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1.
Rev Soc Bras Med Trop ; 53: e20180046, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31994653

RESUMO

Hepatopulmonary hydatidosis in young children is a rare and atypical presentation of Echinococcus granulosus infection. We report the first case of cystic echinococcosis caused by a microvariant of E. granulosus sensu stricto. Chemotherapy and systemic corticoids were administered before curative surgery was performed. Recurrence was not observed for more than 24 months of follow-up.


Assuntos
Albendazol/administração & dosagem , Equinococose Hepática/diagnóstico por imagem , Equinococose Pulmonar/diagnóstico por imagem , Echinococcus granulosus/isolamento & purificação , Animais , Pré-Escolar , Equinococose Hepática/terapia , Equinococose Pulmonar/terapia , Feminino , Seguimentos , Humanos , Toracoscopia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
2.
Parasit Vectors ; 12(1): 503, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31665080

RESUMO

BACKGROUND: National deworming programmes rely almost exclusively on mass drug administration (MDA) to children to control morbidity caused by these parasitic infections. The provision of other interventions, consisting of preventive chemotherapy at high population level coverage together with water, sanitation and hygiene (WaSH) and changes in risk behaviour, should enable sustainable control of soil-transmitted helminths (STH) and schistosomiasis and ultimately interrupt transmission. METHODS/DESIGN: Two interventions will be implemented by the project: (i) community-wide biannual albendazole and annual praziquantel treatment with a target of 80-90% treatment coverage ("expanded MDA"); and (ii) provision of WaSH with behaviour change communication (BCC), within the Wolaita zone, Ethiopia. The project has three study arms: (i) expanded community-wide MDA, WaSH and BCC; (ii) expanded community-wide MDA only; and (iii) annual school-based MDA (the current National STH/schistosomiasis Control Programme). The impact of these interventions will be evaluated through prevalence mapping at baseline and endline (after four rounds of MDA), combined with annual longitudinal parasitological surveillance in defined cohorts of people to monitor trends in prevalence and reinfection throughout the project. Treatment coverage and individual compliance to treatment will be monitored by employing fingerprint biometric technology and barcoded identification cards at treatment. WaSH utilisation will be evaluated through school and household level observations and annual WaSH assessment survey. Complementary qualitative surveys will explore practices, cultural and social drivers of risk behaviours, uptake of WaSH and treatment, and assessing the impact of the BCC. DISCUSSION: The study has the potential to define an 'End Game' for STH and schistosomiasis programmes through provision of multiple interventions. Interrupting transmission of these infections would eliminate the need for long-term repeated MDA, lead to sustained health improvements in children and adults, thereby allowing health systems to focus on other disease control priorities.


Assuntos
Albendazol/administração & dosagem , Anti-Helmínticos/administração & dosagem , Helmintíase/prevenção & controle , Praziquantel/administração & dosagem , Esquistossomose/prevenção & controle , Adolescente , Criança , Pré-Escolar , Análise Custo-Benefício , Estudos Transversais , Demografia , Etiópia/epidemiologia , Comportamentos Relacionados com a Saúde , Helmintíase/epidemiologia , Helmintíase/transmissão , Humanos , Higiene/normas , Lactente , Estudos Longitudinais , Administração Massiva de Medicamentos/economia , Modelos Biológicos , Doenças Negligenciadas/prevenção & controle , Prevalência , Saneamento/normas , Esquistossomose/epidemiologia , Esquistossomose/transmissão , Instituições Acadêmicas , Solo/parasitologia , Inquéritos e Questionários , Abastecimento de Água/normas
4.
Korean J Parasitol ; 57(4): 429-434, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31533411

RESUMO

A complicated case of echinococcosis with multiple organ involvement is reported in a 53-year-old businessman who frequently traveled overseas, including China, Russia, and Kazakhstan from 2001 to 2007. The patient was first diagnosed with a large liver cyst during a screening abdomen ultrasonography in 2011, but he did not follow up on the lesion afterwards. Six years later, dizziness, dysarthria, and cough developed, and cystic lesions were found in the brain, liver and lungs. The clinical course was complicated when the patient went through multiple surgeries and inadequate treatment with a short duration of albendazole without a definite diagnosis. The patient visited our hospital for the first time in August 2018 due to worsening symptoms; he was finally diagnosed with echinococcosis using imaging and serologic criteria. He is now on prolonged albendazole treatment (400 mg twice a day) with gradual clinical and radiological improvement. A high index of suspicion is warranted to early diagnose echinococcosis in a patient with a travel history to endemic areas of echinococcosis.


Assuntos
Equinococose Hepática/complicações , Albendazol/administração & dosagem , Albendazol/uso terapêutico , Anti-Helmínticos/administração & dosagem , Anti-Helmínticos/uso terapêutico , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , China , Diagnóstico Tardio , Equinococose Hepática/tratamento farmacológico , Equinococose Hepática/patologia , Humanos , Cazaquistão , Fígado/diagnóstico por imagem , Fígado/patologia , Pulmão/diagnóstico por imagem , Pulmão/patologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , República da Coreia , Federação Russa , Tomografia Computadorizada por Raios X , Viagem
5.
PLoS Negl Trop Dis ; 13(9): e0007685, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31483784

RESUMO

BACKGROUND: Despite decades of community-based mass drug administration (MDA) for neglected tropical diseases, it remains an open question as to what constitutes the best combination of community medicine distributors (CMDs) for achieving high (>65%/75%) treatment rates within a village. METHODS: Routine community-based MDA was evaluated in Mayuge District, Uganda. For one month, we tracked 6,148 individuals aged 1+ years in 1,118 households from 28 villages. Praziquantel, albendazole, and ivermectin were distributed to treat Schistosoma mansoni, lymphatic filariasis, and soil-transmitted helminths. The similarity/diversity between CMDs was observed and used to predict the division of labour and overall village treatment rates. The division of labour was calculated by dividing the lowest treatment rate by the highest treatment rate achieved by two CMDs within a village. CMD similarity was measured for 16 characteristics including friendship network overlap, demographic and socioeconomic factors, methods of CMD selection, and years as CMD. Relevant variables for MDA outcomes were selected through least absolute shrinkage and selection operators with leave-one-out cross validation. Final models were run with ordinary least squares regression and robust standard errors. RESULTS: The percentage of individuals treated with at least one drug varied across villages from 2.79-89.74%. The only significant predictor (p-value<0.05) of village treatment rates was the division of labour. The estimated difference between a perfectly equal (a 50-50 split of individuals treated) and unequal (one CMD treating no one) division of labour was 39.69%. A direct tie (close friendship) between CMDs was associated with a nearly twofold more equitable distribution of labour when compared to CMDs without a direct tie. CONCLUSIONS: An equitable distribution of labour between CMDs may be essential for achieving treatment targets of 65%/75% within community-based MDA. To improve the effectiveness of CMDs, national programmes should explore interventions that seek to facilitate communication, friendship, and equal partnership between CMDs.


Assuntos
Anti-Helmínticos/administração & dosagem , Agentes Comunitários de Saúde/estatística & dados numéricos , Filariose Linfática/tratamento farmacológico , Doenças Negligenciadas/tratamento farmacológico , Esquistossomose mansoni/tratamento farmacológico , Adolescente , Adulto , Idoso , Albendazol/administração & dosagem , Animais , Criança , Pré-Escolar , Medicina Comunitária/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Lactente , Ivermectina/administração & dosagem , Masculino , Administração Massiva de Medicamentos , Pessoa de Meia-Idade , Praziquantel/administração & dosagem , População Rural , Uganda , Adulto Jovem
6.
PLoS Negl Trop Dis ; 13(9): e0007697, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31557154

RESUMO

BACKGROUND: Lymphatic filariasis (LF) is a neglected tropical disease, and the Global Program to Eliminate LF delivers mass drug administration (MDA) to 500 million people every year. Adverse events (AEs) are common after LF treatment. METHODOLOGY/PRINCIPAL FINDINGS: To better understand the pathogenesis of AEs, we studied LF-patients from a treatment trial. Plasma levels of many filarial antigens increased post-treatment in individuals with AEs, and this is consistent with parasite death. Circulating immune complexes were not elevated in these participants, and the classical complement cascade was not activated. Multiple cytokines increased after treatment in persons with AEs. A transcriptomic analysis was performed for nine individuals with moderate systemic AEs and nine matched controls. Differential gene expression analysis identified a significant transcriptional signature associated with post-treatment AEs; 744 genes were upregulated. The transcriptional signature was enriched for TLR and NF-κB signaling. Increased expression of seven out of the top eight genes upregulated in persons with AEs were validated by qRT-PCR, including TLR2. CONCLUSIONS/SIGNIFICANCE: This is the first global study of changes in gene expression associated with AEs after treatment of lymphatic filariasis. Changes in cytokines were consistent with prior studies and with the RNAseq data. These results suggest that Wolbachia lipoprotein is involved in AE development, because it activates TLR2-TLR6 and downstream NF-κB. Additionally, LPS Binding Protein (LBP, which shuttles lipoproteins to TLR2) increased post-treatment in individuals with AEs. Improved understanding of the pathogenesis of AEs may lead to improved management, increased MDA compliance, and accelerated LF elimination.


Assuntos
Filariose Linfática/tratamento farmacológico , Filaricidas/uso terapêutico , Adolescente , Adulto , Idoso , Albendazol/administração & dosagem , Albendazol/efeitos adversos , Antígenos de Helmintos/sangue , Citocinas/sangue , Citocinas/imunologia , Dietilcarbamazina/efeitos adversos , Dietilcarbamazina/uso terapêutico , Filariose Linfática/genética , Filariose Linfática/imunologia , Feminino , Filaricidas/efeitos adversos , Humanos , Ivermectina/administração & dosagem , Ivermectina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
7.
PLoS Negl Trop Dis ; 13(8): e0007471, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31369562

RESUMO

BACKGROUND: Preventive chemotherapy (PC) with benzimidazole drugs is the backbone of soil-transmitted helminth (STH) control programs. Over the past decade, drug coverage has increased and with it, the possibility of developing anthelmintic resistance. It is therefore of utmost importance to monitor drug efficacy. Currently, a variety of novel diagnostic methods are available, but it remains unclear whether they can be used to monitor drug efficacy. In this study, we compared the efficacy of albendazole (ALB) measured by different diagnostic methods in a head-to-head comparison to the recommended single Kato-Katz. METHODS: An ALB efficacy trial was performed in 3 different STH-endemic countries (Ethiopia, Lao PDR and Tanzania), each with a different PC-history. During these trials, stool samples were evaluated with Kato-Katz (single and duplicate), Mini-FLOTAC, FECPAKG2, and qPCR. The reduction rate in mean eggs per gram of stool (ERR) and mean genome equivalents / ml of DNA extract (GERR) were calculated to estimate drug efficacy. PRINCIPAL FINDINGS AND CONCLUSIONS: The results of the efficacy trials showed that none of the evaluated diagnostic methods could provide reduction rates that were equivalent to a single Kato-Katz for all STH. However, despite differences in clinical sensitivity and egg counts, they agreed in classifying efficacy according to World Health Organization (WHO) guidelines. This demonstrates that diagnostic methods for assessing drug efficacy should be validated with their intended-use in mind and that other factors like user-friendliness and costs will likely be important factors in driving the choice of diagnostics. In addition, ALB efficacy against STH infections was lower in sites with a longer history of PC. Yet, further research is needed to identify factors that contribute to this finding and to verify whether reduced efficacy can be associated with mutations in the ß-tubulin gene that have previously been linked to anthelmintic resistance. TRIAL REGISTRATION: ClinicalTrials.gov NCT03465488.


Assuntos
Albendazol/uso terapêutico , Anti-Helmínticos/uso terapêutico , Helmintíase/diagnóstico , Helmintíase/tratamento farmacológico , Solo/parasitologia , Administração Oral , Albendazol/administração & dosagem , Animais , Brasil , Criança , Testes Diagnósticos de Rotina/métodos , Etiópia , Fezes/parasitologia , Feminino , Helmintos/genética , Humanos , Laos , Masculino , Contagem de Ovos de Parasitas/métodos , Sensibilidade e Especificidade , Tanzânia , Tubulina (Proteína)/genética , Organização Mundial da Saúde
8.
BMJ Case Rep ; 12(8)2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31466983

RESUMO

Ascariasis is a soil-sourced, second most common parasitic infection worldwide. Because of its wandering nature, it migrates from the intestine to other organs of the body like the lungs and biliary system. This results in complications such as biliary colic, acute cholecystitis, pyogenic cholangitis, liver abscesses, pancreatitis and loeffler's pneumonia. We report a unique case of an 8-year-old boy who presented with upper gastrointestinal bleed and chest infection. He was diagnosed as haemobilia and loeffler's pneumonia caused by ascaris lumbricoides.


Assuntos
Ascaríase/complicações , Ascaríase/parasitologia , Hemobilia/etiologia , Eosinofilia Pulmonar/etiologia , Albendazol/administração & dosagem , Albendazol/uso terapêutico , Animais , Anti-Helmínticos/administração & dosagem , Anti-Helmínticos/uso terapêutico , Ascaríase/imunologia , Ascaris lumbricoides/isolamento & purificação , Criança , Hematemese/diagnóstico , Hematemese/etiologia , Humanos , Imunoglobulina E/sangue , Masculino , Resultado do Tratamento
10.
Emerg Infect Dis ; 25(8): 1574-1576, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31310225

RESUMO

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 Jovem
11.
Turkiye Parazitol Derg ; 43(2): 99-101, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31204466

RESUMO

Hydatid disease is a parasitic disease. Although the disease causes many organ involvement, intracranial involvement is rarely seen. Clinical findings vary according to the number, size, localization of the cyst and the immune status of the patient. We aimed to present a rare case with intracranial hydatid cyst. A 8-year-old male patient presented with headache and vomiting. Physical examination revealed papillary edema. Brain computerized tomography imaging revealed a 13x13 cm cystic formation in the brain. The patient's echinococcal indirect hemagglutination test result was positive. The patient was started on oral albendazole therapy for intracranial hydatid cyst and was operated by brain surgery. Pathologic examination of the cyst was compatible with hydatid cyst. Although cysts are detected in the liver and lungs, cysts may be seen in atypically located areas. It should be kept in mind in clinically suspected patients that the disease can develop in rare organs, especially in patients with endemic areas. In patients with hydatid disease, advanced radiological examinations such as lung X-ray, abdominal ultrasonography and brain magnetic resonance imaging and echocardiographic examination should be performed for other organ involvement.


Assuntos
Encéfalo/parasitologia , Equinococose/diagnóstico , Administração Oral , Albendazol/administração & dosagem , Albendazol/uso terapêutico , Animais , Anti-Helmínticos/administração & dosagem , Anti-Helmínticos/uso terapêutico , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Encéfalo/cirurgia , Criança , Equinococose/tratamento farmacológico , Equinococose/cirurgia , Echinococcus/isolamento & purificação , Cefaleia , Testes de Hemaglutinação , Humanos , Masculino , Tomografia Computadorizada por Raios X , Vômito
12.
Acta Trop ; 197: 105050, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31170379

RESUMO

To investigate the preventive effect of the combination of albendazole (ABZ) and pomegranate peel aqueous extract (PGE) treatment in cystic echinococcosis, we assess in vivo the antihydatic and the anti-inflammatory effects of the combination of ABZ/ PGE in cystic echinococcosis mice model. To evaluate the in vivo efficacy, mice were inoculated intraperitoneally with viable protoscolices and then treated with ABZ and/or PGE during cystic echinococcosis development. Mice were randomly allocated into eight groups: ABZ/CE group, PGE/CE group, (ABZ+PGE)/CE group, CE group, and control groups (Ctrl, PBS, ABZ, and PGE groups). Drugs in diverse treated groups were orally administered daily during CE development for two months. Mice were then euthanized and associated indications were investigated to evaluate the therapeutic efficacy. Cyst development and hepatic damage were macroscopically and histologically analyzed. The hepatic expression of iNOS, TNF-α, NF-κß, vimentin, and CD68 was examined. Interestingly, the association of ABZ and PGE enhanced a significant reduction of the rate of hydatid cyst growth inhibition in comparison to the infected or ABZ-treated groups. This effect was strongly related to the histological structure of liver improvement. A significant iNOS, TNF-α, NF-κß, vimentin, and CD68 decrease expression was observed in liver tissue of (ABZ+PGE)-treated group compared with infested and ABZ-treated groups. PGE treatment indicates a significant beneficial additive antihydatic effect with a reduction of the liver side effects. The combination of albendazole and PGE treatment is more efficient and suggests its potential preventive value against Echinococcus granulosus infection.


Assuntos
Albendazol/administração & dosagem , Equinococose/prevenção & controle , Lythraceae , Extratos Vegetais/administração & dosagem , Animais , Modelos Animais de Doenças , Feminino , Camundongos
13.
PLoS Negl Trop Dis ; 13(5): e0007325, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31107869

RESUMO

BACKGROUND: A single co-administered dose of ivermectin (IVM) plus diethylcarbamazine (DEC) plus albendazole (ALB), or triple-drug therapy, was recently found to be more effective for clearing microfilariae (Mf) than standard DEC plus ALB currently used for mass drug administration programs for lymphatic filariasis (LF) outside of sub-Saharan Africa. Triple-drug therapy has not been previously tested in LF-uninfected individuals from Africa. This study evaluated the pharmacokinetics (PK), safety, and efficacy of triple-drug therapy in people with and without Wuchereria bancrofti infection in West Africa. METHODS: In this open-label cohort study, treatment-naïve microfilaremic (>50 mf/mL, n = 32) and uninfected (circulating filarial antigen negative, n = 24) adults residing in Agboville district, Côte d'Ivoire, were treated with a single dose of IVM plus DEC plus ALB, and evaluated for adverse events (AEs) until 7 days post treatment. Drug levels were assessed by liquid chromatography and mass spectrometry. Persons responsible for assessing AEs were blinded to participants' infection status. FINDINGS: There was no difference in AUC0-inf or Cmax between LF-infected and uninfected participants (P>0.05 for all comparisons). All subjects experienced mild AEs; 28% and 25% of infected and uninfected participants experienced grade 2 AEs, respectively. There were no severe or serious adverse events. Only fever (16 of 32 versus 4 of 24, P<0.001) and scrotal pain/swelling in males (6 of 20 versus 0 of 12, P = 0.025) were more frequent in infected than uninfected participants. All LF positive participants were amicrofilaremic at 7 days post-treatment and 27 of 31 (87%) remained amicrofilaremic 12 months after treatment. CONCLUSIONS: Moderate to heavy W. bancrofti infection did not affect PK parameters for IVM, DEC or ALB following a single co-administered dose of these drugs compared to uninfected individuals. The drugs were well tolerated. This study confirmed the efficacy of the triple-drug therapy for clearing W. bancrofti Mf and has added important information to support the use of this regimen in LF elimination programs in areas of Africa without co-endemic onchocerciasis or loiasis. TRIAL REGISTRATION: ClinicalTrials.gov NCT02845713.


Assuntos
Albendazol/administração & dosagem , Dietilcarbamazina/administração & dosagem , Filariose Linfática/tratamento farmacológico , Filaricidas/administração & dosagem , Ivermectina/administração & dosagem , Wuchereria bancrofti/efeitos dos fármacos , Adolescente , Adulto , Idoso , Albendazol/efeitos adversos , Albendazol/farmacocinética , Animais , Estudos de Coortes , Costa do Marfim , Dietilcarbamazina/efeitos adversos , Dietilcarbamazina/farmacocinética , Combinação de Medicamentos , Filariose Linfática/parasitologia , Feminino , Filaricidas/efeitos adversos , Filaricidas/farmacocinética , Humanos , Ivermectina/efeitos adversos , Ivermectina/farmacocinética , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Wuchereria bancrofti/fisiologia , Adulto Jovem
14.
PLoS Negl Trop Dis ; 13(5): e0007436, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31120872

RESUMO

Despite worldwide mass drug administration, it is estimated that 68 million individuals are still infected with lymphatic filariasis with 19 million hydrocele and 17 million lymphedema reported cases. Despite the staggering number of pathology cases, the majority of LF-infected individuals do not develop clinical symptoms and present a tightly regulated immune system characterized by higher frequencies of regulatory T cells (Treg), suppressed proliferation and Th2 cytokine responses accompanied with increased secretion of IL-10, TGF-ß and infection-specific IgG4. Nevertheless, the filarial-induced modulation of the host`s immune system and especially the role of regulatory immune cells like regulatory B (Breg) and Treg during an ongoing LF infection remains unknown. Thus, we analysed Breg and Treg frequencies in peripheral blood from Ghanaian uninfected endemic normals (EN), lymphedema (LE), asymptomatic patent (CFA+MF+) and latent (CFA+MF-) W. bancrofti-infected individuals as well as individuals who were previously infected with W. bancrofti (PI) but had cleared the infection due to the administration of ivermectin (IVM) and albendazole (ALB). In summary, we observed that IL-10-producing CD19+CD24highCD38dhigh Breg were specifically increased in patently infected (CFA+MF+) individuals. In addition, CD19+CD24highCD5+CD1dhigh and CD19+CD5+CD1dhighIL-10+ Breg as well as CD4+CD127-FOXP3+ Treg frequencies were significantly increased in both W. bancrofti-infected cohorts (CFA+MF+ and CFA+MF-). Interestingly, the PI cohort presented frequency levels of all studied regulatory immune cell populations comparable with the EN group. In conclusion, the results from this study show that an ongoing W. bancrofti infection induces distinct Breg and Treg populations in peripheral blood from Ghanaian volunteers. Those regulatory immune cell populations might contribute to the regulated state of the host immune system and are probably important for the survival and fertility (microfilaria release) of the helminth.


Assuntos
Anti-Helmínticos/administração & dosagem , Linfócitos B Reguladores/imunologia , Filariose Linfática/tratamento farmacológico , Filariose Linfática/imunologia , Interleucina-10/imunologia , Linfócitos T Reguladores/imunologia , Wuchereria bancrofti/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Albendazol/administração & dosagem , Animais , Filariose Linfática/genética , Filariose Linfática/parasitologia , Feminino , Gana , Humanos , Interleucina-10/genética , Ivermectina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Células Th2/imunologia , Adulto Jovem
15.
BMJ Case Rep ; 12(4)2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31036733

RESUMO

Hypereosinophilic syndromes are rare in children. Sporadic, mild-severity FIP1L1-platelet-derived growth factor receptor α (PDGFRα) rearrangement cases have been reported, mainly in boys. We present the case of a 5-year-old girl referred from her African country of birth, due to severe constitutional symptoms, multifocal bone pain, headache, gastrointestinal complaints, cardiomyopathy and unexplained hypereosinophilia. She presented multiple end-organ diseases and striking bone involvement. Although she had a positive serology for Strongyloides stercoralis, extensive evaluation detected a FIP1L1-PDGFRA fusion gene. Systemic corticosteroids and low-dose imatinib were started and the child became asymptomatic. After 9 months of treatment, FIP1L1-PDGFRA was no longer detected.


Assuntos
Corticosteroides/uso terapêutico , Síndrome Hipereosinofílica/genética , Estrongiloidíase/parasitologia , Corticosteroides/administração & dosagem , África/epidemiologia , Albendazol/administração & dosagem , Albendazol/uso terapêutico , Animais , Anti-Helmínticos/uso terapêutico , Antiparasitários/uso terapêutico , Doenças Ósseas/diagnóstico por imagem , Doenças Ósseas/patologia , Pré-Escolar , Combinação de Medicamentos , Feminino , Humanos , Síndrome Hipereosinofílica/tratamento farmacológico , Síndrome Hipereosinofílica/patologia , Mesilato de Imatinib/administração & dosagem , Mesilato de Imatinib/uso terapêutico , Ivermectina/administração & dosagem , Ivermectina/uso terapêutico , Proteínas de Fusão Oncogênica , Inibidores de Proteínas Quinases/uso terapêutico , Doenças Raras , Receptor alfa de Fator de Crescimento Derivado de Plaquetas , Strongyloides stercoralis/imunologia , Estrongiloidíase/complicações , Estrongiloidíase/diagnóstico , Resultado do Tratamento , Fatores de Poliadenilação e Clivagem de mRNA
17.
BMJ Case Rep ; 12(4)2019 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-30948413

RESUMO

A 17-year-old man presented to the emergency department with complaints of retro-orbital pain of the left eye and an altitudinal visual field defect for 2 weeks. Fundus examination revealed ipsilateral hyperaemic optic disc oedema, and the patient was admitted with the presumptive diagnosis of left optic neuritis. Subsequently, during follow-up, the patient developed a retinal granulomatous lesion in the superior temporal arcade with vitritis and fibrotic strands extending to the mid-periphery. Serum antibodies detection by ELISA and aqueous humour immunoblot were positive for Toxocara canis Medical therapy with albendazole and oral steroids was instituted with satisfactory results. One year later, a new macular lesion developed with consequent vision loss.


Assuntos
Infecções Oculares Parasitárias/diagnóstico , Toxocaríase/diagnóstico , Adolescente , Albendazol/administração & dosagem , Animais , Anti-Helmínticos/administração & dosagem , Anticorpos Anti-Helmínticos/sangue , Ensaio de Imunoadsorção Enzimática , Infecções Oculares Parasitárias/tratamento farmacológico , Glucocorticoides/administração & dosagem , Humanos , Imagem por Ressonância Magnética , Masculino , Metilprednisolona/administração & dosagem , Recidiva , Artéria Retiniana/diagnóstico por imagem , Toxocara canis/isolamento & purificação , Toxocaríase/tratamento farmacológico
18.
PLoS Negl Trop Dis ; 13(4): e0007365, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31009482

RESUMO

BACKGROUND: Sri Lanka's Anti-Filariasis Campaign conducted 5 annual rounds of mass drug administration (MDA) with diethylcarbamazine (DEC) plus albendazole to eliminate lymphatic filariasis (LF) in all endemic districts between 2002 and 2006. Post-MDA surveillance has consistently documented Wuchereria bancrofti microfilaremia (Mf) rates below 1% in all sentinel and spot check sites since that time, and all implementation units easily satisfied WHO's target for school-based transmission assessment surveys (school-TAS) in 2013. However, more detailed studies have identified foci of persistent infection in the large coastal evaluation unit (EU) (population about 0.6 million) in Galle district. Therefore, the purpose of this study was to assess the sensitivity and feasibility of community-based TAS in adults (adult-TAS) and to compare results obtained by adult-TAS with prior school-TAS and molecular xenomonitoring (MX, molecular detection of filarial DNA in systematically sampled mosquitoes) results in this known problem area. METHODOLOGY AND PRINCIPAL FINDINGS: Two cluster surveys were performed in independent samples of 30 evaluation areas (EAs) in the coastal Galle EU in 2015. Each survey tested approximately 1,800 adults for circulating filarial antigenemia (CFA) with the Alere Filariasis Test Strip. The CFA prevalence for all persons tested (N = 3,612) was 1.8% (CI 1.4-2.2), and this was significantly higher than the CFA rate of 0.4% obtained by school-TAS in 2013. CFA prevalences in the two samples were similar [1.5% (CI 1.0-2.2), and 2.0% (CI 1.4-2.7)]. Antigenemia prevalence in sampled EUs was highly variable (range 0-11%), and it exceeded 5% in 6 EAs. The 30 EAs sampled in one of our adult-TAS surveys had recently been assessed for persistent filariasis by molecular xenomonitoring (MX). CFA prevalence in adults and filarial DNA prevalence in mosquitoes in these EAs were significantly correlated (r = 0.43; P = 0.02). CONCLUSIONS: Community based adult-TAS provided a reproducible measure of persistent W. bancrofti infection in a large evaluation unit in Sri Lanka that has low-level persistence of LF following multiple rounds of MDA. In addition, adult-TAS and MX results illustrate the focality of persistent LF in this setting. Adult-TAS may be more sensitive than school-TAS for this purpose. Adult-TAS and MX are potential options for post-MDA and post-validation surveillance programs to identify problem areas that require mop-up activities. Adult-TAS should also be useful for remapping areas with uncertain LF endemicity for possible inclusion in national LF elimination programs.


Assuntos
Albendazol/administração & dosagem , Dietilcarbamazina/administração & dosagem , Filariose Linfática/tratamento farmacológico , Filariose Linfática/epidemiologia , Wuchereria bancrofti/isolamento & purificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Feminino , Humanos , Masculino , Administração Massiva de Medicamentos , Pessoa de Meia-Idade , Prevalência , Sri Lanka/epidemiologia , Inquéritos e Questionários , Adulto Jovem
20.
PLoS Negl Trop Dis ; 13(2): e0006591, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30768602

RESUMO

BACKGROUND: Mass drug administration (MDA), targeted at school-aged children (SAC) is the method recommended by the World Health Organization for the control of morbidity induced by soil-transmitted helminth (STH) infection in endemic countries. However, MDA does not prevent reinfection between treatment rounds and research suggests that only treating SAC will not be sufficient to bring prevalence to low levels and possibly interrupt transmission of STH. In countries with endemic infection, such as Myanmar, the coverage, who is targeted, and rates of reinfection will determine how effective MDA is in suppressing transmission in the long-term. METHODS/PRINCIPAL FINDINGS: In this paper, data from an epidemiological study on STH, comprising three surveys conducted between June 2015 and June 2016 in the delta region of Myanmar, are analysed to determine how STH prevalence and intensity in the study community changes over the course of a year, including reinfection after two MDA rounds in which the whole study sample (all age groups, n = 523) were treated with albendazole. Prevalence in the first survey (August 2015) was 27.92% for any STH, 5.54% for Ascaris lumbricoides, 17.02% for Trichuris trichiura and 9.75% for hookworm. Over the year (survey one to survey three), prevalence of any STH decreased by 8.99% (P < 0.001) and mean EPG significantly decreased for T. trichiura (P < 0.01) and hookworm (P < 0.001). Risk ratios (RRs) for a four-month reinfection period (August to December) were statistically significant and were below one, indicating that STH prevalence had not bounced back to the prevalence levels recorded immediately prior to the last round of treatment (any STH RR = 0.67, 95% CI 0.56-0.81; A. lumbricoides RR = 0.31, 95% CI 0.16-0.59; T. trichiura RR = 0.70, 95% CI 0.55-0.88; hookworm RR = 0.69, 95% CI 0.50-0.95). The only statistically significant RR for the six-month reinfection period (December to June) was for A. lumbricoides infection in SAC (RR = 2.67, 95% CI 1.37-5.21). All six-month RRs were significantly higher than four-month RRs (P < 0.05). Evidence of predisposition to infection (low and high), as measured by the Kendall Tau-b statistic, was found for all species overall and within most age groups stratifications, except for hookworm infection in preschool-aged children. CONCLUSIONS/SIGNIFICANCE: This study demonstrates that, for certain demographic groups, a six-month gap between MDA in these communities is enough time for STH infection to return to STH prevalence levels recorded immediately before the previous MDA round, and that on average the same individuals are being consistently infected between MDA rounds.


Assuntos
Albendazol/uso terapêutico , Anti-Helmínticos/uso terapêutico , Ascaríase/tratamento farmacológico , Infecções por Uncinaria/tratamento farmacológico , Administração Massiva de Medicamentos , Tricuríase/tratamento farmacológico , Adolescente , Adulto , Albendazol/administração & dosagem , Anti-Helmínticos/administração & dosagem , Ascaríase/epidemiologia , Criança , Feminino , Infecções por Uncinaria/epidemiologia , Humanos , Masculino , Mianmar/epidemiologia , Fatores de Risco , Solo/parasitologia , Tricuríase/epidemiologia , Adulto Jovem
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