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Vernaza A, Pinilla-Monsalve G, Cañas F, Carrillo D, David López J, Flórez N, Gomez-Mesa JE. Malaria and encephalopathy in a heart transplant recipient: A case report in the context of multiorgan donation. Transpl Infect Dis 2021; 23:e13565. [PMID: 33432737 DOI: 10.1111/tid.13565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/10/2020] [Accepted: 12/30/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Malaria is an endemic infection in tropical circles. It can be transmitted from mosquitoes bite, but exceptional cases have been attributed to multiorgan transplantation. CASE REPORT This is a 34-year-old woman who received a heart transplant for final-stage dilated cardiomyopathy. Over the hospitalization, she developed fever, cephalalgia, and tonic-clonic seizures with MRI findings compatible with posterior reversible encephalopathy. A thick blood smear revealed hemoparasitic forms of Plasmodium vivax. Afterward, malaria was also diagnosed in recipients of one kidney and liver of the same organ donor. First-line treatment with artesunate was prescribed for 3 days and chloroquine with primaquine thereafter for 14 days. The patient was discharged and returned to the emergency department 5 days later, complaining of gastrointestinal symptoms and developed multiorgan failure that led to death. CONCLUSION We report a case of malaria transmission through heart transplantation. Despite adequate and supervised treatment, it can be related to a fatal outcome. Malaria screening in organ donors should be considered in regions where endemicity can lead to rare cases of transmission by transplantation.
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Affiliation(s)
- Armando Vernaza
- Faculty of Health Sciences, Icesi University, Cali, Colombia.,Department of Cardiology, Fundación Valle del Lili, Cali, Colombia
| | - Gabriel Pinilla-Monsalve
- Faculty of Health Sciences, Icesi University, Cali, Colombia.,Department of Neurology, Fundación Valle del Lili, Cali, Colombia
| | - Felipe Cañas
- Faculty of Health Sciences, Icesi University, Cali, Colombia.,Department of Cardiology, Fundación Valle del Lili, Cali, Colombia
| | - Diana Carrillo
- Faculty of Health Sciences, Icesi University, Cali, Colombia.,Department of Cardiology, Fundación Valle del Lili, Cali, Colombia
| | - Juan David López
- Faculty of Health Sciences, Icesi University, Cali, Colombia.,Department of Cardiology, Fundación Valle del Lili, Cali, Colombia
| | - Noel Flórez
- Faculty of Health Sciences, Icesi University, Cali, Colombia.,Department of Cardiology, Fundación Valle del Lili, Cali, Colombia
| | - Juan Esteban Gomez-Mesa
- Faculty of Health Sciences, Icesi University, Cali, Colombia.,Department of Cardiology, Fundación Valle del Lili, Cali, Colombia
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2
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de Sousa Arantes Ferreira G, Conde Watanabe AL, de Carvalho Trevizoli N, Felippe Jorge FM, de Fatima Couto C, de Oliveira Nunes Cajá G, Viana de Lima L, Liduario Raupp DR. Visceral Leishmaniasis in a Liver Transplant Patient: A Case Report. Transplant Proc 2020; 52:1417-1421. [PMID: 32192740 DOI: 10.1016/j.transproceed.2020.01.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 01/02/2020] [Indexed: 02/07/2023]
Abstract
Leishmaniasis is an infection caused by protozoa of the genus Leishmania, transmitted by sandflies and endemic to more than 88 countries. Visceral leishmaniasis in immunosuppressed patients is a growing concern. We report the case of a 61-year-old male patient with a previous history of alcoholic cirrhosis and portal vein thrombosis who underwent liver transplantation for the treatment of hepatocellular carcinoma. Thirty-six days after the procedure, the patient showed an increase in liver enzymes and was diagnosed with moderate acute rejection of the graft. He was treated with high-dose intravenous corticosteroids, and while showing improvement in biochemical markers, he became febrile 12 days after corticosteroid treatment. He presented daily episodes of fever, even after the use of several antimicrobial, antiviral, and antifungal agents, and a number of negative cultures from different sites were obtained. A bone marrow biopsy was then performed, showing a large number of amastigote forms of Leishmania spp. Treatment with liposomal amphotericin B was initiated; however, the patient progressed to refractory septic shock and death. This case highlights several aspects of visceral leishmaniasis in liver transplant recipients, such as the association of malnutrition to Leishmania infection and the challenges of diagnosing leishmaniasis in cirrhotic patients in which splenomegaly and pancytopenia, the hallmarks of leishmaniasis, may also be attributed to portal hypertension and end-stage liver disease. A high index of suspicion is necessary for the correct diagnosis and treatment of leishmaniasis in this group of patients. This study is compliant with the Helsinki Congress and the Istanbul Declaration.
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3
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da Silva A, Semeano ATS, Dourado AH, Ulrich H, Cordoba de Torresi SI. Novel Conducting and Biodegradable Copolymers with Noncytotoxic Properties toward Embryonic Stem Cells. ACS OMEGA 2018; 3:5593-5604. [PMID: 30023923 PMCID: PMC6045332 DOI: 10.1021/acsomega.8b00510] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 05/08/2018] [Indexed: 06/01/2023]
Abstract
Electroactive biomaterials that are easily processed as scaffolds with good biocompatibility for tissue regeneration are difficult to design. Herein, the synthesis and characterization of a variety of novel electroactive, biodegradable biomaterials based on poly(3,4-ethylenedioxythiphene) copolymerized with poly(d,l lactic acid) (PEDOT-co-PDLLA) are presented. These copolymers were obtained using (2,3-dihydrothieno[3,4-b][1,4]dioxin-2-yl)methanol (EDOT-OH) as an initiator in a lactide ring-opening polymerization reaction, resulting in EDOT-PDLLA macromonomer. Conducting PEDOT-co-PDLLA copolymers (in three different proportions) were achieved by chemical copolymerization with 3,4-ethylenedioxythiophene (EDOT) monomers and persulfate oxidant. The PEDOT-co-PDLLA copolymers were structurally characterized by 1H NMR and Fourier transform infrared spectroscopy. Cyclic voltammetry confirmed the electroactive character of the materials, and conductivity measurements were performed via electrochemical impedance spectroscopy. In vitro biodegradability was evaluated using proteinase K over 35 days, showing 29-46% (w/w) biodegradation. Noncytotoxicity was assessed by adhesion, migration, and proliferation assays using embryonic stem cells (E14.tg2a); excellent neuronal differentiation was observed. These novel electroactive and biodegradable PEDOT-co-PDLLA copolymers present surface chemistry and charge density properties that make them potentially useful as scaffold materials in different fields of applications, especially for neuronal tissue engineering.
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Affiliation(s)
- Aruã
C. da Silva
- Department
of Fundamental Chemistry, Institute of Chemistry, University of São Paulo, Av. Prof. Lineu Prestes, 748, 05508-000 São Paulo, São Paulo, Brazil
| | - Ana Teresa S. Semeano
- Department
of Biochemistry, Institute of Chemistry, University of São Paulo, 05508-000 São Paulo, Brazil
| | - André H.
B. Dourado
- Department
of Fundamental Chemistry, Institute of Chemistry, University of São Paulo, Av. Prof. Lineu Prestes, 748, 05508-000 São Paulo, São Paulo, Brazil
| | - Henning Ulrich
- Department
of Biochemistry, Institute of Chemistry, University of São Paulo, 05508-000 São Paulo, Brazil
| | - Susana I. Cordoba de Torresi
- Department
of Fundamental Chemistry, Institute of Chemistry, University of São Paulo, Av. Prof. Lineu Prestes, 748, 05508-000 São Paulo, São Paulo, Brazil
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4
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Gad A, Ali S, Zahoor T, Azarov N. Case Report: A Case of Severe Cerebral Malaria Managed with Therapeutic Hypothermia and Other Modalities for Brain Edema. Am J Trop Med Hyg 2018; 98:1120-1122. [PMID: 29405103 DOI: 10.4269/ajtmh.17-0794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Malarial infections are uncommon in the United States and almost all reported cases stem from recent travelers coming from endemic countries. Cerebral malaria (CM) is a severe form of the disease usually affecting children and individuals with limited immunity. Despite proper management, mortality from CM can reach up to 25%, especially when it is associated with brain edema. Inefficient management of the edema may result in brain herniation and death. Uniform guidelines for management of CM-associated brain edema are lacking. In this report, we present a case of CM with associated severe brain edema that was successfully managed using a unique combination of therapeutic hypothermia, hypertonic saline, mannitol, and hyperventilation along with the antimalarial drugs quinidine and doxycycline. Our use of hypothermia was based on its proven benefit for improving neurological outcomes in post-cardiac arrest patients and previous in vitro research, suggesting its potential inhibitory role on malaria growth.
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Affiliation(s)
- AbdAllah Gad
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Odessa, Texas
| | - Sajjad Ali
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Odessa, Texas
| | - Talal Zahoor
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Odessa, Texas
| | - Nick Azarov
- Department of Critical Care, Texas Tech University Health Sciences Center, Odessa, Texas
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5
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Elliesen R, Walther A. Commentary: Physical Functional Capacity and C-Reactive Protein in Schizophrenia. Front Psychiatry 2018; 9:7. [PMID: 29434554 PMCID: PMC5790803 DOI: 10.3389/fpsyt.2018.00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/11/2018] [Indexed: 11/29/2022] Open
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6
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Lehner F, Kudlinzki D, Richter C, Müller-Werkmeister HM, Eberl KB, Bredenbeck J, Schwalbe H, Silvers R. Impact of Azidohomoalanine Incorporation on Protein Structure and Ligand Binding. Chembiochem 2017; 18:2340-2350. [DOI: 10.1002/cbic.201700437] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Florian Lehner
- Organic Chemistry and Chemical Biology; Goethe University Frankfurt; Max-von-Laue-Strasse 7 60438 Frankfurt am Main Germany
| | - Denis Kudlinzki
- Organic Chemistry and Chemical Biology; Goethe University Frankfurt; Max-von-Laue-Strasse 7 60438 Frankfurt am Main Germany
- German Cancer Consortium; DKTK; German Cancer Research Center; DKFZ; Im Neuenheimer Feld 280 69120 Heidelberg Germany
| | - Christian Richter
- Organic Chemistry and Chemical Biology; Goethe University Frankfurt; Max-von-Laue-Strasse 7 60438 Frankfurt am Main Germany
| | | | - Katharina B. Eberl
- Institute for Biophysics; Goethe University Frankfurt; Max-von-Laue-Strasse 1 60438 Frankfurt am Main Germany
| | - Jens Bredenbeck
- Institute for Biophysics; Goethe University Frankfurt; Max-von-Laue-Strasse 1 60438 Frankfurt am Main Germany
| | - Harald Schwalbe
- Organic Chemistry and Chemical Biology; Goethe University Frankfurt; Max-von-Laue-Strasse 7 60438 Frankfurt am Main Germany
| | - Robert Silvers
- Organic Chemistry and Chemical Biology; Goethe University Frankfurt; Max-von-Laue-Strasse 7 60438 Frankfurt am Main Germany
- Present address: Francis Bitter Magnet Laboratory; Massachusetts Institute of Technology; Cambridge MA 02139 USA
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7
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Respiratory Syncytial Virus: Infection, Detection, and New Options for Prevention and Treatment. Clin Microbiol Rev 2017; 30:277-319. [PMID: 27903593 DOI: 10.1128/cmr.00010-16] [Citation(s) in RCA: 326] [Impact Index Per Article: 46.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Respiratory syncytial virus (RSV) infection is a significant cause of hospitalization of children in North America and one of the leading causes of death of infants less than 1 year of age worldwide, second only to malaria. Despite its global impact on human health, there are relatively few therapeutic options available to prevent or treat RSV infection. Paradoxically, there is a very large volume of information that is constantly being refined on RSV replication, the mechanisms of RSV-induced pathology, and community transmission. Compounding the burden of acute RSV infections is the exacerbation of preexisting chronic airway diseases and the chronic sequelae of RSV infection. A mechanistic link is even starting to emerge between asthma and those who suffer severe RSV infection early in childhood. In this article, we discuss developments in the understanding of RSV replication, pathogenesis, diagnostics, and therapeutics. We attempt to reconcile the large body of information on RSV and why after many clinical trials there is still no efficacious RSV vaccine and few therapeutics.
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8
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Melo GD, Goyard S, Fiette L, Boissonnas A, Combadiere C, Machado GF, Minoprio P, Lang T. Unveiling Cerebral Leishmaniasis: parasites and brain inflammation in Leishmania donovani infected mice. Sci Rep 2017; 7:8454. [PMID: 28814754 PMCID: PMC5559479 DOI: 10.1038/s41598-017-09085-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 07/21/2017] [Indexed: 11/09/2022] Open
Abstract
Visceral leishmaniasis (VL) is a systemic disease with multifaceted clinical manifestations, including neurological signs, however, the involvement of the nervous system during VL is underestimated. Accordingly, we investigated both brain infection and inflammation in a mouse model of VL. Using bioluminescent Leishmania donovani and real-time 2D-3D imaging tools, we strikingly detected live parasites in the brain, where we observed a compartmentalized dual-phased inflammation pattern: an early phase during the first two weeks post-infection, with the prompt arrival of neutrophils and Ly6Chigh macrophages in an environment presenting a variety of pro-inflammatory mediators (IFN-γ, IL-1β, CXCL-10/CXCR-3, CCL-7/CCR-2), but with an intense anti-inflammatory response, led by IL-10; and a re-inflammation phase three months later, extremely pro-inflammatory, with novel upregulation of mediators, including IL-1β, TNF-α and MMP-9. These new data give support and corroborate previous studies connecting human and canine VL with neuroinflammation and blood-brain barrier disruption, and conclusively place the brain among the organs affected by this parasite. Altogether, our results provide convincing evidences that Leishmania donovani indeed infects and inflames the brain.
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Affiliation(s)
- Guilherme D Melo
- Institut Pasteur, Laboratoire des Processus Infectieux à Trypanosomatidés, Département Infection et Epidémiologie, 25-28 rue du Dr Roux, 75724, Cedex 15, Paris, France
- UNESP - Univ Estadual Paulista, Faculdade de Medicina Veterinária, Laboratório de Patologia Aplicada (LApap), Rua Clóvis Pestana 793, 16050-680, Araçatuba, São Paulo, Brazil
| | - Sophie Goyard
- Institut Pasteur, Laboratoire des Processus Infectieux à Trypanosomatidés, Département Infection et Epidémiologie, 25-28 rue du Dr Roux, 75724, Cedex 15, Paris, France
- Institut Pasteur, Centre d'Innovation et Recherche Technologique, Paris, France
| | - Laurence Fiette
- Institut Pasteur, Unité d'Histopathologie Humaine et Modèles Animaux, Département Infection et Epidémiologie, 25-28 rue du Dr Roux, 75724, CEDEX 15, Paris, France
| | - Alexandre Boissonnas
- Sorbonne Universités, UPMC Univ Paris 06, Inserm, UMR 1135, CNRS, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), 91 Boulevard de l'Hôpital, 75013, Paris, France
| | - Christophe Combadiere
- Sorbonne Universités, UPMC Univ Paris 06, Inserm, UMR 1135, CNRS, ERL 8255, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), 91 Boulevard de l'Hôpital, 75013, Paris, France
| | - Gisele F Machado
- UNESP - Univ Estadual Paulista, Faculdade de Medicina Veterinária, Laboratório de Patologia Aplicada (LApap), Rua Clóvis Pestana 793, 16050-680, Araçatuba, São Paulo, Brazil
| | - Paola Minoprio
- Institut Pasteur, Laboratoire des Processus Infectieux à Trypanosomatidés, Département Infection et Epidémiologie, 25-28 rue du Dr Roux, 75724, Cedex 15, Paris, France
| | - Thierry Lang
- Institut Pasteur, Laboratoire des Processus Infectieux à Trypanosomatidés, Département Infection et Epidémiologie, 25-28 rue du Dr Roux, 75724, Cedex 15, Paris, France.
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9
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Portes A, Giestal-de-Araujo E, Fagundes A, Pandolfo P, de Sá Geraldo A, Lira MLF, Amaral VF, Lagrota-Candido J. Leishmania amazonensis infection induces behavioral alterations and modulates cytokine and neurotrophin production in the murine cerebral cortex. J Neuroimmunol 2016; 301:65-73. [DOI: 10.1016/j.jneuroim.2016.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 11/08/2016] [Accepted: 11/11/2016] [Indexed: 12/31/2022]
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10
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Iliyasu G, Abdu A, Dayyab F, Tiamiyu A, Habib Z, Adamu B, Habib A. Post-renal transplant infections: single-center experience from Nigeria. Transpl Infect Dis 2016; 18:566-74. [DOI: 10.1111/tid.12548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 08/13/2015] [Accepted: 02/14/2016] [Indexed: 11/27/2022]
Affiliation(s)
- G. Iliyasu
- Infectious Disease Unit; Department of Medicine; College of Health Science; Bayero University Kano; Kano Nigeria
| | - A. Abdu
- Nephrology Unit; Department of Medicine; College of Health Science; Bayero University Kano; Kano Nigeria
| | - F.M. Dayyab
- Department of Medicine; Aminu Kano Teaching Hospital; Kano Nigeria
| | - A.B. Tiamiyu
- Department of Medicine; Aminu Kano Teaching Hospital; Kano Nigeria
| | - Z.G. Habib
- Department of Medicine; Aminu Kano Teaching Hospital; Kano Nigeria
| | - B. Adamu
- Nephrology Unit; Department of Medicine; College of Health Science; Bayero University Kano; Kano Nigeria
| | - A.G. Habib
- Infectious Disease Unit; Department of Medicine; College of Health Science; Bayero University Kano; Kano Nigeria
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11
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Schmidt-Hieber M, Silling G, Schalk E, Heinz W, Panse J, Penack O, Christopeit M, Buchheidt D, Meyding-Lamadé U, Hähnel S, Wolf HH, Ruhnke M, Schwartz S, Maschmeyer G. CNS infections in patients with hematological disorders (including allogeneic stem-cell transplantation)-Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann Oncol 2016; 27:1207-25. [PMID: 27052648 PMCID: PMC4922317 DOI: 10.1093/annonc/mdw155] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 03/24/2016] [Indexed: 12/22/2022] Open
Abstract
Diagnosis of CNS infections remains a great challenge in patients with hematological disorders since symptoms might both be masked and be mimicked by other conditions such as metabolic disturbances or consequences from antineoplastic treatment. Thus, awareness of this complication is crucial and any suspicion of a CNS infection should lead to timely and adequate diagnostics and treatment to improve the outcome in this population. Infections of the central nervous system (CNS) are infrequently diagnosed in immunocompetent patients, but they do occur in a significant proportion of patients with hematological disorders. In particular, patients undergoing allogeneic hematopoietic stem-cell transplantation carry a high risk for CNS infections of up to 15%. Fungi and Toxoplasma gondii are the predominant causative agents. The diagnosis of CNS infections is based on neuroimaging, cerebrospinal fluid examination and biopsy of suspicious lesions in selected patients. However, identification of CNS infections in immunocompromised patients could represent a major challenge since metabolic disturbances, side-effects of antineoplastic or immunosuppressive drugs and CNS involvement of the underlying hematological disorder may mimic symptoms of a CNS infection. The prognosis of CNS infections is generally poor in these patients, albeit the introduction of novel substances (e.g. voriconazole) has improved the outcome in distinct patient subgroups. This guideline has been developed by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) with the contribution of a panel of 14 experts certified in internal medicine, hematology/oncology, infectious diseases, intensive care, neurology and neuroradiology. Grades of recommendation and levels of evidence were categorized by using novel criteria, as recently published by the European Society of Clinical Microbiology and Infectious Diseases.
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Affiliation(s)
- M Schmidt-Hieber
- Department of Hematology, Oncology and Tumor Immunology, HELIOS Clinic Berlin-Buch, Berlin
| | - G Silling
- Department of Hematology, Oncology and Stem Cell Transplantation, University Hospital, Aachen, Medical Faculty, RWTH Aachen, Aachen
| | - E Schalk
- Department of Hematology and Oncology, Otto-von-Guericke University Hospital Magdeburg, Magdeburg
| | - W Heinz
- Department of Internal Medicine II, University Hospital Würzburg, Center of Internal Medicine, Würzburg
| | - J Panse
- Department of Hematology, Oncology and Stem Cell Transplantation, University Hospital, Aachen, Medical Faculty, RWTH Aachen, Aachen
| | - O Penack
- Department of Hematology, Oncology and Tumor Immunology, Charité University Medicine, Campus Virchow Clinic, Berlin
| | - M Christopeit
- Department of Stem Cell Transplantation, University Medical Center Hamburg Eppendorf, Hamburg
| | - D Buchheidt
- Department of Hematology and Oncology, Mannheim University Hospital, University of Heidelberg, Mannheim
| | - U Meyding-Lamadé
- Department of Neurology, Hospital Nordwest Frankfurt, Frankfurt/M., Germany Brunei Neuroscience Stroke and Rehabilitation Centre, Jerudong, Brunei Darussalam Department of Neuroinfectiology, Otto-Meyerhof-Centre, University of Heidelberg, Heidelberg
| | - S Hähnel
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg
| | - H H Wolf
- Department of Hematology and Oncology, University Hospital Halle, Halle
| | - M Ruhnke
- Paracelsus Clinic Osnabrück, Osnabrück
| | - S Schwartz
- Department of Hematology and Oncology, Charité University Medicine, Campus Benjamin Franklin, Berlin
| | - G Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Ernst von Bergmann Clinic, Potsdam, Germany
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12
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Carpio A, Romo ML, Parkhouse RME, Short B, Dua T. Parasitic diseases of the central nervous system: lessons for clinicians and policy makers. Expert Rev Neurother 2016; 16:401-14. [PMID: 26894629 PMCID: PMC4926779 DOI: 10.1586/14737175.2016.1155454] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Parasitic diseases of the central nervous system are associated with high mortality and morbidity, especially in resource-limited settings. The burden of these diseases is amplified as survivors are often left with neurologic sequelae affecting mobility, sensory organs, and cognitive functions, as well as seizures/epilepsy. These diseases inflict suffering by causing lifelong disabilities, reducing economic productivity, and causing social stigma. The complexity of parasitic life cycles and geographic specificities, as well as overlapping clinical manifestations in the host reflecting the diverse pathogenesis of parasites, can present diagnostic challenges. We herein provide an overview of these parasitic diseases and summarize clinical aspects, diagnosis, therapeutic strategies and recent milestones, and aspects related to prevention and control.
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Affiliation(s)
- Arturo Carpio
- a Escuela de Medicina , Universidad de Cuenca , Cuenca , Ecuador.,b GH Sergievsky Center, College of Physicians and Surgeons , Columbia University , New York , NY , USA.,c Consultorios Sta Inés, F. Proaño y D. Cordova (esquina) , Cuenca , Ecuador
| | - Matthew L Romo
- d Epidemiology and Biostatistics Program, CUNY School of Public Health, Hunter College , New York , NY , USA.,e Dirección de Investigación , Universidad de Cuenca , Cuenca , Ecuador
| | | | - Brooke Short
- g World Health Organization (WHO Geneva) , Geneva , Switzerland
| | - Tarun Dua
- g World Health Organization (WHO Geneva) , Geneva , Switzerland
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13
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Maia CSF, Monteiro MC, Gavioli EC, Oliveira FR, Oliveira GB, Romão PRT. Neurological disease in human and canine leishmaniasis--clinical features and immunopathogenesis. Parasite Immunol 2015; 37:385-93. [PMID: 25983042 DOI: 10.1111/pim.12203] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 04/22/2015] [Indexed: 12/20/2022]
Abstract
Leishmaniasis is a vectorborne disease caused by Leishmania protozoa, which is a major health problem and a neglected disease common in many regions of the world. Leishmania is an intracellular parasite transmitted by sand flies that causes clinical manifestations ranging from a severe and potentially fatal disease named visceral leishmaniasis to less severe but in many cases disfiguring diseases that mainly affect the skin or mucosal tissues, known as cutaneous leishmaniasis. Despite the detection of Leishmania parasites in the brain and cerebrospinal fluid of human patients and dogs, epidemiological data, as well as information about the mechanisms of central and peripheral nervous system alterations, are poorly described. This review is focused on the current knowledge about the neurological manifestations and immunopathogenic mechanisms in human patients and animals infected with Leishmania.
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Affiliation(s)
- C S F Maia
- Pharmaceutical Science Post-graduation Program, Federal University of Pará, Pará, Brazil.,Neuroscience and Cellular Biology Post-graduation Program, Health Science Institute, Federal University of Pará, Pará, Brazil
| | - M C Monteiro
- Pharmaceutical Science Post-graduation Program, Federal University of Pará, Pará, Brazil.,Neuroscience and Cellular Biology Post-graduation Program, Health Science Institute, Federal University of Pará, Pará, Brazil
| | - E C Gavioli
- Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - F R Oliveira
- Neuroscience and Cellular Biology Post-graduation Program, Health Science Institute, Federal University of Pará, Pará, Brazil
| | - G B Oliveira
- Neuroscience and Cellular Biology Post-graduation Program, Health Science Institute, Federal University of Pará, Pará, Brazil
| | - P R T Romão
- Laboratory of Cellular and Molecular Immunology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
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14
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Berkowitz AL, Raibagkar P, Pritt BS, Mateen FJ. Neurologic manifestations of the neglected tropical diseases. J Neurol Sci 2015; 349:20-32. [PMID: 25623803 DOI: 10.1016/j.jns.2015.01.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 12/24/2014] [Accepted: 01/02/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND The World Health Organization has identified 17 neglected tropical diseases (NTDs) that disproportionately affect the world's poorest populations. The neurologic aspects of many of these NTDs have received relatively little attention. METHODS A review was performed in PubMed (MedLine) for each NTD by disease name, name of its causative organism, and neurology, neurosurgery, neurologist, brain, spinal cord, peripheral nerve, muscle, nervous system, encephalitis, meningitis, encephalopathy, stroke, neuropathy, and myopathy (1968-Sept. 2013). The Oxford Center for Evidence-based Medicine guidelines were used to determine the level of evidence of neurological involvement and treatment based on the reports identified. RESULTS Neurologic manifestations were reported for all NTDs except yaws. Neurologic involvement was described in systematic reviews for four NTDs (Chagas disease, echinococcosis, rabies, cysticercosis) (levels 2a-3a), retrospective cohort studies for six (dengue, human African trypanosomiasis, leishmaniasis, leprosy, onchocerciasis, schistosomiasis) (levels 2b-3b), case series for one (foodborne trematodiasis) (level 4), and case reports for five (Buruli ulcer, dracunculiasis, filariasis, soil-transmitted helminthes, and trachoma). Level 1 evidence for treatment of neurologic manifestations of NTDs was found for human African trypanosomiasis, leprosy, and cysticercosis and level 2 evidence exists for treatment of neurologic involvement in Chagas disease. For the remaining NTDs, treatment of neurologic complications is described in case series and case reports only. CONCLUSIONS Neurologic manifestations of NTDs cause significant morbidity and mortality, although limited evidence exists on how best to treat these neurologic complications. Increased awareness of neurologic manifestations of the NTDs can increase their early identification and treatment, contributing to ongoing elimination and eradication campaigns.
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Affiliation(s)
- Aaron L Berkowitz
- Brigham and Women's Hospital, Department of Neurology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Pooja Raibagkar
- Brigham and Women's Hospital, Department of Neurology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Massachusetts General Hospital, Department of Neurology, Boston, MA, United States
| | - Bobbi S Pritt
- Mayo Clinic, Department of Laboratory Medicine and Pathology, Rochester, MN, United States
| | - Farrah J Mateen
- Harvard Medical School, Boston, MA, United States; Massachusetts General Hospital, Department of Neurology, Boston, MA, United States.
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15
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Sudarshi D, Lawrence S, Pickrell WO, Eligar V, Walters R, Quaderi S, Walker A, Capewell P, Clucas C, Vincent A, Checchi F, MacLeod A, Brown M. Human African trypanosomiasis presenting at least 29 years after infection--what can this teach us about the pathogenesis and control of this neglected tropical disease? PLoS Negl Trop Dis 2014; 8:e3349. [PMID: 25522322 PMCID: PMC4270486 DOI: 10.1371/journal.pntd.0003349] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Darshan Sudarshi
- Hospital for Tropical Diseases, University College London Hospital, London, United Kingdom
| | - Sarah Lawrence
- Hospital for Tropical Diseases, University College London Hospital, London, United Kingdom
| | | | - Vinay Eligar
- Princess of Wales Hospital, Bridgend Hospital, Wales, United Kingdom
| | - Richard Walters
- Morriston Hospital, Swansea, Wales, United Kingdom
- Princess of Wales Hospital, Bridgend Hospital, Wales, United Kingdom
| | - Shumonta Quaderi
- Hospital for Tropical Diseases, University College London Hospital, London, United Kingdom
| | - Alice Walker
- Hospital for Tropical Diseases, University College London Hospital, London, United Kingdom
| | - Paul Capewell
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Caroline Clucas
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Angela Vincent
- Nuffield Dept of Clinical Neurology, University of Oxford, Oxford, United Kingdom
| | - Francesco Checchi
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Annette MacLeod
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Michael Brown
- Hospital for Tropical Diseases, University College London Hospital, London, United Kingdom
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
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16
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José-López R, de la Fuente C, Pumarola M, Añor S. Intramedullary spinal cord mass presumptively associated with leishmaniasis in a dog. J Am Vet Med Assoc 2014; 244:200-4. [PMID: 24378030 DOI: 10.2460/javma.244.2.200] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 9-year-old male Miniature Poodle was evaluated because of progressive severe right hemiparesis, right forelimb lameness, and signs of cervical pain. CLINICAL FINDINGS A low body condition score (2/9) and popliteal lymphadenopathy were detected. Results of a CBC, serum biochemical analyses, urinalysis, cytologic examination of bone marrow and popliteal lymph node aspirates, and serum ELISA were consistent with systemic leishmaniasis. Magnetic resonance imaging of the cervical spinal cord revealed an intramedullary mass extending from the caudal aspect of the C5 vertebral body to the C5-6 intervertebral disk space with a contrast medium-enhanced pattern that had 3 zones (central contrast medium-enhanced core, intermediate isointense zone, and peripheral contrast medium-enhanced ring). Surgical biopsy of the mass was performed by means of a right C5-6 dorsal hemilaminectomy. Results of PCR assays for detection of Leishmania DNA in CSF and tissue biopsy samples were positive. TREATMENT AND OUTCOME Treatment for systemic leishmaniasis was initiated. Two months later, body condition, neurologic signs, and gait of the dog had substantially improved; the dog had mild right forelimb paresis at that time. Results of follow-up MRI indicated resolution of the cervical spinal cord lesion. Four months after diagnosis, the dog's neurologic condition was stable. CLINICAL RELEVANCE To the authors' knowledge, this report is the first in which clinical findings, clinicopathologic data, and MRI characteristics of an intramedullary inflammatory spinal cord lesion presumptively attributable to leishmaniasis in a dog have been reported, and the first report of CNS leishmaniasis in a dog with MRI resolution and a successful clinical response to treatment.
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Affiliation(s)
- Roberto José-López
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain., Fundació Hospital Clínic Veterinari, Facultat de Veterinària, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain
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17
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In vitro cytokines profile and ultrastructural changes of microglia and macrophages following interaction with Leishmania. Parasitology 2014; 141:1052-63. [PMID: 24717447 DOI: 10.1017/s0031182014000274] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In the present study, we assessed morphological changes and cytokine production after in vitro interaction with causative agents of American cutaneous leishmaniasis and compared the microglia and macrophage immune responses. Cultures of microglia and macrophages infected with stationary-phase promastigotes of Leishmania (Viannia) shawi, Leishmania (Viannia) braziliensis or Leishmania (Leishmania) amazonensis were evaluated 24, 48 and 72 h after interaction. Macrophages only presented the classical phagocytic process while microglia also displayed large cytoplasmic projections similar to the ruffles described in macropinocytosis. In the macrophage cultures, the percentage of infected cells increased over time, in a fashion that was dependent on the parasite species. In contrast, in microglial cells as the culture time progressed, there was a significant reduction in the percentage of infected cells independent of parasite species. Measurements of cytokines in macrophage cultures 48 h after interactions revealed distinct expression patterns for different parasites, whereas in microglial cultures they were similar for all Leishmania tested species. Taken together, our results suggest that microglia may have a higher phagocytic ability and cytotoxic potential than macrophages for all investigated species. The robust response of microglia against all parasite species may suggest microglia have an important role in the defence against cerebral leishmaniasis.
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18
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Nyamngee A, Edungbola LD, Agbede OO, Salami AK, Nwabuisi C, Akanbi AA, Ibrahim OOK, Tilahun M, Moser DB. Prevalence, intensity and complications of Microsporidium spores amongst HIV-positive hospital patients in Ilorin, Nigeria. Afr J Lab Med 2013; 2:66. [PMID: 29043165 PMCID: PMC5637780 DOI: 10.4102/ajlm.v2i1.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 04/09/2013] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Microsporidiasis, which is of great concern for immunocompromised patients, is poorly studied in developing countries. OBJECTIVES A study was carried out amongst HIV-positive hospital patients and HIV-negative hospital controls in Ilorin, Nigeria, between January 2009 and July 2010 to determine the prevalence and intensity of Microsporidium spores and the complications associated with their presence. METHOD Stool samples from 750 HIV-positive patients and 375 HIV-negative patients were studied using the Chromotrope-2R staining technique. Determination of CD4+ count was performed on the Partec Cyflow SL-3 CD4/8 instrument. Intensity of spores was determined by counting the total number of the spores in a 10 µl stained smear of stool. Images were captured with Phenix Microimage Analysis Software and data obtained were analysed using the Statistical Package for the Social Sciences. RESULTS The prevalence of Microsporidium isolates amongst the HIV-positive hospital patients was significantly higher (42.4%) than amongst the HIV-negative controls (19.2%) (p < 0.05). The intensity of microsporidial spores amongst HIV-positive hospital patients was also significantly higher than amongst the controls (p < 0.05). However, the difference in the intensity of spores amongst HIV-positive patients who were on antiretroviral therapy (n = 411) and those who were not (n = 339) was not significant (p = 0.236). Microsporidiasis in HIV infection infection was common amongst patients with with low CD4+ counts, diarrhoea, body rashes and cough. CONCLUSION Both the prevalence and intensity of Microsporidiasis are high amongst HIV-positive hospital patients; campaigns to promote awareness, prevention and control are required. Laboratory testing for microsporidia in HIV patients should be performed routinely so as to identify the organism for prompt medical attention.
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Affiliation(s)
- Amase Nyamngee
- Department of Medical Microbiology and Parasitology, University of Ilorin, Nigeria
| | - Luke D Edungbola
- Department of Medical Microbiology and Parasitology, University of Ilorin, Nigeria
| | - Olajide O Agbede
- Department of Medical Microbiology and Parasitology, University of Ilorin, Nigeria
| | | | - Charles Nwabuisi
- Department of Medical Microbiology and Parasitology, University of Ilorin, Nigeria
| | - Aliu A Akanbi
- Department of Medical Microbiology and Parasitology, University of Ilorin, Nigeria
| | | | - Muchae Tilahun
- Ethiopian Health and Nutrition Research Institute, Ethiopia
| | - Douglas B Moser
- Division of Global HIV/AIDS, U.S Centers for Disease Control and Prevention, USA
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19
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Abstract
Parasitic diseases are rare infections after a solid organ transplant (SOT). Toxoplasmosis, Trypanosoma cruzi, and visceral leishmanias are the 3 main opportunistic protozoal infections that have the potential to be lethal if not diagnosed early and treated appropriately after SOT. Strongyloides stercoralis is the one helminthic disease that is life-threatening after transplant. This review addresses modes of transmission, methods of diagnosis, and treatment of the most serious parasitic infections in SOT. The role of targeted pretransplant screening of the donor and recipient for parasitic diseases is also discussed.
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Affiliation(s)
- Laura O'Bryan Coster
- Department of Infectious Diseases, Georgetown University Hospital, Washington, DC 20007, USA.
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20
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Llanos-Cuentas A, Valencia BM, Petersen CA. Neurological manifestations of human leishmaniasis. HANDBOOK OF CLINICAL NEUROLOGY 2013; 114:193-8. [DOI: 10.1016/b978-0-444-53490-3.00013-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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21
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Márquez M, Pedregosa JR, López J, Marco-Salazar P, Fondevila D, Pumarola M. Leishmania amastigotes in the central nervous system of a naturally infected dog. J Vet Diagn Invest 2012; 25:142-6. [DOI: 10.1177/1040638712466728] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 4-year-old male Labrador Retriever dog was presented with a 10-day history of tetraplegia, depression, and absent postural reflexes. The cerebrospinal fluid was positive for Leishmania spp. DNA. At necropsy, a 2-cm long mass was observed adhered to C7 and C8 left spinal nerves. Microscopically, nerve fiber destruction together with mixed inflammatory infiltration was observed in the spinal nerves. Cervical spinal cord sections showed multifocal, diffuse granulomatous inflammation in the white matter. In the brain, perivascular infiltrates were observed in some areas together with subtle pallor of the parenchyma. Immunohistochemistry for Leishmania infantum confirmed the presence of amastigotes in the spinal nerves, spinal cord, brain parenchyma, and choroid plexuses. The current study describes the presence of Leishmania amastigotes in nervous tissue inciting radiculoneuritis, myelitis, and mild meningoencephalitis, suggesting a likely route by which L. infantum amastigotes reach and affect the central nervous system parenchyma.
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Affiliation(s)
- Merce Márquez
- Servicio de Neurología y Neurocirugía, Hospital Veterinario Al Sur, José Luis Pérez Pujadas, Granada, Spain (Pedregosa, López), Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Departament de Medicina i Cirurgia Animals (Marco-Salazar), Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Centre de Biotecnologia Animal i Teràpia Gènica (Márquez, Fondevila, Pumarola), Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - José Raúl Pedregosa
- Servicio de Neurología y Neurocirugía, Hospital Veterinario Al Sur, José Luis Pérez Pujadas, Granada, Spain (Pedregosa, López), Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Departament de Medicina i Cirurgia Animals (Marco-Salazar), Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Centre de Biotecnologia Animal i Teràpia Gènica (Márquez, Fondevila, Pumarola), Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Jesús López
- Servicio de Neurología y Neurocirugía, Hospital Veterinario Al Sur, José Luis Pérez Pujadas, Granada, Spain (Pedregosa, López), Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Departament de Medicina i Cirurgia Animals (Marco-Salazar), Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Centre de Biotecnologia Animal i Teràpia Gènica (Márquez, Fondevila, Pumarola), Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Paola Marco-Salazar
- Servicio de Neurología y Neurocirugía, Hospital Veterinario Al Sur, José Luis Pérez Pujadas, Granada, Spain (Pedregosa, López), Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Departament de Medicina i Cirurgia Animals (Marco-Salazar), Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Centre de Biotecnologia Animal i Teràpia Gènica (Márquez, Fondevila, Pumarola), Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Dolors Fondevila
- Servicio de Neurología y Neurocirugía, Hospital Veterinario Al Sur, José Luis Pérez Pujadas, Granada, Spain (Pedregosa, López), Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Departament de Medicina i Cirurgia Animals (Marco-Salazar), Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Centre de Biotecnologia Animal i Teràpia Gènica (Márquez, Fondevila, Pumarola), Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Martí Pumarola
- Servicio de Neurología y Neurocirugía, Hospital Veterinario Al Sur, José Luis Pérez Pujadas, Granada, Spain (Pedregosa, López), Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Departament de Medicina i Cirurgia Animals (Marco-Salazar), Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Centre de Biotecnologia Animal i Teràpia Gènica (Márquez, Fondevila, Pumarola), Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
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22
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Melo GD, Seraguci TF, Schweigert A, Silva JES, Grano FG, Peiró JR, Lima VMF, Machado GF. Pro-inflammatory cytokines predominate in the brains of dogs with visceral leishmaniasis: a natural model of neuroinflammation during systemic parasitic infection. Vet Parasitol 2012. [PMID: 23207017 DOI: 10.1016/j.vetpar.2012.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Visceral leishmaniasis is a multisystemic zoonotic disease that can manifest with several symptoms, including neurological disorders. To investigate the pathogenesis of brain alterations occurring during visceral leishmaniasis infection, the expression of the cytokines IL-1β, IL-6, IL-10, IL-12p40, IFN-γ, TGF-β and TNF-α and their correlations with peripheral parasite load were evaluated in the brains of dogs naturally infected with Leishmania infantum. IL-1β, IFN-γ and TNF-α were noticeably up-regulated, and IL-10, TGF-β and IL-12p40 were down-regulated in the brains of infected dogs. Expression levels did not correlate with parasite load suggestive that the brain alterations are due to the host's immune response regardless of the phase of the disease. These data indicate the presence of a pro-inflammatory status in the nervous milieu of dogs with visceral leishmaniasis especially because IL-1β and TNF-α are considered key factors for the initiation, maintenance and persistence of inflammation.
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Affiliation(s)
- Guilherme D Melo
- UNESP - Univ Estadual Paulista, College of Veterinary Medicine, Araçatuba, São Paulo, Brazil
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23
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Co-infection of HIV and tropical infectious agents that affect the nervous system. Rev Neurol (Paris) 2012; 168:270-82. [PMID: 22405463 DOI: 10.1016/j.neurol.2012.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 02/03/2012] [Indexed: 11/22/2022]
Abstract
Tropical infections refer to a group of diseases usually located in regions with a warm climate, particularly affecting developing countries, partly because of the conditions that allow them to thrive. However, due to the increased international travel, infectious agents that were previously limited to tropical regions pose an increasing threat to populations at risk for opportunistic infection (OI), especially those infected with the HIV. Tropical infections can facilitate HIV transmission and accelerate the progression of asymptomatic HIV infection to AIDS. Some have the potential to alter the epidemiology, natural history, and/or response to treatment of the other. The introduction of highly active antiretroviral therapy has provided a huge benefit for the vast majority of patients infected with the HIV, by allowing the immune system to recover, improving the clinical and radiological results and reducing the number of OI. On the other hand, some patients have developed various disorders of immune reconstitution, resulting in either hyper-immune inflammatory response to an exogenous antigen or autoimmunity. A significant proportion of these cases have been reported in immigrants from tropical countries to high-income countries, therefore awareness of these phenomena is needed since clinical presentations are often atypical and pose diagnostic challenges. This article reviews some of the key diagnostic aspects of tropical infections associated with HIV infection.
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24
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Abstract
PURPOSE OF REVIEW To provide an updated perspective of the most common parasitic infections occurring in solid-organ transplant (SOT) recipients. RECENT FINDINGS Parasitic infections are an emerging problem in SOT programs and represent a diagnostic and therapeutic challenge. Transplantation in endemic areas - including medical tourism, international travel and migration - justify the necessity of considering parasitic infections in the differential diagnosis of posttransplant complications. Molecular techniques, such as PCR, may improve the diagnostic accuracy and help during the follow-up. SUMMARY Parasitic infections are an uncommon but potentially severe complication in SOT recipients. An increase of donors emigrated from tropical areas and more posttransplant patients traveling to endemic areas have led to a rise in parasitic infections reported among SOT recipients. Transplant physicians should get familiar with parasitic infections and promote adherence to preventive measures in SOT recipients.
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25
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Satishchandra P, Sinha S. Relevance of neuroimaging in the diagnosis and management of tropical neurologic disorders. Neuroimaging Clin N Am 2011; 21:737-56, vii. [PMID: 22032497 DOI: 10.1016/j.nic.2011.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The development in neuroimaging techniques has revolutionized the way neurology is practiced, including neurologic disorders in tropics. Some diseases occur exclusively, whereas some are more common in tropical regions. However, some are becoming increasingly prevalent in the developed world too, as a result of patterns of human migration and globalization. It is imperative to learn about the role of imaging in tropical neurology, which might assist early diagnosis and treatment and also add to the existing knowledge. Infections are more common in the tropics and require special attention in view of their potential treatability.
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Affiliation(s)
- P Satishchandra
- Department of Neurology, NIMHANS, Bangalore, Karnataka, India.
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26
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Chimelli L. A morphological approach to the diagnosis of protozoal infections of the central nervous system. PATHOLOGY RESEARCH INTERNATIONAL 2011; 2011:290853. [PMID: 21785681 PMCID: PMC3140201 DOI: 10.4061/2011/290853] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2011] [Accepted: 05/03/2011] [Indexed: 11/25/2022]
Abstract
Protozoal infections, though endemic to certain regions, can be seen all around the world, because of the increase in travel and migration. In addition, immunosuppression associated with various conditions, particularly with HIV infection, favors the occurrence of more severe manifestations and failure to respond to treatments. The CNS may be the only affected system; when not, it is often the most severely affected. Despite information obtained from clinical, laboratory, and imaging procedures that help to narrow the differential diagnosis of intracranial infections, there are cases that need confirmation with biopsy or autopsy. Predominant presentations are meningoencephalitis (trypanosomiasis), encephalopathy (cerebral malaria), or as single or multiple pseudotumoral enhancing lesions (toxoplasmosis, reactivated Chagas' disease). The immune reconstitution disease, resulting from enhancement of pathogen-specific immune responses after HAART, has altered the typical presentation of toxoplasmosis and microsporidiosis. In this paper, a morphological approach for the diagnosis of protozoal infections affecting the CNS (amoebiasis, cerebral malaria, toxoplasmosis, trypanosomiasis, and microsporidiosis) is presented.
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Affiliation(s)
- Leila Chimelli
- Department of Pathology, University Hospital, Federal University of Rio de Janeiro, 21941-913 Rio de Janeiro, RJ, Brazil
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27
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Wright EJ, Nunn M, Joseph J, Robertson K, Lal L, Brew BJ. NeuroAIDS in the Asia Pacific Region. J Neurovirol 2010; 14:465-73. [PMID: 19031289 DOI: 10.1080/13550280802235932] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Over 8.3 million people living in the Asia Pacific region are human immunodeficiency virus (HIV) positive and up to 40% of these individuals have had prior acquired immunodeficiency syndrome (AIDS) illnesses. Recently endeavors have been made to better characterize the burden of HIV-related neurological disease within the Asia Pacific region and, with this in mind, the NeuroAIDS in Asia and the Pacific Rim workshop was held in Sydney, Australia, as an affiliated event of the 4th IAS Conference on HIV Pathogenesis, Treatment and Prevention. The workshop was supported by the National Institute of Neurological Disorders and Stroke (NINDS) and the National Institute of Mental Health (NIMH) of the United States National Institutes of Health and the Australian Government overseas AID program, AusAID. HIV neurologists, infectious disease physicians, pediatricians, psychiatrists, immunologists, virologists,and researchers from 12 countries of the Asia Pacific region (including Australia), the United States, and the United Kingdom attended the meeting. A broad range of topics were addressed, including common HIV neurological disorders, the lack of diagnostic, management, and research infrastructure, central nervous system (CNS) immune restoration disease, pediatric neuroAIDS, and current clinical and laboratory research projects being undertaken within the Asia Pacific region.
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Affiliation(s)
- Edwina J Wright
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia.
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28
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Abstract
Parasitic infections are an uncommon but potentially severe complication in solid organ transplant (SOT) recipients. An increase in donors who have emigrated from tropical areas and more transplant recipients traveling to endemic areas have led to a rise in parasitic infections reported among SOT recipients. Clinicians should include these infections in their differential diagnosis and promote adherence to preventive measures in SOT recipients.
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29
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Scrimgeour EM. Other parasitic infections of the central nervous system. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00106-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Buonomano R, Brinkmann F, Leupin N, Boscacci R, Zimmermann A, Müller N, Fux CA. Holiday souvenirs from the Mediterranean: Three instructive cases of visceral leishmaniasis. ACTA ACUST UNITED AC 2009; 41:777-81. [DOI: 10.1080/00365540903104127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Transplantation and tropical infectious diseases. Int J Infect Dis 2009; 14:e189-96. [PMID: 19647464 DOI: 10.1016/j.ijid.2009.04.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 04/03/2009] [Accepted: 04/14/2009] [Indexed: 02/08/2023] Open
Abstract
The number of transplant recipients with tropical infectious diseases is growing due to increasing international travel and the rising number of transplants taking place in the tropics and subtropics. With increases in population migration, the prevalence of individuals infected with geographically restricted organisms also rises. There are three potential categories of tropical infections in transplant patients: (1) donor-related infections transmitted by the graft or through transfusion of blood products; (2) reactivation or recrudescence of latent infections in the donor recipient; and (3) de novo acquisition of infection in the post-transplant period through the traditional route of infection. We present an overall discussion of the association of parasitic (protozoa and helminths) and non-parasitic (viral, bacterial, and fungal) tropical infectious diseases and solid-organ and hematopoietic transplantation. We also suggest potential screening guidelines for some of these tropical infections.
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Patel KK, Patel AK, Sarda P, Shah BA, Ranjan R. Immune Reconstitution Visceral Leishmaniasis Presented as Hemophagocytic Syndrome in a Patient With AIDS From a Nonendemic Area: A Case Report. ACTA ACUST UNITED AC 2009; 8:217-20. [DOI: 10.1177/1545109709337902] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Visceral Leishmaniasis (VL) is endemic in the Ganges and Brahmaputra plains of India. Leishmaniasis/HIV coinfection is on the rise in India and may pose a real diagnostic and therapeutic challenge. HIV-related immunosuppression increases the risk of reactivating leishmaniasis by 100 to 1000 times and it also increases the risk of drug resistant leishmaniasis. Immune reconstitution VL is not very well reported in literature. Hemophagocytosis is known to occur with various infectious agents like viruses, bacteria, and parasites, but is rare to occur with leishmaniasis. Here the authors describe a case of VL presenting as immune reconstitution disease and hemophagocytosis in an HIV infected patient coming from a nonendemic area.
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Affiliation(s)
- Ketan K. Patel
- Infectious Diseases Clinic, VEDANTA Institute of Medical Sciences, Navrangpura, Ahmedabad, Gujarat, India,
| | - Atul K. Patel
- Infectious Diseases Clinic, VEDANTA Institute of Medical Sciences, Navrangpura, Ahmedabad, Gujarat, India
| | - Parimal Sarda
- Department of Pathology, Hemato-Oncology Clinic, VEDANTA Institute of Medical Sciences, Navrangpura, Ahmedabad, Gujarat, India
| | - Bhavin A. Shah
- Department of Oncology, Hemato-Oncology Clinic, VEDANTA Institute of Medical Sciences, Navrangpura, Ahmedabad, Gujarat, India
| | - Rajiv Ranjan
- Infectious Diseases Clinic, VEDANTA Institute of Medical Sciences, Navrangpura, Ahmedabad, Gujarat, India
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Bally S, Caillard S, Moulin B. [Recommendations before travelling for renal transplant patients]. Nephrol Ther 2009; 5:265-79. [PMID: 19406696 DOI: 10.1016/j.nephro.2009.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Revised: 02/02/2009] [Accepted: 02/03/2009] [Indexed: 10/20/2022]
Abstract
Travel is now a reasonable objective of CKD patients after renal transplantation. However, immunosuppressive treatment makes them particularly susceptible to infections and may interfere with vaccinations and other drugs. Travel in countries with low health level should be strongly discouraged in the first six months after transplantation or following an acute event. Otherwise, specific consultations should be arranged to prepare the patient as soon as possible. Vaccinations should be started early before departure. Specific immunisations include vaccines against hepatitis A, typhoid, meningococcus and rabies in some cases. Living vaccines are formally contra-indicated. Particular attention should be paid for protection against insects because this is the only effective measure against diseases. In the case of malaria, it should be complemented by adapted chemoprophylaxis that should be started 15 days before the departure date. Advice on hygiene measures should be clarified because this can prevent numerous infections, especially of the digestive tract. Advice on the management of diarrhoea is essential, especially in terms of preventing dehydration. Finally, advice about transport and physical risks, especially those related to sun exposure, should also be addressed.
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Affiliation(s)
- Stéphane Bally
- Service de néphrologie-dialyse-transplantation rénale, Nouvel hôpital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.
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Bakunova SM, Bakunov SA, Patrick DA, Kumar EVKS, Ohemeng KA, Bridges AS, Wenzler T, Barszcz T, Jones SK, Werbovetz KA, Brun R, Tidwell RR. Structure-activity study of pentamidine analogues as antiprotozoal agents. J Med Chem 2009; 52:2016-35. [PMID: 19267462 DOI: 10.1021/jm801547t] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Diamidine 1 (pentamidine) and 65 analogues (2-66) have been tested for in vitro antiprotozoal activities against Trypanosoma brucei rhodesiense, Plasmodium falciparum, and Leishmania donovani, and for cytotoxicity against mammalian cells. Dications 32, 64, and 66 exhibited antitrypanosomal potencies equal or greater than melarsoprol (IC(50) = 4 nM). Nine congeners (2-4, 12, 27, 30, and 64-66) were more active against P. falciparum than artemisinin (IC(50) = 6 nM). Eight compounds (12, 32, 33, 44, 59, 62, 64, and 66) exhibited equal or better antileishmanial activities than 1 (IC(50) = 1.8 microM). Several congeners were more active than 1 in vivo, curing at least 2/4 infected animals in the acute mouse model of trypanosomiasis. The diimidazoline 66 was the most promising compound in the series, showing excellent in vitro activities and high selectivities against T. b. rhodesiense, P. falciparum, and L. donovani combined with high antitrypanosomal efficacy in vivo.
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Affiliation(s)
- Svetlana M Bakunova
- Department of Pathology and Laboratory Medicine, School of Medicine, The University of North Carolina, Chapel Hill, North Carolina 27599, USA
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Schmidt-Hieber M, Zweigner J, Uharek L, Blau IW, Thiel E. Central nervous system infections in immunocompromised patients: update on diagnostics and therapy. Leuk Lymphoma 2009; 50:24-36. [PMID: 19031169 DOI: 10.1080/10428190802517740] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Infections of the central nervous system (CNS) are increasingly reported in patients with malignancies. Heavily immunocompromised patients like those after allogeneic stem cell transplantation (SCT) or previous T cell depleting treatment regimens (e.g. with fludarabine or alemtuzumab) are at highest risk for cerebral infections. The spectrum of causative organisms may vary greatly, depending on the underlying malignancy, its treatment and various other factors. Toxoplasma gondii and fungi are the leading causative organisms in patients after allogeneic SCT, but also viruses such as herpes simplex virus or JC virus may be detected in these patients. Definitive diagnosis of cerebral infection still remains a high challenge, although diagnostics have improved by the wide availability of imaging techniques and polymerase chain reaction in recent years. Novel therapeutic options are arising, particularly for fungal CNS infections. Here, we summarise aspects on epidemiology, clinical symptoms and prognosis of CNS infections in patients with malignancies. Additionally, we give an overview on the diagnostics and management of cerebral infections in these patients including evidence evaluation of efficacy of treatment.
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Affiliation(s)
- Martin Schmidt-Hieber
- Medizinische Klinik III, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
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Tunkel AR, Glaser CA, Bloch KC, Sejvar JJ, Marra CM, Roos KL, Hartman BJ, Kaplan SL, Scheld WM, Whitley RJ. The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2008; 47:303-27. [PMID: 18582201 DOI: 10.1086/589747] [Citation(s) in RCA: 628] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Guidelines for the diagnosis and treatment of patients with encephalitis were prepared by an Expert Panel of the Infectious Diseases Society of America. The guidelines are intended for use by health care providers who care for patients with encephalitis. The guideline includes data on the epidemiology, clinical features, diagnosis, and treatment of many viral, bacterial, fungal, protozoal, and helminthic etiologies of encephalitis and provides information on when specific etiologic agents should be considered in individual patients with encephalitis.
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Affiliation(s)
- Allan R Tunkel
- Dept of Medicine, Monmouth Medical Center, Long Branch, New Jersey 07740, USA.
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Abstract
Fevers of unknown origin have been classified as classic, nosocomial, immune-deficient, and HIV-related. More than half of the 1407 human pathogens are zoonotic, making zoonotic infections an important subcategory in each of the classifications. This article describes both common and unusual zoonoses causing fevers of unknown origin. Simian immune virus is considered as a possible emerging infection. For special populations (the homeless, zoophiliacs, those whose occupation or leisure brings them in close contact with oceans or lakes, and veterinarians), zoonotic infection potentials are discussed.
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Affiliation(s)
- Dennis J Cleri
- Department of Medicine, St. Francis Medical Center, Room B-158, 601 Hamilton Avenue, Trenton, NJ 08629-1986, USA.
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Martín-Dávila P, Fortún J, López-Vélez R, Norman F, Montes de Oca M, Zamarrón P, González MI, Moreno A, Pumarola T, Garrido G, Candela A, Moreno S. Transmission of tropical and geographically restricted infections during solid-organ transplantation. Clin Microbiol Rev 2008; 21:60-96. [PMID: 18202437 PMCID: PMC2223841 DOI: 10.1128/cmr.00021-07] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
In recent years, the increasing number of donors from different regions of the world is providing a new challenge for the management and selection of suitable donors. This is a worldwide problem in most countries with transplantation programs, especially due to the increase in immigration and international travel. This paper elaborates recommendations regarding the selection criteria for donors from foreign countries who could potentially transmit tropical or geographically restricted infections to solid-organ transplant recipients. For this purpose, an extensive review of the medical literature focusing on viral, fungal, and parasitic infections that could be transmitted during transplantation from donors who have lived or traveled in countries where these infections are endemic has been performed, with special emphasis on tropical and imported infections. The review also includes cases described in the literature as well as risks of transmission during transplantation, microbiological tests available, and recommendations for each infection. A table listing different infectious agents with their geographic distributions and specific recommendations is included.
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Affiliation(s)
- P Martín-Dávila
- Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Ctra. Colmenar km. 9,100, 28034 Madrid, Spain.
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Bouza E, Loeches B, Muñoz P. Fever of Unknown Origin in Solid Organ Transplant Recipients. Infect Dis Clin North Am 2007; 21:1033-54, ix-x. [DOI: 10.1016/j.idc.2007.09.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Agteresch HJ, van 't Veer MB, Cornelissen JJ, Sluiters JF. Visceral leishmaniasis after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2007; 40:391-3. [PMID: 17572716 DOI: 10.1038/sj.bmt.1705728] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
PURPOSE OF REVIEW The numbers of international travelers and complexity of their underlying medical conditions continue to increase. Traveling with compromised immunity warrants special consideration regarding the prevention and treatment of travel-related diseases, ideally with the help of a travel medicine specialist. There is a need for careful weighing of the potential health risks in persons with severe immunosuppression, including that related to HIV, use of immunomodulating agents, malignancy and cancer chemotherapy, solid organ and bone marrow transplantation, and asplenia. RECENT FINDINGS Over the past year, a number of articles and texts have been published addressing the health risks and management strategies for travelers with underlying immune compromise, including the potential interactions between HIV and malaria, and transplant outcomes for those receiving transplants through medical tourism. SUMMARY Tailored advice and treatment strategies for compromised travelers can help facilitate safe travel for individuals who choose risk-taking travel.
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Zunt J, Walker M, Kublin J. Reply to Stauffer et al. Clin Infect Dis 2006. [DOI: 10.1086/504957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Stauffer WM, Magill A, Kain KC. Parasitic Central Nervous System Infections in Immunocompromised Hosts: Clarification of Malaria Diagnosis. Clin Infect Dis 2006; 43:114-5; author reply 115-6. [PMID: 16758433 DOI: 10.1086/504951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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