Posts filed under ‘FIEBRE en el POST-VIAJE’

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)

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September 30, 2018 at 10:51 am

Tickborne Diseases — Confronting a Growing Threat

N Engl J of Medic August 23, 2018

PERSPECTIVE

C.I. Paules and Others

Every spring, public health officials prepare for an upsurge in vectorborne diseases. As mosquito-borne illnesses have notoriously surged in the Americas, the U.S. incidence of tickborne infections has risen insidiously, triggering heightened attention from clinicians and researchers …

FULL TEXT

https://www.nejm.org/doi/full/10.1056/NEJMp1807870?query=infectious-disease

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMp1807870

September 4, 2018 at 8:34 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

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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

Zika-Associated Birth Defects and Neurodevelopmental Abnormalities Possibly Associated with Congenital Zika Virus Infection — U.S. Territories and Freely Associated States, 2018

MMWR August 8, 2018 V.67  Early Release

Marion E. Rice, MPH; Romeo R. Galang, MD; Nicole M. Roth, MPH; et al.

Introduction

Zika virus infection during pregnancy causes serious birth defects and might be associated with neurodevelopmental abnormalities in children. Early identification of and intervention for neurodevelopmental problems can improve cognitive, social, and behavioral functioning.

Methods

Pregnancies with laboratory evidence of confirmed or possible Zika virus infection and infants resulting from these pregnancies are included in the U.S. Zika Pregnancy and Infant Registry (USZPIR) and followed through active surveillance methods. This report includes data on children aged ≥1 year born in U.S. territories and freely associated states. Receipt of reported follow-up care was assessed, and data were reviewed to identify Zika-associated birth defects and neurodevelopmental abnormalities possibly associated with congenital Zika virus infection.

Results

Among 1,450 children of mothers with laboratory evidence of confirmed or possible Zika virus infection during pregnancy and with reported follow-up care, 76% had developmental screening or evaluation, 60% had postnatal neuroimaging, 48% had automated auditory brainstem response-based hearing screen or evaluation, and 36% had an ophthalmologic evaluation. Among evaluated children, 6% had at least one Zika-associated birth defect identified, 9% had at least one neurodevelopmental abnormality possibly associated with congenital Zika virus infection identified, and 1% had both.

Conclusion

One in seven evaluated children had a Zika-associated birth defect, a neurodevelopmental abnormality possibly associated with congenital Zika virus infection, or both reported to the USZPIR. Given that most children did not have evidence of all recommended evaluations, additional anomalies might not have been identified. Careful monitoring and evaluation of children born to mothers with evidence of Zika virus infection during pregnancy is essential for ensuring early detection of possible disabilities and early referral to intervention services.

PDF

https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6731e1-H.pdf

 

 

MMWR August 8, 2018 V.67  Early Release

Interim Guidance for Preconception Counseling and Prevention of Sexual Transmission of Zika Virus for Men with Possible Zika Virus Exposure — United States, August 2018

Kara D. Polen, MPH; Suzanne M. Gilboa, PhD; Susan Hills, MBBS; et al.

Zika virus infection can occur as a result of mosquitoborne or sexual transmission of the virus. Infection during pregnancy is a cause of fetal brain abnormalities and other serious birth defects (1,2). CDC has updated the interim guidance for men with possible Zika virus exposure who 1) are planning to conceive with their partner, or 2) want to prevent sexual transmission of Zika virus at any time (3). CDC now recommends that men with possible Zika virus exposure who are planning to conceive with their partner wait for at least 3 months after symptom onset (if symptomatic) or their last possible Zika virus exposure (if asymptomatic) before engaging in unprotected sex. CDC now also recommends that for couples who are not trying to conceive, men can consider using condoms or abstaining from sex for at least 3 months after symptom onset (if symptomatic) or their last possible Zika virus exposure (if asymptomatic) to minimize their risk for sexual transmission of Zika virus. All other guidance for Zika virus remains unchanged. The definition of possible Zika virus exposure remains unchanged and …

PDF

https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6731e2-H.pdf

August 8, 2018 at 8:26 am

Zika virus infection: epidemiology, clinical manifestations and diagnosis

Current Opinion in Infectious Diseases: October 2016 – Volume 29 – Issue 5 – p 459–466

Calvet, Guilherme Amaral; Santos, Flavia Barreto dos; Sequeira, Patricia Carvalho

Purpose of review

Zika virus (ZIKV) is an arbovirus previously believed to cause only a mild and self-limiting illness. Recently, it has emerged as a new public health threat that caused a large outbreak in French Polynesia in 2013–2014 and since 2015 an explosive outbreak in Brazil, with an increase in severe congenital malformations (microcephaly) and neurological complications, mainly Guillain–Barré syndrome (GBS). Since then, it has spread through the Americas. On 1 February 2016, the WHO declared the ZIKV epidemic in Brazil a Public Health Emergency of International Concern. We reviewed the epidemiology of ZIKV infection, clinical presentations and diagnosis. We highlighted the clinical features and nonvector borne transmission of the virus.

Recent findings

Association between ZIKV infection and severe foetal outcomes, including microcephaly and other birth defects; increased rate of GBS and other neurological complications due to the ongoing ZIKV outbreak; increased evidence to date of ZIKV being the only arbovirus linked to sexual transmission; the challenge of ZIKV diagnosis; and the need for a specific point-of care test in epidemic scenarios.

Summary

The findings illustrate the emergence of a viral disease with the identification of new associated disorders, new modes of transmission, including maternal–foetal and sexual transmission.

FULL TEXT

https://journals.lww.com/co-infectiousdiseases/Fulltext/2016/10000/Zika_virus_infection___epidemiology,_clinical.6.aspx?WT.mc_id=HPxADx20100319xMP

PDF (CLIC en ARTICLE as PDF)

June 30, 2018 at 10:51 am

Minireview – Nipah Virus Infection

J. Clin. Microbiol. June 2018 56:10 e01875-17

Brenda S. P. Ang, Tchoyoson C. C. Lim, and Linfa Wang

Nipah virus, a paramyxovirus related to Hendra virus, first emerged in Malaysia in 1998.

Clinical presentation ranges from asymptomatic infection to fatal encephalitis.

Malaysia has had no more cases since 1999, but outbreaks continue to occur in Bangladesh and India.

In the Malaysia-Singapore outbreak, transmission occurred primarily through contact with pigs, whereas in Bangladesh and India, it is associated with ingestion of contaminated date palm sap and human-to-human transmission.

Bats are the main reservoir for this virus, which can cause disease in humans and animals.

There are currently no effective therapeutics, and supportive care and prevention are the mainstays of management.

abstract

http://jcm.asm.org/content/56/6/e01875-17.abstract

PDF

http://jcm.asm.org/content/56/6/e01875-17.full.pdf+html

June 12, 2018 at 7:37 am

Wound healing: Natural history and risk factors for delay in Australian patients treated with antibiotics for Mycobacterium ulcerans disease.

PLoS Negl Trop Dis. 2018 Mar 19;12(3):e0006357.

O’Brien DP1,2,3, Friedman ND1, McDonald A4, Callan P4, Hughes A1, Walton A1, Athan E1.

Author information

1 Department of Infectious Diseases, Barwon Health, Geelong, Australia.

2 Department of Medicine and Infectious Diseases, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.

3 Manson Unit, Médecins Sans Frontières, London, United Kingdom.

4 Department of Plastic Surgery, Barwon Health, Geelong, Australia.

Abstract

BACKGROUND:

Healing times following treatment with antibiotics, and factors that influence healing, have not been reported in Australian patients with Mycobacterium ulcerans.

METHODOLOGY/PRINCIPAL FINDINGS:

Healing times were determined for all M. ulcerans cases treated by a single physician with antibiotics at Barwon Health, Victoria, from 1/1/13-31/12/16. Lesions were categorised by induration size: category A ≤ 400mm2, Category B 401-1600mm2 and Category C ≥1601mm2. A logistic regression analysis was performed to determine risk factors for prolonged wound healing (>150 days from antibiotic commencement). 163 patients were included; 92 (56.4%) were male and median age was 58 years (IQR 39-73 years). Baseline lesion size [available in 145 (89.0%) patients] was categorised as A in 46 (31.7%), B in 67 (46.2%) and C in 32 (22.1%) patients. Fifty (30.7%) patients had surgery. In those treated with antibiotics alone, 83.0% experienced a reduction in induration size after 2 weeks, then 70.9% experienced an increase in induration size from the lowest point, and 71.7% experienced an increase in ulceration size. A linear relationship existed between the time induration resolved and wound healing began. Median time to heal was 91 days (IQR 70-148 days) for category A lesions; significantly shorter than for category B lesions (128 days, IQR 91-181 days, p = 0.05) and category C lesions (169 days, IQR 159-214 days, p<0.001). Fifty-seven (35.0%) patients experienced a paradoxical reaction. Of those treated with antibiotics alone, lesions experiencing a paradoxical reaction had longer healing times [median time to heal 177 days (IQR 154-224 days) compared to 107 days (IQR 79-153 days), p<0.001]. On multivariable logistic regression, lesion size at baseline (p<0.001) and paradoxical reactions (p<0.001) were independently associated with prolonged healing times. For category A and B lesions, healing time was significantly shorter with antibiotics plus excision and direct closure compared with antibiotics alone [Category A lesions median 55 days (IQR 21-63 days) compared with 91 days (IQR 70-148 days), p<0.001; Category B lesions median 74 days (IQR 21-121 days) compared to 128 days (IQR 97-181 days), p<0.001].

CONCLUSIONS:

In Australian patients treated with antibiotics M. ulcerans lesions usually initially improve, then clinically deteriorate with increased induration and ulceration, before healing after the inflammation associated with lesions resolves. The time to complete healing of lesions is generally long, and is further prolonged in those with larger initial lesion size or who develop paradoxical reactions. For small lesions (<4cm2), excisional surgery may reduce healing times.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5875894/pdf/pntd.0006357.pdf

April 23, 2018 at 7:22 pm

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