromicina/administración & dosificación , Fiebre/tratamiento farmacológico , Combinación Trimetoprim y Sulfametoxazol/administración & dosificación , Fiebre Tifoidea/tratamiento farmacológico , Tifus Epidémico Transmitido por Piojos/tratamiento farmacológico , Administración Oral , Adolescente , Adulto , Anciano , Antibacterianos/efectos adversos , Azitromicina/efectos adversos , Niño , Preescolar , Protocolos Clínicos , Método Doble Ciego , Farmacorresistencia Bacteriana , Femenino , Fiebre/diagnóstico , Fiebre/microbiología , Humanos , Masculino , Persona de Mediana Edad , Nepal , Proyectos de Investigación , Factores de Tiempo , Resultado del Tratamiento , Combinación Trimetoprim y Sulfametoxazol/efectos adversos , Fiebre Tifoidea/diagnóstico , Fiebre Tifoidea/microbiología , Tifus Epidémico Transmitido por Piojos/diagnóstico , Tifus Epidémico Transmitido por Piojos/microbiología , Adulto Joven
4.
Am J Trop Med Hyg ; 96(5): 1088-1093, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-28500797

RESUMEN

AbstractFlea-borne (murine) typhus is a global rickettsiosis caused by Rickettsia typhi. Although flea-borne typhus is no longer nationally notifiable, cases are reported for surveillance purposes in a few U.S. states. The infection is typically self-limiting, but may be severe or life-threatening in some patients. We performed a retrospective review of confirmed or probable cases of fatal flea-borne typhus reported to the Texas Department of State Health Services during 1985-2015. When available, medical charts were also examined. Eleven cases of fatal flea-borne typhus were identified. The median patient age was 62 years (range, 36-84 years) and 8 (73%) were male. Patients presented most commonly with fever (100%), nausea and vomiting (55%), and rash (55%). Respiratory (55%) and neurologic (45%) manifestations were also identified frequently. Laboratory abnormalities included thrombocytopenia (82%) and elevated hepatic transaminases (63%). Flea or animal contact before illness onset was frequently reported (55%). The median time from hospitalization to administration of a tetracycline-class drug was 4 days (range, 0-5 days). The median time from symptom onset to death was 14 days (range, 1-34 days). Flea-borne typhus can be a life-threatening disease if not treated in a timely manner with appropriate tetracycline-class antibiotics. Flea-borne typhus should be considered in febrile patients with animal or flea exposure and respiratory or neurologic symptoms of unknown etiology.


Asunto(s)
Rickettsia prowazekii/patogenicidad , Rickettsia typhi/patogenicidad , Tifus Endémico Transmitido por Pulgas/diagnóstico , Tifus Epidémico Transmitido por Piojos/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Animales , Antibacterianos/administración & dosificación , Exantema/diagnóstico , Exantema/fisiopatología , Resultado Fatal , Femenino , Fiebre/diagnóstico , Fiebre/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Náusea/diagnóstico , Náusea/fisiopatología , Rickettsia prowazekii/aislamiento & purificación , Rickettsia typhi/aislamiento & purificación , Texas , Trombocitopenia/diagnóstico , Trombocitopenia/fisiopatología , Tiempo de Tratamiento , Transaminasas/metabolismo , Insuficiencia del Tratamiento , Tifus Endémico Transmitido por Pulgas/tratamiento farmacológico , Tifus Endémico Transmitido por Pulgas/microbiología , Tifus Endémico Transmitido por Pulgas/patología , Tifus Epidémico Transmitido por Piojos/tratamiento farmacológico , Tifus Epidémico Transmitido por Piojos/microbiología , Tifus Epidémico Transmitido por Piojos/patología , Vómitos/diagnóstico , Vómitos/fisiopatología
5.
Am J Trop Med Hyg ; 96(5): 1084-1087, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-28500808

RESUMEN

AbstractRickettsial infections are recognized as important causes of fever throughout southeast Asia. Herein, we determined the seroprevalence to rickettsioses within rural and urban populations of northern Vietnam. Prevalence of individuals with evidence of prior rickettsial infections (IgG positive) was surprisingly low, with 9.14% (83/908) testing positive to the three major rickettsial serogroups thought to circulate in the region. Prevalence of typhus group rickettsiae (TG)-specific antibodies (6.5%, 58/908) was significantly greater than scrub typhus group orientiae (STG)- or spotted fever group rickettsiae (SFG)-specific antibodies (P < 0.05). The majority of TG seropositives were observed among urban rather than rural residents (P < 0.05). In contrast, overall antibody prevalence to STG and SFG were both very low (1.1%, 10/908 for STG; 1.7%, 15/908 for SFG), with no significant differences between rural and urban residents. These results provide data on baseline population characteristics that may help inform development of Rickettsia serological testing criteria in future clinical studies.


Asunto(s)
Anticuerpos Antibacterianos/sangre , Infecciones por Rickettsia/epidemiología , Tifus por Ácaros/epidemiología , Tifus Epidémico Transmitido por Piojos/epidemiología , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Masculino , Orientia tsutsugamushi/clasificación , Orientia tsutsugamushi/aislamiento & purificación , Prevalencia , Rickettsia/clasificación , Rickettsia/aislamiento & purificación , Infecciones por Rickettsia/sangre , Infecciones por Rickettsia/diagnóstico , Rickettsia prowazekii/clasificación , Rickettsia prowazekii/aislamiento & purificación , Población Rural , Tifus por Ácaros/sangre , Tifus por Ácaros/diagnóstico , Estudios Seroepidemiológicos , Serotipificación , Tifus Epidémico Transmitido por Piojos/sangre , Tifus Epidémico Transmitido por Piojos/diagnóstico , Población Urbana , Vietnam/epidemiología
6.
Indian J Ophthalmol ; 64(10): 780-783, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27905346

RESUMEN

Tick typhus causes hemorrhagic lesions over the skin. Retina also shows hemorrhages and exudates. Many cases have been reported in western literature about this condition. To our best of knowledge, this is the first case report of tick typhus in India which was also associated with inflammatory choroidal neovascularization.


Asunto(s)
Bevacizumab/administración & dosificación , Neovascularización Coroidal/tratamiento farmacológico , Tifus Epidémico Transmitido por Piojos/complicaciones , Adulto , Inhibidores de la Angiogénesis/administración & dosificación , Encéfalo/patología , Neovascularización Coroidal/diagnóstico , Neovascularización Coroidal/etiología , Femenino , Angiografía con Fluoresceína , Fondo de Ojo , Humanos , India , Inyecciones Intravítreas , Imagen por Resonancia Magnética , Tomografía de Coherencia Óptica , Tifus Epidémico Transmitido por Piojos/diagnóstico , Agudeza Visual
7.
Am J Trop Med Hyg ; 95(2): 452-6, 2016 08 03.
Artículo en Inglés | MEDLINE | ID: mdl-27352876

RESUMEN

In August 2012, laboratory tests confirmed a mixed outbreak of epidemic typhus fever and trench fever in a male youth rehabilitation center in western Rwanda. Seventy-six suspected cases and 118 controls were enrolled into an unmatched case-control study to identify risk factors for symptomatic illness during the outbreak. A suspected case was fever or history of fever, from April 2012, in a resident of the rehabilitation center. In total, 199 suspected cases from a population of 1,910 male youth (attack rate = 10.4%) with seven deaths (case fatality rate = 3.5%) were reported. After multivariate analysis, history of seeing lice in clothing (adjusted odds ratio [aOR] = 2.6, 95% confidence interval [CI] = 1.1-5.8), delayed (≥ 2 days) washing of clothing (aOR = 4.0, 95% CI = 1.6-9.6), and delayed (≥ 1 month) washing of beddings (aOR = 4.6, 95% CI = 2.0-11) were associated with illness, whereas having stayed in the rehabilitation camp for ≥ 6 months was protective (aOR = 0.20, 95% CI = 0.10-0.40). Stronger surveillance and improvements in hygiene could prevent future outbreaks.


Asunto(s)
Bartonella quintana/aislamiento & purificación , Brotes de Enfermedades , Phthiraptera/microbiología , Rickettsia prowazekii/aislamiento & purificación , Fiebre de las Trincheras/epidemiología , Tifus Epidémico Transmitido por Piojos/epidemiología , Adolescente , Adulto , Animales , Bartonella quintana/patogenicidad , Estudios de Casos y Controles , Coinfección , Humanos , Incidencia , Masculino , Oportunidad Relativa , Centros de Rehabilitación , Rickettsia prowazekii/patogenicidad , Factores de Riesgo , Rwanda/epidemiología , Análisis de Supervivencia , Fiebre de las Trincheras/diagnóstico , Fiebre de las Trincheras/mortalidad , Fiebre de las Trincheras/transmisión , Tifus Epidémico Transmitido por Piojos/diagnóstico , Tifus Epidémico Transmitido por Piojos/mortalidad , Tifus Epidémico Transmitido por Piojos/transmisión
9.
Intern Med J ; 43(7): 823-5, 2013 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-23841762

RESUMEN

Queensland tick typhus (QTT), caused by Rickettsia australis, is usually a relatively mild illness but can occasionally be severe. We describe three cases of probable QTT with unusual clinical features, namely splenic infarction, fulminant myopericarditis and severe leukocytoclastic vasculitis. QTT may present with uncommon clinical features in addition to the more common manifestations. A high index of suspicion enables specific antibiotic therapy that may hasten recovery.


Asunto(s)
Infecciones por Rickettsia/diagnóstico , Tifus Epidémico Transmitido por Piojos/diagnóstico , Adulto , Antibacterianos/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Queensland/epidemiología , Infecciones por Rickettsia/tratamiento farmacológico , Infecciones por Rickettsia/epidemiología , Tifus Epidémico Transmitido por Piojos/tratamiento farmacológico , Tifus Epidémico Transmitido por Piojos/epidemiología
11.
Neuroimaging Clin N Am ; 22(4): 633-57, 2012 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-23122260

RESUMEN

This article is an update and literature review of the clinical and neuroimaging findings of the commonly known rickettsial, spirochetal, and eukaryotic parasitic infections. Being familiar with clinical presentation and imaging findings of these infections is crucial for early diagnosis and treatment especially in patients who live in or have a travel history to endemic regions or are immunocompromised.


Asunto(s)
Infecciones Bacterianas del Sistema Nervioso Central/diagnóstico , Infecciones Parasitarias del Sistema Nervioso Central/diagnóstico , Interpretación de Imagen Asistida por Computador , Imagen por Resonancia Magnética , Infecciones por Rickettsiaceae/diagnóstico , Fiebre Maculosa de las Montañas Rocosas , Infecciones por Spirochaetales/diagnóstico , Tomografía Computarizada por Rayos X , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/etiología , Encéfalo/patología , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/secundario , Infecciones Bacterianas del Sistema Nervioso Central/etiología , Infecciones Parasitarias del Sistema Nervioso Central/etiología , Diagnóstico Diferencial , Diagnóstico Precoz , Humanos , Enfermedad de Lyme/diagnóstico , Enfermedad de Lyme/etiología , Neurosífilis/diagnóstico , Neurosífilis/etiología , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/etiología , Fiebre Q/diagnóstico , Fiebre Q/epidemiología , Fiebre Q/etiología , Infecciones por Rickettsiaceae/etiología , Fiebre Maculosa de las Montañas Rocosas/diagnóstico , Fiebre Maculosa de las Montañas Rocosas/etiología , Médula Espinal/patología , Infecciones por Spirochaetales/etiología , Toxoplasmosis Cerebral/diagnóstico , Toxoplasmosis Cerebral/etiología , Tifus Epidémico Transmitido por Piojos/diagnóstico , Tifus Epidémico Transmitido por Piojos/etiología
12.
Conn Med ; 76(9): 555-9, 2012 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-23155676

RESUMEN

In 1825 Dr. Thomas Miner wrote about an epidemic that occurred in Middletown, Connecticut in 1823. He called this disease "Typhus syncopalis," sinking typhus, or New England spotted fever. Differences in the understanding of disease processes in the early 19th century preclude a definitive modern equivalent fortyphus syncopalis. In addition, there are disagreements among Dr. Miners' contemporaries with regard to fever classification systems. Examination of the symptoms and physical findings as described by Dr. Miner suggest the presence of encephalitis or meningitis as well as a syndrome resembling a shock-like state. Based on symptom comparisons, this paper suggests that typhus syncopalis was likely meningococcemia caused by Neisseria meningiditis.


Asunto(s)
Meningitis Meningocócica/historia , Tifus Epidémico Transmitido por Piojos/historia , Connecticut , Diagnóstico Diferencial , Epidemias , Historia del Siglo XX , Humanos , Meningitis Meningocócica/diagnóstico , Meningitis Meningocócica/epidemiología , Neisseria meningitidis , Tifus Epidémico Transmitido por Piojos/diagnóstico , Tifus Epidémico Transmitido por Piojos/epidemiología
17.
Clin Infect Dis ; 51(6): 712-5, 2010 Sep 15.
Artículo en Inglés | MEDLINE | ID: mdl-20687836

RESUMEN

Recrudescent Rickettsia prowazekii infection, also known as Brill-Zinsser disease, can manifest decades after untreated primary infection but is rare in contemporary settings. We report the first known case of Brill-Zinsser disease in a patient originally infected with a zoonotic strain of R. prowazekii acquired from flying squirrels.


Asunto(s)
Rickettsia prowazekii/aislamiento & purificación , Sciuridae/microbiología , Tifus Epidémico Transmitido por Piojos/diagnóstico , Anciano , Animales , Anticuerpos Antibacterianos/sangre , Humanos , Inmunoglobulina G/sangre , Masculino , Tifus Epidémico Transmitido por Piojos/patología , Estados Unidos , Zoonosis/transmisión
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