Posts filed under ‘Antiparasitarios’

Diseases Transmitted by Cats.

Microbiol Spectr. October 2015 V.3 N.5

Goldstein EJC1, Abrahamian FM2.

Abstract

Humans and cats have shared a close relationship since ancient times. Millions of cats are kept as household pets, and 34% of households have cats.

There are numerous diseases that may be transmitted from cats to humans.

General modes of transmission, with some overlapping features, can occur through inhalation (e.g., bordetellosis); vector-borne spread (e.g., ehrlichiosis); fecal-oral route (e.g., campylobacteriosis); bite, scratch, or puncture (e.g., rabies); soil-borne spread (e.g., histoplasmosis); and direct contact (e.g., scabies).

It is also likely that the domestic cat can potentially act as a reservoir for many other zoonoses that are not yet recognized.

The microbiology of cat bite wound infections in humans is often polymicrobial with a broad mixture of aerobic (e.g., Pasteurella, Streptococcus, Staphylococcus) and anaerobic (e.g., Fusobacterium, Porphyromonas, Bacteroides) microorganisms.

Bacteria recovered from infected cat bite wounds are most often reflective of the oral flora of the cat, which can also be influenced by the microbiome of their ingested prey and other foods.

Bacteria may also originate from the victim’s own skin or the physical environment at the time of injury.

abstract

http://www.asmscience.org/content/journal/microbiolspec/10.1128/microbiolspec.IOL5-0013-2015

PDF (CLIC en PDF)

 

November 19, 2018 at 11:23 am

Pet-Related Infections.

Am Fam Physician. November 15, 2016 V.94 N.10 P.794-802.

Day MJ1.

Abstract

Physicians and veterinarians have many opportunities to partner in promoting the well-being of people and their pets, especially by addressing zoonotic diseases that may be transmitted between a pet and a human family member.

Common cutaneous pet-acquired zoonoses are dermatophytosis (ringworm) and sarcoptic mange (scabies), which are both readily treated.

Toxoplasmosis can be acquired from exposure to cat feces, but appropriate hygienic measures can minimize the risk to pregnant women.

Persons who work with animals are at increased risk of acquiring bartonellosis (e.g., cat-scratch disease); control of cat fleas is essential to minimize the risk of these infections.

People and their pets share a range of tick-borne diseases, and exposure risk can be minimized with use of tick repellent, prompt tick removal, and appropriate tick control measures for pets.

Pets such as reptiles, amphibians, and backyard poultry pose a risk of transmitting Salmonella species and are becoming more popular.

Personal hygiene after interacting with these pets is crucial to prevent Salmonella infections.

Leptospirosis is more often acquired from wildlife than infected dogs, but at-risk dogs can be protected with vaccination.

The clinical history in the primary care office should routinely include questions about pets and occupational or other exposure to pet animals.

Control and prevention of zoonoses are best achieved by enhancing communication between physicians and veterinarians to ensure patients know the risks of and how to prevent zoonoses in themselves, their pets, and other people.

FULL TEXT

https://www.aafp.org/afp/2016/1115/p794.html

PDF

https://www.aafp.org/afp/2016/1115/p794.pdf

November 19, 2018 at 11:20 am

2017 GUIA ARGENTINA PARA USO de ANTIBIOTICOS en el 1er Nivel Asistencial – MSN 181 pags.

Guía de medicamentos esenciales para el PNA – Antimicrobianos 1ra edición – Ciudad Autónoma de Buenos Aires : Ministerio de Salud de la Nación. Cobertura Universal de Salud. Medicamentos, 2017

“Guía de Medicamentos Esenciales en el PNA – Grupo Antimicrobianos” describe las características farmacológicas y clínicas más relevantes de los Medicamentos Esenciales utilizados en el manejo de las enfermedades infecciosas prevalentes en el primer nivel de atención.

La misma se agrupa a su vez en: antibióticos, antimicóticos, antivirales, antiparasitarios y fármacos para el tratamiento de la Tuberculosis.

PDF

http://www.msal.gob.ar/images/stories/bes/graficos/0000001087cnt-medicamentos-esenciales-primer-nivel-atencion-antimicrobianos.pdf

November 3, 2018 at 5:44 pm

Symptomatic Acute Toxoplasmosis in Returning Travelers

Open Forum Infectious Diseases, April 2018 V.5 N.4

Andrés F Henao-Martínez; Carlos Franco-Paredes; Alan G Palestine; Jose G Montoya

We report a family who acquired acute toxoplasmosis after a trip to Central America. One member developed severe clinical manifestations including bilateral chorioretinitis, hepatitis, and myocarditis requiring therapy. Symptomatic acute toxoplasmosis is unusual and possesses a diagnostic challenge. We discuss the clinical and epidemiological implications, laboratory diagnosis, and treatment plan.

FULL TEXT

https://academic.oup.com/ofid/article/5/4/ofy058/4925380

PDF (CLIC en PDF)

September 30, 2018 at 10:51 am

Improving Plasmodium vivax malaria treatment: a little more chloroquine

LANCET INFECTIOUS DISEASES September 2018 V.18 N.9 P.934-935

COMMENT

The efficacy of first-line malaria treatment underpins the success of malaria control programmes. Left untreated, malaria infections will generally recur over many months. These recurrences increase malaria morbidity and enhance transmission. Crucially, suboptimal parasite clearance promotes the emergence of drug resistance. Thus, treatment should aim at total parasite elimination. Defining optimal dose, and monitoring for efficacy, rely on findings from clinical trials done in endemic areas. Patients, although monitored over 4 weeks or longer (depending on the drugs’ pharmacokinetics), are usually discharged within days as symptoms wane and parasites become undetectable microscopically. Drug efficacy, or indeed indication of resistance, are deduced from the occurrence, timing, and frequency of recurrent episodes during follow-up…

FULL TEXT

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30413-4/fulltext?dgcid=raven_jbs_etoc_email

PDF

https://www.thelancet.com/action/showPdf?pii=S1473-3099%2818%2930413-4

– – –

LANCET INFECTIOUS DISEASES September 2018 V.18 N.9 P.1025-1034

ARTICLE

The effect of chloroquine dose and primaquine on Plasmodium vivax recurrence: a WorldWide Antimalarial Resistance Network systematic review and individual patient pooled meta-analysis

Robert J Commons, FRACPProf Julie A Simpson, PhDKamala Thriemer, PhDGeorgina S Humphreys, PhDTesfay Abreha, MPHSisay G Alemu, MScArletta Añez, PhDProf Nicholas M Anstey, PhDGhulam R Awab, PhD …

Background

Chloroquine remains the mainstay of treatment for Plasmodium vivax malaria despite increasing reports of treatment failure. We did a systematic review and meta-analysis to investigate the effect of chloroquine dose and the addition of primaquine on the risk of recurrent vivax malaria across different settings.

Methods

A systematic review done in MEDLINE, Web of Science, Embase, and Cochrane Database of Systematic Reviews identified P vivax clinical trials published between Jan 1, 2000, and March 22, 2017. Principal investigators were invited to share individual patient data, which were pooled using standardised methods. Cox regression analyses with random effects for study site were used to investigate the roles of chloroquine dose and primaquine use on rate of recurrence between day 7 and day 42 (primary outcome). The review protocol is registered in PROSPERO, number CRD42016053310.

Findings

Of 134 identified chloroquine studies, 37 studies (from 17 countries) and 5240 patients were included. 2990 patients were treated with chloroquine alone, of whom 1041 (34·8%) received a dose below the target 25 mg/kg. The risk of recurrence was 32·4% (95% CI 29·8–35·1) by day 42. After controlling for confounders, a 5 mg/kg higher chloroquine dose reduced the rate of recurrence overall (adjusted hazard ratio [AHR] 0·82, 95% CI 0·69–0·97; p=0·021) and in children younger than 5 years (0·59, 0·41–0·86; p=0·0058). Adding primaquine reduced the risk of recurrence to 4·9% (95% CI 3·1–7·7) by day 42, which is lower than with chloroquine alone (AHR 0·10, 0·05–0·17; p<0·0001).

Interpretation

Chloroquine is commonly under-dosed in the treatment of vivax malaria. Increasing the recommended dose to 30 mg/kg in children younger than 5 years could reduce substantially the risk of early recurrence when primaquine is not given. Radical cure with primaquine was highly effective in preventing early recurrence and may also improve blood schizontocidal efficacy against chloroquine-resistant P vivax.

Funding

Wellcome Trust, Australian National Health and Medical Research Council, and Bill & Melinda Gates Foundation.

FULL TEXT

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30348-7/fulltext?dgcid=raven_jbs_etoc_email

PDF

https://www.thelancet.com/action/showPdf?pii=S1473-3099%2818%2930348-7

August 25, 2018 at 11:17 am

Scabies outbreaks in ten care homes for elderly people: a prospective study of clinical features, epidemiology, and treatment outcomes

LANCET INFECTIOUS DISEASES August 2018 V.18 N.8 P.894–902

Background

Scabies outbreaks in residential and nursing care homes for elderly people are common, subject to diagnostic delay, and hard to control. We studied clinical features, epidemiology, and outcomes of outbreaks in the UK between 2014 and 2015.

Methods

We did a prospective observational study in residential care homes for elderly people in southeast England that reported scabies outbreaks to Public Health England health protection teams. An outbreak was defined as two or more cases of scabies (in either residents or staff) at a single care home. All patients who provided informed consent were included; patients with dementia were included if a personal or nominated consultee (ie, a family member or nominated staff member) endorsed participation. Dermatology-trained physicians examined residents at initial clinical visits, which were followed by two mass treatments with topical scabicide as per local health protection team guidance. Follow-up clinical visits were held 6 weeks after initial visits. Scabies was diagnosed through pre-defined case definitions as definite, probable, or possible with dermatoscopy and microscopy as appropriate.

Findings

230 residents were examined in ten outbreaks between Jan 23, 2014, and April 13, 2015. Median age was 86·9 years (IQR 81·5–92·3), 174 (76%) were female, and 157 (68%) had dementia. 61 (27%) residents were diagnosed with definite, probable, or possible scabies, of whom three had crusted scabies. Physical signs differed substantially from classic presentations. 31 (51%) of the 61 people diagnosed with scabies were asymptomatic, and only 25 (41%) had burrows. Mites were visualised with dermatoscopy in seven (11%) patients, and further confirmed by microscopy in three (5%). 35 (57%) cases had signs of scabies only on areas of the body that would normally be covered. Dementia was the only risk factor for a scabies diagnosis that we identified (odds ratio 2·37 [95% CI 1·38–4·07]). At clinical follow-up, 50 people who were initially diagnosed with scabies were examined. No new cases of scabies were detected, but infestation persisted in ten people.

Interpretation

Clinical presentation of scabies in elderly residents of care homes differs from classic descriptions familiar to clinicians. This difference probably contributes to delayed recognition and suboptimal management in this vulnerable group. Dermatoscopy and microscopy were of little value. Health-care workers should be aware of the different presentation of scabies in elderly people, and should do thorough examinations, particularly in people with dementia.

Funding

Public Health England and British Skin Foundation.

FULL TEXT

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30347-5/fulltext?dgcid=raven_jbs_etoc_email

PDF

https://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(18)30347-5.pdf

July 26, 2018 at 12:40 pm

Clinical and epidemiological features of chronic Trypanosoma cruzi infection in patients with HIV/AIDS in Buenos Aires, Argentina

International Journal of Infectious Diseases February 2018 V.67 P.118–121

Andrés Guillermo Benchetrit, Marisa Fernández, Amadeo Javier Bava, Marcelo Corti, Norma Porteiro, Liliana Martínez Peralta

Highlights

  • Chagas disease reactivation is an AIDS-defining illness with a high mortality rate.
  • Besides the vector-borne route, other means of T. cruzi infection acquisition must be assessed.
  • HIV-infected patients with lower CD4 T-cell counts are at higher risk of Chagas disease reactivation.
  • Severely immunecompromised patients infected with T. cruzi may have negative serological assay results.
  • Direct parasitological techniques should be performed in the diagnosis of patients for whom there is a suspicion of T. cruzi reactivation.

Objectives

Trypanosoma cruzi reactivation in HIV patients is considered an opportunistic infection, usually with a fatal outcome. The aim of this study was to describe the epidemiological and clinical features of T. cruzi infection in HIV patients and to compare these findings between patients with and without Chagas disease reactivation.

Methods

The medical records of T. cruzi–HIV co-infected patients treated at the Muñiz Infectious Diseases Hospital from January 2005 to December 2014 were reviewed retrospectively. Epidemiological and clinical features were assessed and compared between patients with and without Chagas disease reactivation.

Results

The medical records of 80 T. cruzi–HIV co-infected patients were reviewed. The most likely route of T. cruzi infection was vector-borne (32/80 patients), followed by intravenous drug use (12/80). Nine of 80 patients had reactivation. Patients without reactivation had a significantly higher CD4 T-cell count at diagnosis of T. cruzi infection (144 cells/μl vs. 30 cells/μl, p = 0.026). Chagas disease serology was negative in two of nine patients with reactivation.

Conclusions

Serological assays for T. cruzi infection may be negative in severely immunocompromised patients. Direct parasitological techniques should be performed in the diagnosis of patients for whom there is a suspicion of T. cruzi reactivation. HIV patients with a lower CD4 count are at higher risk of reactivation.

abstract

http://www.ijidonline.com/article/S1201-9712(17)30309-0/fulltext

PDF

http://www.ijidonline.com/article/S1201-9712(17)30309-0/pdf

February 18, 2018 at 4:05 pm

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