Posts filed under ‘Infecciones parasitarias’

Is it safe to go back into the water? A systematic review and meta-analysis of the risk of acquiring infections from recreational exposure to seawater

International Journal of Epidemiology February 26, 2018

Anne F C Leonard  Andrew Singer  Obioha C Ukoumunne  William H Gaze  Ruth Garside

Abstract

Background

Numerous illnesses are associated with bathing in natural waters, although it is assumed that the risk of illness among bathers exposed to relatively clean waters found in high-income countries is negligible. A systematic review was carried out to quantify the increased risk of experiencing a range of adverse health outcomes among bathers exposed to coastal water compared with non-bathers.

Methods

In all 6919 potentially relevant titles and abstracts were screened, and from these 40 studies were eligible for inclusion in the review. Odds ratios (OR) were extracted from 19 of these reports and combined in random-effect meta-analyses for the following adverse health outcomes: incident cases of any illness, ear infections, gastrointestinal illness and infections caused by specific microorganisms.

Results

There is an increased risk of experiencing symptoms of any illness [OR = 1.86, 95% confidence interval (CI): 1.31 to 2.64, P = 0.001] and ear ailments (OR = 2.05, 95% CI: 1.49 to 2.82, P < 0.001) in bathers compared with non-bathers. There is also an increased risk of experiencing gastrointestinal ailments (OR = 1.29, 95% CI: 1.12 to 1.49, P < 0.001).

Conclusions

This is the first systematic review to evaluate evidence on the increased risk of acquiring illnesses from bathing in seawater compared with non-bathers. Our results support the notion that infections are acquired from bathing in coastal waters, and that bathers have a greater risk of experiencing a variety of illnesses compared with non-bathers.

FULL TEXT

https://academic.oup.com/ije/advance-article/doi/10.1093/ije/dyx281/4911079

PDF (CLIC en PDF) FREE

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March 23, 2018 at 7:55 am

Treating malaria: new drugs for a new era

Lancet Infectious Diseases December 2017 V.17 N.12 P.1223–1224

COMMENT

Treating malaria: new drugs for a new era

G Dennis Shanks, Jörg J Möhrle

In The Lancet Infectious Diseases, Ousmane Koita and colleagues1 reported the results of a randomised, phase 2, non-inferiority clinical trial. They compared AQ-13, a next generation 4-aminoquinoline (4-AQ) compound, with artemether plus lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in 66 Malian men.

The per-protocol analysis of this well executed trial showed that both groups had similar proportions cured (28 [100%] of 28 for AQ-13 vs 31 [93·9%] of 33 for artemether plus lumefantrine; p=0·50) and non-inferiority of AQ-13 to artemether plus lumefantrine (difference −6·1%, 95% CI −14·7 to 2·4). The intention-to-treat analysis also showed that proportions cured were also similar between the groups (28 [84·8%] of 33 for AQ-13 vs 31 [93·9%] of 33 for artemether plus lumefantrine; p=0·43); however, this analysis did not show non-inferiority of AQ-13 to artemether plus lumefantrine (difference 9·1%, 95% CI −5·6 to 23·8). The study’s suboptimal number of participants was possibly due to civil military disturbances in Mali or improving malaria control in the Sahel. The data presented show AQ-13 to be efficacious in this relatively easy-to-treat population. The next challenge is to understand how well AQ-13 will treat patients who have lower or no immunity to malaria, such as African children….

FULL TEXT

http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30475-9/fulltext?elsca1=etoc

PDF

http://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(17)30475-9.pdf

 

 

Lancet Infectious Diseases December 2017 V.17 N.12 P.1266–1275

AQ-13, an investigational antimalarial, versus artemether plus lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria: a randomised, phase 2, non-inferiority clinical trial

Prof Ousmane A Koita, PhD, Lansana Sangaré, PhD, Haiyan D Miller, BS, Aliou Sissako, MD, Moctar Coulibaly, MD, Trevor A Thompson, BS, Prof Saharé Fongoro, MD, Youssouf Diarra, PharmD, Mamadou Ba, PhD, Prof Ababacar Maiga, PhD, Prof Boubakar Diallo, MD, David M Mushatt, MD, Frances J Mather, PhD, Jeffrey G Shaffer, PhD, Asif H Anwar, MD, Prof Donald J Krogstad

Background

Chloroquine was used for malaria treatment until resistant Plasmodium falciparum was identified. Because 4-aminoquinolines with modified side chains, such as AQ-13, are active against resistant parasites, we compared AQ-13 against artemether plus lumefantrine for treatment of uncomplicated P falciparum malaria.

Methods

We did a randomised, non-inferiority trial. We screened men (≥18 years) with uncomplicated malaria in Missira (northeast Mali) and Bamako (capital of Mali) for eligibility (≥2000 asexual P falciparum parasites per μL of blood). Eligible participants were randomly assigned to either the artemether plus lumefantrine group or AQ-13 group by permuting blocks of four with a random number generator. Physicians and others caring for the participants were masked, except for participants who received treatment and the research pharmacist who implemented the randomisation and provided treatment. Participants received either 80 mg of oral artemether and 480 mg of oral lumefantrine twice daily for 3 days or 638·50 mg of AQ-13 base (two oral capsules) on days 1 and 2, and 319·25 mg base (one oral capsule) on day 3. Participants were monitored for parasite clearance (50 μL blood samples twice daily at 12 h intervals until two consecutive negative samples were obtained) and interviewed for adverse events (once every day) as inpatients during week 1. During the 5-week outpatient follow-up, participants were examined for adverse events and recurrent infection twice per week. All participants were included in the intention-to-treat analysis and per-protocol analysis, except for those who dropped out in the per-protocol analysis. The composite primary outcome was clearance of asexual parasites and fever by day 7, and absence of recrudescent infection by parasites with the same molecular markers from days 8 to 42 (defined as cure). Non-inferiority was considered established if the proportion of patients who were cured was higher for artemether plus lumefantrine than for AQ-13 and the upper limit of the 95% CI was less than the non-inferiority margin of 15%. This trial is registered at ClinicalTrials.gov, number NCT01614964.

Findings

Between Aug 6 and Nov 18, 2013, and between Sept 18 and Nov 20, 2015, 66 Malian men with uncomplicated malaria were enrolled. 33 participants were randomly assigned to each group. There were no serious adverse events (grade 2–4) and asexual parasites were cleared by day 7 in both groups. 453 less-severe adverse events (≤grade 1) were reported: 214 in the combination group and 239 in the AQ-13 group. Two participants withdrew from the AQ-13 group after parasite clearance and three were lost to follow-up. In the artemether plus lumefantrine group, two participants had late treatment failures (same markers as original isolates). On the basis of the per-protocol analysis, the AQ-13 and artemether plus lumefantrine groups had similar proportions cured (28 [100%] of 28 vs 31 [93·9%] of 33; p=0·50) and AQ-13 was not inferior to artemether plus lumefantrine (difference −6·1%, 95% CI −14·7 to 2·4). Proportions cured were also similar between the groups in the intention-to-treat analysis (28 of 33, 84·8% for AQ-13 vs 31 of 33, 93·9% for artemether and lumefantrine; p=0·43) but the upper bound of the 95% CI exceeded the 15% non-inferiority margin (difference 9·1%, 95% CI −5·6 to 23·8).

Interpretation

The per-protocol analysis suggested non-inferiority of AQ-13 to artemether plus lumefantrine. By contrast, the intention-to-treat analysis, which included two participants who withdrew and three who were lost to follow-up from the AQ-13 group, did not meet the criterion for non-inferiority of AQ-13, although there were no AQ-13 treatment failures. Studies with more participants (and non-immune participants) are needed to decide whether widespread use of modified 4-aminoquinolones should be recommended.

Funding

US Food and Drug Administration Orphan Product Development, National Institutes of Health, US Centers for Disease Control and Prevention, Burroughs-Wellcome Fund, US State Department, and WHO.

FULL TEXT

http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30365-1/fulltext?elsca1=etoc

PDF

http://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(17)30365-1.pdf

 

November 24, 2017 at 8:35 am

A Rose by Any Other Name: Practical Updates on Microbial Nomenclature for Clinical Microbiology

Journal of Clinical Microbiology January 2017 V.55 N.1 P.3-4

EDITORIAL

Colleen S. Kraft, Alexander J. McAdam, and Karen C. Carroll

aDepartment of Pathology and Laboratory Medicine, Division of Infectious Disease, Emory University, Atlanta, Georgia, USA

bDepartment of Laboratory Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA

cDivision of Medical Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

The clinical microbiology laboratory stands at the interface between basic science, including the study of phylogeny, and applications of science in the very practical world of medical care.

In this context, it is important that laboratory reports balance scientific accuracy with medical utility, and it is particularly difficult to do this in the naming of microorganisms.

New organisms are discovered and named, and our understanding of the relationships between known organisms improves, resulting in the reclassification and renaming of organisms as they are sorted into the correct groups.

In this issue of Journal of Clinical Microbiology, we are pleased to provide several minireviews that are intended to help clinical microbiologists keep up-to-date with changes in nomenclature for bacteria (1), parasites (2), viruses (3), and fungi (4).

Most of these minireviews focus on human pathogens, but the minireview on viruses includes those affecting nonhuman animals. An article about mycobacterial nomenclature is in preparation and will be published in Journal of Clinical Microbiology when available.

The idea for this informative resource was proposed by Dr. Karen Carroll at the editors’ meeting in 2015.

The editors enthusiastically agreed these reviews would be a useful resource for clinical microbiologists, infectious diseases physicians, laboratory technologists, pharmacists, and infection preventionists, in addition to fostering discussion and teaching of trainees and students.

Several editors volunteered to write the articles, and we plan to update these minireviews every 2 years if they prove to be as useful as we expect….

PDF

http://jcm.asm.org/content/55/1/3.full.pdf+html

October 19, 2017 at 3:02 pm

False-Positive Rapid Malaria Antigen Test Result in a Returned Traveler

Journal of Clinical Microbiology August 2017 V.55 N.8 P.2294-2297

The Brief Case

Kristle L. Haberichter, Paul C. Johnson, Paul J. Chittick, Peter Millward, Barbara Robinson-Dunn, and Bobby L. Boyanton Jr.

A previously healthy 43-year-old female presented to her primary care physician with a 13-day history of recurrent nightly fevers (100°F to 101°F), nonproductive cough, and respiratory congestion. She was prescribed azithromycin, albuterol, and benzonatate. She presented to the emergency center 2 days later without improvement and at that time reported night sweats. She had recently traveled to Thailand, Laos, Cambodia, and the United Arab Emirates. The nightly fevers began 11 days after returning home. She acknowledged being bitten by mosquitoes throughout her travels and did not take malaria prophylaxis.

A previously healthy 43-year-old female presented to her primary care physician with a 13-day history of recurrent nightly fevers (100°F to 101°F), nonproductive cough, and respiratory congestion. She was prescribed azithromycin, albuterol, and benzonatate. She presented to the emergency center 2 days later without improvement and at that time reported night sweats. She had recently traveled to Thailand, Laos, Cambodia, and the United Arab Emirates. The nightly fevers began 11 days after returning home. She acknowledged being bitten by mosquitoes throughout her travels and did not take malaria prophylaxis….

PDF

http://jcm.asm.org/content/55/8/2294.full.pdf+html

 

 

Journal of Clinical Microbiology August 2017 V.55 N.8 P.2560-2561

Closing the Brief Case: False-Positive Rapid Malaria Antigen Test Result in a Returned Traveler

Kristle L. Haberichter, Paul C. Johnson, Paul J. Chittick, Peter Millward, Barbara Robinson-Dunn, and Bobby L. Boyanton Jr.

aDepartment of Pathology and Laboratory Medicine, Beaumont Health, Royal Oak, Michigan, USA

bDepartment of Infectious Disease, Beaumont Health, Royal Oak, Michigan, USA

cOakland University William Beaumont School of Medicine, Rochester, Michigan, USA

ANSWERS TO SELF-ASSESSMENT QUESTIONS

PDF

http://jcm.asm.org/content/55/8/2560.full.pdf+html

July 26, 2017 at 9:23 am

Sexual transmission of American trypanosomiasis in humans: a new potential pandemic route for Chagas parasites

Memórias do Instituto Oswaldo Cruz June 2017 V.112 N.6

Perla F Araujo1, Adriana B Almeida1, Carlos F Pimentel1, Adriano R Silva1, Alessandro Sousa1, Sebastião A Valente2,

Vera C Valente2, Manuela M Britto1, Ana C Rosa1, Rozeneide M Alves1, Luciana Hagström1, Antonio RL Teixeira1  *  +

1Universidade de Brasília, Faculdade de Medicina, Laboratório Multidisciplinar de Pesquisa em Doença de Chagas, Brasília, DF, Brasil

2Instituto Evandro Chagas, Belém, PA, Brasil

BACKGROUND

The Trypanosoma cruzi infection endemic in Latin America has now spread to several countries across four continents; this endemic involves triatomine vector-free protists. We hypothesised that the sexual transmission of T. cruzi contributes to the ongoing spread of Chagas disease.

OBJECTIVES

A short-term longitudinal study was conducted to evaluate this hypothesis.

METHODS

The study population comprised 109 subjects from four families, among whom 21 had been diagnosed with acute Chagas disease by direct parasitological analysis. Blood mononuclear cells and serum samples were obtained from each study subject once per year for three consecutive years. Enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescence serological examinations were used to detect specific T. cruzi antibodies. Polymerase chain reaction of T. cruzi DNA revealed 188-nucleotide bands, which hybridised to a specific radiolabelled probe and were confirmed by cloning and sequencing.

RESULTS

Three independent assessments at different time points revealed T. cruzi nuclear DNA footprints in 76% (83/109) of the study population with active infection. In contrast, the ELISA and indirect immunofluorescence assays detected the T. cruzi antibody in 28.4% (31/109) of the study samples. Moreover, the semen from 82.6% (19/23) of subjects people revealed harboured the 188- bp base pair T. cruzi footprint. Interestingly, the ejaculates of nuclear DNA-positive Chagas patient transmitted the T. cruzi upon peritoneal injection or infusion in the vagina of mice, and amastigotes were detected in the skeletal muscle, myocardium, vas deferens, and uterine tube.

MAIN CONCLUSIONS

T. cruzi infections can be transmitted from females or males to naïve mates through intercourse, and progeny showed discrepancies between the ratios of nuclear DNA footprints and specific antibody that can be explained by the tolerance attained during early embryo growth. Additional studies are needed to develop drugs to eradicate the infections. Additionally, the importance of a vigorous education, information, and communication program to prevent sexually transmitted Chagas disease in humans cannot be underemphasised.

PDF

http://www.scielo.br/pdf/mioc/v112n6/0074-0276-mioc-112-6-0437.pdf

July 14, 2017 at 8:23 am

Abordaje terapéutico actual de la malaria grave importada

Revista Española de Quimioterapia Septiembre 2016 V.29 Supl.1

EMMANUELE VENANZI, ROGELIO LÓPEZ-VÉLEZ

PDF

http://www.seq.es/seq/0214-3429/29/sup1/15venanzi.pdf

 

Resistencia a los antimaláricos

EMMANUELE VENANZI, ROGELIO LÓPEZ-VÉLEZ

PDF

http://www.seq.es/seq/0214-3429/29/sup1/16venanzi.pdf

 

April 9, 2017 at 12:44 pm

A New Development in Trypanosoma cruzi Detection

Journal of Clinical Microbiology March 2017 V.55 N.3 P.690-692

Herbert B. Tanowitz and Louis M. Weiss

Department of Pathology, Division of Tropical Medicine and Parasitology, and Department of Medicine, Division of Infectious Disease, Albert Einstein College of Medicine, Bronx, New York, USA

Chagas disease is caused by the parasite Trypanosoma cruzi and is an important cause of morbidity and mortality in areas of Latin America where Chagas disease is endemic and among infected individuals who have migrated to nonendemic areas of North America and Europe.

There are many diagnostic tests that are employed in the serological diagnosis of this infection. In this issue of the Journal of Clinical Microbiology, Bautista-López et al. provide characterization of excretory vesicles (EVs) from Vero cells infected with T. cruzi and provide data on the EVs produced by trypomastigotes and amastigotes (N. L. Bautista-López et al., J Clin Microbiol 55:744–758, 2017, https://doi.org/10.1128/JCM.01649-16).

Their proteomic study defines potential targets to evaluate for improved diagnostic tests, effects on host cell biology that contribute to the pathogenesis of infection, and vaccine candidates. If any of the EV-associated proteins identified were to be correlated to cure of infection, this would be a major advance….

PDF

http://jcm.asm.org/content/55/3/690.full.pdf+html

February 24, 2017 at 8:01 am

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