Respiratory Complications of Plasmodium vivax Malaria: Systematic Review and Meta-Analysis.

Malaria, a major global public health problem, is mainly caused by Plasmodium falciparum and Plasmodium vivax, and is responsible for nearly half a million deaths annually. Although P. vivax malaria was not believed to cause severe disease, recent robust studies have proved otherwise. However, the clinical spectrum and pathogenesis of severe vivax malaria and, especially, its respiratory complications remain poorly understood. A systematic search for articles reporting respiratory complications associated with vivax malaria was performed in Lilacs, Cochrane, Scielo, Web of Science, and Medline databases irrespective of publication date. Prevalence of acute respiratory distress syndrome (ARDS) and associated mortality among vivax patients were calculated from cross-sectional and longitudinal studies, whereas factors associated with mortality were calculated from data pooled from case reports and series of cases. A total of 101 studies were included (49 cross-sectional or longitudinal and 52 case reports or series of cases). Prevalence of ARDS was 2.8% and 2.2% in children and adults, respectively, with nearly 50% mortality. Moreover, female sex (P = 0.013), having any comorbidity (P = 0.036), lower body temperature (P = 0.032), lower hemoglobin (P = 0.043), and oxygen saturation (P = 0.053) values were significantly associated with mortality. Plasmodium vivax malaria respiratory complications included ARDS and were associated with high mortality. Demographics and clinical characteristics upon presentation to hospital were associated with mortality among patients with respiratory complications in vivax malaria. This study reaffirms the evidence of severe and fatal complications of P. vivax malaria and its associated respiratory complications.

Low Health System Performance, Indigenous Status and Antivenom Underdosage Correlate with Spider Envenoming Severity in the Remote Brazilian Amazon.

BACKGROUND: A better knowledge of the burden and risk factors associated with severity due to spider bites would lead to improved management with a reduction of sequelae usually seen for this neglected health problem, and would ensure proper use of antivenoms in remote localities in the Brazilian Amazon. The aim of this study was to analyze the profile of spider bites reported in the state of Amazonas in the Western Brazilian Amazon, and to investigate potential risk factors associated with severity of envenomation. METHODOLOGY/PRINCIPAL FINDINGS: We used a case-control study in order to identify factors associated with spider bite severity in the Western Brazilian Amazon from 2007 to 2014. Patients evolving to any severity criteria were considered cases and those with non-severe bites were included in the control group. All variables were retrieved from the official Brazilian reporting systems. Socioeconomical and environmental components were also included in a multivariable analysis in order to identify ecological determinants of incidence and severity. A total of 1,181 spider bites were recorded, resulting in an incidence of 4 cases per 100,000 person/year. Most of the spider bites occurred in males (65.8%). Bites mostly occurred in rural areas (59.5%). The most affected age group was between 16 and 45 years old (50.9%). A proportion of 39.7% of the bites were related to work activities. Antivenom was prescribed to 39% of the patients. Envenomings recorded from urban areas [Odds ratio (OR) = 0.40 (95%CI = 0.30-0.71; p<0.001)] and living in a municipality with a mean health system performance index (MHSPI >median [OR = 0.64 (95%CI = 0.39-0.75; p<0.001)] were independently associated with decreased risk of severity. Work related accidents [OR = 2.09 (95%CI = 1.49-2.94; p<0.001)], Indigenous status [OR = 2.15 (95%CI = 1.19-3.86; p = 0.011)] and living in a municipality located >300 km away from the state capital Manaus [OR = 1.90 (95%CI = 1.28-2.40; p<0.001)] were independently associated with a risk of severity. Living in a municipality located >300 km away from the state capital Manaus [OR = 1.53 (95%CI = 1.15-2.02; p = 0.003)] and living in a municipality with a MHSPI 300 km away from the state capital Manaus could be contributing factors to higher severity of spider envenomings in this area, as well as to antivenom underdosage.

Micronutrient Deficiencies and Plasmodium vivax Malaria among Children in the Brazilian Amazon.

BACKGROUND: There is a growing body of evidence linking micronutrient deficiencies and malaria incidence arising mostly from P. falciparum endemic areas. We assessed the impact of micronutrient deficiencies on malaria incidence and vice versa in the Brazilian state of Amazonas. METHODOLOGY/PRINCIPAL FINDINGS: We evaluated children <10 years old living in rural communities in the state of Amazonas, Brazil, from May 2010 to May 2011. All children were assessed for sociodemographic, anthropometric and laboratory parameters, including vitamin A, beta-carotene, zinc and iron serum levels at the beginning of the study (May 2010) and one year later (May 2011). Children were followed in between using passive surveillance for detection of symptomatic malaria. Those living in the study area at the completion of the observation period were reassessed for micronutrient levels. Univariate Cox-proportional Hazards models were used to assess whether micronutrient deficiencies had an impact on time to first P. vivax malaria episode. We included 95 children median age 4.8 years (interquartile range [IQR]: 2.3-6.6), mostly males (60.0%) and with high maternal illiteracy (72.6%). Vitamin A deficiencies were found in 36% of children, beta-carotene deficiency in 63%, zinc deficiency in 61% and iron deficiency in 51%. Most children (80%) had at least one intestinal parasite. During follow-up, 16 cases of vivax malaria were diagnosed amongst 13 individuals. Micronutrient deficiencies were not associated with increased malaria incidence: vitamin A deficiency [Hazard ratio (HR): 1.51; P-value: 0.45]; beta-carotene [HR: 0.47; P-value: 0.19]; zinc [HR: 1.41; P-value: 0.57] and iron [HR: 2.31; P-value: 0.16]). Upon reevaluation, children with al least one episode of malaria did not present significant changes in micronutrient levels. CONCLUSION: Micronutrient serum levels were not associated with a higher malaria incidence nor the malaria episode influenced micronutrient levels. Future studies targeting larger populations to assess micronutrients levels in P. vivax endemic areas are warranted in order to validate these results.

Cardiovascular changes in patients with non-severe Plasmodium vivax malaria.

BACKGROUND: Cardiovascular system involvement in patients with Plasmodium vivax malaria has been poorly addressed. The aim of this study was to evaluate cardiac structures and function, and serum markers of cardiovascular injury in patients with the non-severe form of vivax malaria in Manaus, Amazonas State, Brazil. METHODS AND RESULTS: We prospectively evaluated 26 patients with vivax malaria in an outpatient referral hospital and compared results with a control group of 25 gender- and age-matched healthy individuals. Patients underwent clinical evaluation, laboratory tests, and transthoracic echocardiography at first evaluation (day zero, D0) and seven days (D7) after malaria diagnosis. At D0 echocardiography showed higher left ventricular (LV) systolic diameter (28.8 ± 2.82 vs 30.9 ± 4.03 mm; p = 0.037) and LV diastolic volume (82.4 ± 12.3 vs 93.8 ± 25.9 ml; p = 0.05), and lower LV ejection fraction (Teicholz method: 73.2 ± 6.59 vs 68.4 ± 4.87%; p = 0.004) in patients compared to controls. Right ventricle (RV) fractional area change (54.7 ± 5.11 vs 50.5 ± 6.71%; p = 0.014) was lower, and RV myocardial performance index (0.21 ± 0.07 vs 0.33 ± 0.19; p = 0.007), and pulmonary vascular resistance (1.13 ± 0.25 vs 1.32 ± 0.26 Woods unit; p = 0.012) were higher in patients than controls. Patients presented higher serum levels of unconjugated bilirubin (0.24 ± 0.15 vs 1.30 ± 0.89 mg/dL; p < 0.001), soluble vascular cell adhesion molecule-1 (sVCAM-1; 453 ± 143 vs 1983 ± 880 ng/mL; p < 0.001), N-terminal prohormone brain natriuretic peptide (0.59 ± 0.86 vs 1.08 ± 0.81 pg/mL; p = 0.045), and troponin T (861 ± 338 vs 1037 ± 264 pg/mL; p = 0.045), and lower levels of plasma nitrite (13.42 ± 8.15 vs 8.98 ± 3.97 µM; p = 0.016) than controls. Most alterations had reversed by D7. CONCLUSION: Patients with non-severe Plasmodium vivax malaria present subclinical reversible cardiovascular changes.

Comportamiento clínico y epidemiológico de los pacientes con cirrosis hepática en el Hospital Nacional Dos de Mayo, enero del 2008 a diciembre del 2013 / Clinical and epidemiological behavior of the patients with liver cirrhosis at the National Hospital Dos de Mayo, January 2008 to December 2013

Objetivo: Determinar el comportamiento clínico y epidemiológico de los pacientes con Cirrosis Hepática en el Hospital Nacional Dos de Mayo desde Enero 2008 a Diciembre del 2013. Metodología: Estudio descriptivo, retrospectivo de corte transversal. Se estudiaron a 81 pacientes con diagnóstico de cirrosis hepática atendidos en el Hospital Nacional Dos de Mayo desde de enero 2008 a diciembre de 2013. Para describir las variables cualitativas se usaron frecuencias absolutas y relativas, mientras que para las cuantitativas se emplearon medidas de tendencia central y dispersión. Resultados: La edad promedio de los pacientes fue 59,8±15,2 años, donde la mayoría estaban entre los 35 y 65 años, y eran de sexo masculino. La etiología más frecuente encontrada fue el alcoholismo (45.7 por ciento), seguido de la infección por hepatitis B (14,8 por ciento), hepatitis autoinmune (6,2 por ciento) y criptogénica (3,7 por ciento). Entre otras etiologías menos frecuentes se encontraron trombosis portal, infección por hepatitis C, CEP y NASH, al 23,5 por ciento de los pacientes no se les realizaron estudios para identificar la etiología de la cirrosis. Por otro lado, la clasificación alcanzada por la mayoría de pacientes (48,1 por ciento) según el Score Child-Pugh fue B, 37 (45,7 por ciento) pacientes tuvieron pronósticos menos alentadores al tener una clasificación C. Solo 5 pacientes tuvieron mejor pronóstico, al tener una clasificación A. El 61,7 por ciento de los pacientes tuvo un antecedente de hospitalización, el 27,2 por ciento tuvieron 2 hospitalizaciones y el 11,1 por ciento presentaron de 3 a más hospitalizaciones. Entre las causas de hospitalización más frecuentes de los pacientes con cirrosis hepática el 53,1 por ciento presentó ascitis, el 19,8 por ciento encefalopatía hepática, el 16,0 por ciento tuvo infecciones y HDA variceal en cada uno de ellos, además se observaron otras causas menos frecuentes como la pancitopenia (3), colecistitis aguda (2)...

Objective: To determine the clinical and epidemiological profile of patients with liver cirrhosis in Dos de Mayo National Hospital from January 2008 to December 2013. Methodology: Descriptive, retrospective and cross-sectional study. It was studied 81 patients with diagnosis of liver cirrhosis treated at Dos de Mayo National Hospital from January 2008 to December 2013. To describe the qualitative variables were used absolute and relative frequencies, while for quantitative were used measures of central tendency and dispersion. Results: The average age of patients was 59.8± 15.2 years, most were between 35 and 65 years and male sex. The most common etiology found was alcoholism (45.7 per cent), followed by hepatitis B infection (14.8 per cent), autoimmune (6.2 per cent) and cryptogenic hepatitis (3.7 per cent). Among other less common causes were found portal vein thrombosis, hepatitis C infection, primary sclerosing cholangitis and nonalcoholic hepatic steatosis, 23.5 per cent of patients did not perform test to identify the etiology of cirrhosis. Furthermore, the classification reached by the majority of patients (48.1 per cent) according to the Child-Pugh Score was B, 37 (45.7 per cent) patients had forecast less encouraging to be rated C. Only 5 patients had better forecast to be rated A. The 61.7 per cent of patients had an antecedent of hospitalization, 27.2 per cent had two hospitalizations and 11.1 per cent had 3 or more hospitalizations. Among the most frequent causes of hospitalization of patients with liver cirrhosis 53.1 per cent presented ascites, 19.8 per cent hepatic encephalopathy, 16.0 per cent had infections and variceal upper gastrointestinal bleeding in each one, also other less common causes such as pancytopenia (3), acute cholecystitis (2), HVB decompensation (1) among others were observed. Among the most common infections found in patients with liver cirrhosis were urinary tract infection (UTI) (18.5 per cent), SBP (7.4 per cent) and...

Long-term albendazole effectiveness for hepatic cystic echinococcosis.

Little is known about the long-term effectiveness of albendazole in the medical therapy of non-complicated hepatic cystic echinococcosis (HCE) in resource-constrained settings. We performed a retrospective review of patients starting albendazole for HCE in Lima, Peru from January 1997 to December 2007. Patients successfully recontacted underwent chart abstraction and clinical and ultrasonographic reevaluation. Descriptive statistics were used to delineate patient characteristics and treatment effectiveness at the conclusion of albendazole and after reevaluation. Patients (N = 27) were primarily female, mean age was 51. Initial treatment success at albendazole conclusion was 26% (N = 7) per patient and 37.5% (N = 24) per cyst. After 3.8 ± 2.5 years, albendazole success was 34% (N = 9) per patient and 40% (N = 24) per cyst. We found a gap in the effectiveness of albendazole HCE therapy compared with the efficacy reported in clinical trials. This underscores the need for further investigation into alternate therapeutic strategies for this neglected disease.

[Natural history of chronic hepatitis B virus infection]. / Historia natural de la infección cronica por el virus hepatitis B.

UNLABELLED: In the last years notable steps have been done towards the understanding of the biology of Hepatitis B Virus (HBV), its natural history and immunopathogenesis, while succesful universal vaccination programs were implemented around the world and important advances in antiviral therapeuthics occurred. Nevertheless, HBV infection remains a public health problem with nearly 350 million carriers worlwide. The natural history of chronic hepatitis B and the spectrum of its clinical forms are complex and variable.We review the natural history of chronic HBV infection describing the early replicative phase and late or non-replicative (inactive carrier) in those patients who adquired the infection during adulthood and the immune tolerant phase, immune clearance and non-replicative in those who acquired the infection in the perinatal period. Emphasis is made in the course of HBeAg negative chronic hepatitis and occult hepatitis B. The complexity of the natural history of hepatitis B depends on viral features, hepatocyte behavior and patient immune response. The intrinsic and extrinsic HBV factors associated with the progression to cirrhosis and hepatocellular carcinoma are also reviewed. KEYWORDS: Hepatitis B, Natural history, liver cirrhosis, hepatocellular carcinoma.

Historia natural de la infección crónica por el virus Hepatitis B / Natural history of chronic Hepatitis B virus infection

En los últimos años se han dado notables pasos en el entendimiento de la biología del virus de la hepatitis B (VHB), su historia natural e inmunopatogénesis, mientras que se implementaron exitosos programas de vacunación universal en diferentes partes del mundo y se hicieron importantes avances en la terapéutica antiviral. Sin embargo, La infección por el VHB sigue siendo un problema de salud pública, con cerca de 350 millones de portadores a nivel mundial. La historia natural de la hepatitis B crónica y el espectro de sus formas clínicas son complejos y variables. Revisamos la historia natural de la infección crónica por VHB describiendo las fases replicativa temprana y tardía o no-replicativa (portador inactivo) en los pacientes con adquisición del virus en la adultez y las fases Inmunotolerante, de Inmunoaclaramiento y la no-replicativa en los pacientes que adquirieron el virus en el periodo perinatal. También se pone énfasis en el curso de la hepatitis HBeAg negativa y la hepatitis B oculta. La complejidad de la historia natural del VHB depende de las características del virus, el comportamiento de los hepatocitos y la respuesta inmunitaria del paciente. Los factores intrínsecos y extrínsecos al VHB asociados en la progresión a la cirrosis y el carcinoma hepatocelular también son revisados.

In the last years notable steps have been done towards the understanding of the biology of Hepatitis B Virus (HBV), its natural history and immunopathogenesis, while succesful universal vaccination programs were implemented around the world and important advances in antiviral therapeuthics occurred. Nevertheless, HBV infection remains a public health problem with nearly 350 million carriers worlwide. The natural history of chronic hepatitis B and the spectrum of its clinical forms are complex and variable.We review the natural history of chronic HBV infection describing the early replicative phase and late or non-replicative (inactive carrier) in those patients who adquired the infection during adulthood and the immune tolerant phase, immune clearance and non-replicative in those who acquired the infection in the perinatal period. Emphasis is made in the course of HBeAg negative chronic hepatitis and occult hepatitis B. The complexity of the natural history of hepatitis B depends on viral features, hepatocyte behavior and patient immune response. The intrinsic and extrinsic HBV factors associated with the progression to cirrhosis and hepatocellular carcinoma are also reviewed.

[Infection by Blastocystis: a review]. / Infección por Blastocystis.

Blastocystis sp. is an anaerobic unicellular micro-organism belonging to the kingdom Chromista, frequently found in the digestive tracts of humans and animals, the pathogenic role of which continues being controversial for human beings. Its genetic classification, which shows nine sub-types, some of which seem to have a role in cases with gastrointestinal symptomathology, opens a new field for research. In this article, an extensive revision is carried out which includes the historic development of the parasite, its taxonomy, epidemiology, morphology, vital cycle, as well as biochemical, cytochemical and genetic aspects, the pathogenic role in contrast with different variables which include the sub-types, quantity, response to the treatment and association with other pathogens. Finally, the clinical and therapeutic aspects are also reviewed.

Infección por Blastocystis / Infection by blastocystis

Blastocystis sp. es un microorganismo unicelular anaerobio, perteneciente al reino Cromista, frecuentemente encontrado en el tracto intestinal de humanos y animales, cuyo rol patogénico para el hombre sigue siendo controversial. Su tipificación genética,mostrando nueve subtipos, algunos de los cuales parecen tener un papel en casos de sintomatología gastrointestinal, abre un nuevo campo para la investigación. En el presente artículo se hace una extensa revisión que incluye el desarrollo histórico del parásito, su taxonomía, epidemiología, morfología, ciclo vital, así como aspectos bioquímicos, citoquímicos y genéticos, el rol patogénico contrastado con diferentes variables que incluyen los subtipos, cantidad, respuesta al tratamiento y asociación con otros patógenos. Finalmente se revisan los aspectos clínicos y terapéuticos.

Blastocystis sp. is an anaerobic unicellular micro-organism belonging to the kingdom Chromista, frequently found in the digestive tracts of humans and animals, the pathogenic role of which continues being controversial for human beings. Its genetic classification, which shows nine sub-types, some of which seem to have a role in cases with gastrointestinal symptomathology, opens a new field for research.In this article, an extensive revision is carried out which includes the historic development of the parasite, its taxonomy, epidemiology, morphology, vital cycle, as well as biochemical,cytochemical and genetic aspects, the pathogenic role in contrast with different variables which include the sub-types, quantity, response to the treatment and association withother pathogens. Finally, the clinical and therapeutic aspects are also reviewed.