Posts filed under ‘Infecciones parasitarias’

Toxoplasmosis: The Heart of the Diagnosis

OPEN FORUM INFECTIOUS DISEASES January 2019 V.6 N.1

James H England; Samuel S Bailin; Jeffrey R Gehlhausen; Donald H Rubin

Toxoplasma gondii is a common parasite that infects warm-blooded animals, including humans, and is a foodborne pathogen. We report a case of acute toxoplasmosis in a 76-year-old man after ingestion of the undercooked heart of a white-tailed deer (Odocoileus virginianus) in Tennessee. The patient’s adult grandson, who also consumed part of the heart, became ill with nearly identical symptoms, though he did not seek medical care. This case highlights important public health concerns about deer-to-human transmission of Toxoplasma.

FULL TEXT

https://academic.oup.com/ofid/article/6/1/ofy338/5250666

PDF (CLIC en PDF)

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January 20, 2019 at 12:17 pm

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

Infections in patients affected by rheumatologic diseases associated to glucocorticoid use or tumor necrosis factor-alpha inhibitors.

Rev Chilena Infectol. April 2014 V.31 N.2 P.181-95.

[Article in Spanish]

Fica A.

Abstract

A great diversity of infectious agents can affect patients that use steroids at immunosuppressive doses or tumor necrosis factor alpha (TNF-alpha) antagonists.

The list of participating microorganisms is more restricted in the case of anti TNF-alpha blockers.

Overlapping agents include intracellular bacteria, Mycobacterium tuberculosis, geographic fungal agents that have the ability to establish granulamotous infections, herpes zoster, and reactivation of chronic hepatitis B virus infection.

An important conceptual issue for these infections is the existence of a threshold prednisone daily dose for the emergence of opportunistic infections but higher levels of immunosuppression and cofactors are required in the case of Pneumocystis jiroveci and cytomegalovirus infections.

In order to prevent these threats, a detailed medical evaluation is needed before prescription to detect potential risks and manage them properly.

Prevention rules must be prescribed in every case, that include common sense behaviors, vaccines, and in selected cases, chemoprophylaxis for latent tuberculosis (TB) infection, P. jiroveci pneumonia (PCP) or other specific requirements.

Latent TB infection is probable and requires chemoprophylaxis in the case of remote or recent exposure to a patient with lung TB, a positive tuberculin or interferon-gamma release assay result or residual lung scars in a chest x-ray exam.

PCP prevention is suggested when the patient reaches a daily dose of prednisone of 30 mg but might be needed at lower doses in case of other concomitant immunosuppressive drugs or when lymphopenia arises shortly after prednisone initiation.

PDF

https://scielo.conicyt.cl/pdf/rci/v31n2/art09.pdf

 

November 19, 2018 at 11:12 am

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

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

A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2018 Update by the Infectious Diseases Society of America and the American Society for Microbiology

Clinical Infectious Diseases September 15, 2018 V.67 N.6 P.813–816

IDSA GUIDELINE

J Michael Miller; Matthew J Binnicker; Sheldon Campbell; Karen C Carroll; Kimberle C Chapin …

The critical nature of the microbiology laboratory in infectious disease diagnosis calls for a close, positive working relationship between the physician/advanced practice provider and the microbiologists who provide enormous value to the healthcare team.

This document, developed by experts in laboratory and adult and pediatric clinical medicine, provides information on which tests are valuable and in which contexts, and on tests that add little or no value for diagnostic decisions.

This document presents a system-based approach rather than specimen-based approach, and includes bloodstream and cardiovascular system infections, central nervous system infections, ocular infections, soft tissue infections of the head and neck, upper and lower respiratory infections, infections of the gastrointestinal tract, intra-abdominal infections, bone and joint infections, urinary tract infections, genital infections, and other skin and soft tissue infections; or into etiologic agent groups, including arthropod-borne infections, viral syndromes, and blood and tissue parasite infections.

Each section contains introductory concepts, a summary of key points, and detailed tables that list suspected agents; the most reliable tests to order; the samples (and volumes) to collect in order of preference; specimen transport devices, procedures, times, and temperatures; and detailed notes on specific issues regarding the test methods, such as when tests are likely to require a specialized laboratory or have prolonged turnaround times.

In addition, the pediatric needs of specimen management are also emphasized. There is intentional redundancy among the tables and sections, as many agents and assay choices overlap.

The document is intended to serve as a guidance for physicians in choosing tests that will aid them to quickly and accurately diagnose infectious diseases in their patients.

FULL TEXT

https://academic.oup.com/cid/article/67/6/813/5088024

PDF (CLIC en PDF)

September 2, 2018 at 10:40 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

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