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Hagras NAE, Makled S, Sheta E, El-hawary MA, Mogahed NMFH. Potent efficiency of the novel nitazoxanide-loaded nanostructured lipid carriers against experimental cyclosporiasis. PLoS Negl Trop Dis 2023; 17:e0011845. [PMID: 38100538 PMCID: PMC10756555 DOI: 10.1371/journal.pntd.0011845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 12/29/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023] Open
Abstract
Cyclosporiasis is a ubiquitous infection caused by an obligate intracellular protozoan parasite known as Cyclospora cayetanensis (C. cayetanensis). The disease is characterized by severe diarrhea which may be regrettably fatal in immunosuppressed patients. The commercially available treatment options have either severe side effects or low efficiency. In the present study, the novel formula of nitazoxanide (NTZ)-loaded nanostructured lipid carriers (NLCs) was assessed for the first time for C. cayetanensis treatment in both immunocompetent and immunosuppressed mice in comparison to commercially available drugs (trimethoprim-sulfamethoxazole (TMP-SMX) and NTZ). Swiss Albino mice were orally infected by 104 sporulated oocysts. The experimental groups were treated with the gold standard TMP-SMX, NTZ, blank NLCs and NTZ-loaded NLCs. The results demonstrated that NTZ-loaded NLCs represented the highest significant parasite percent reduction of (>98% reduction) in both immunocompetent and immunosuppressed mice designating successful tissue penetration and avoiding recurrence of infection at the end of the study. Oocysts treated with NTZ-loaded NLCs demonstrated the most mutilated rapturing morphology via scanning electron microscope examination as well as representing the most profound improvement of the histopathological picture. In conclusion, NTZ-loaded NLCs exhibited the uppermost efficacy in the treatment of cyclosporiasis. The safe nature and the anti-parasitic effect of the novel formulation encourage its use as a powerful treatment for human cyclosporiasis.
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Affiliation(s)
- Nancy Abd-elkader Hagras
- Department of Medical Laboratory Technology, Faculty of Applied Health Sciences Technology, Pharos University in Alexandria, Alexandria, Egypt
| | - Shaimaa Makled
- Department of Pharmaceutics, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| | - Eman Sheta
- Department of Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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2
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Abstract
Intestinal parasites include intestinal protozoa and intestinal helminths. Intestinal parasitic infections (IPIs) pose a global health problem affecting over one billion people worldwide. Although these infections are predominantly seen in the developing world, they are frequently seen in the developed countries, particularly in immunocompromised patients. Patients' clinical presentations generally include diarrhea, dysentery, abdominal pain, nausea, vomiting, nutritional deficiency, iron deficiency anemia, anal and perianal itching, and rarely intestinal obstruction. The intestinal parasites have similarities in their mode of transmission and life cycle. The stool test is the primary way of diagnosing IPIs. Treatment is given with various anti-parasitic agents. However, appropriate preventive measures are essential for successfully controlling the IPIs.
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Affiliation(s)
- Monjur Ahmed
- Division of Gastroenterology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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3
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Li J, Xu F, Karim MR, Zhang L. Review on Cyclosporiasis Outbreaks and Potential Molecular Markers for Tracing Back Investigations. Foodborne Pathog Dis 2022; 19:796-805. [PMID: 36450125 DOI: 10.1089/fpd.2022.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Cyclosporiasis is an emerging disease caused by Cyclospora cayetanensis, which induces protracting and relapsing gastroenteritis and has been linked to huge and complicated travel- and food-related outbreaks worldwide. Cyclosporiasis has become more common in both developing and developed countries as a result of increased global travel and the globalization of the human food supply. It is not just a burden on individual human health but also a worldwide public health problem. As a pathogen of interest, the molecular biological characteristics of C. cayetanensis have advanced significantly over the last few decades. However, only one FDA-approved molecular platform has been commercially used in the investigation of cyclosporiasis outbreaks. More potential molecular markers and genotyping of C. cayetanensis in samples based on the polymorphic region of the whole genomes might differentiate between separate case clusters and would be useful in tracing back investigations, especially during cyclosporiasis outbreak investigations. Considering that there is no effective vaccine for cyclosporosis, epidemiological investigation using effective tools is crucial for controlling cyclosporiasis by source tracking. Therefore, more and more epidemiological investigative studies for human cyclosporiasis should be promoted around the world to get a deeper understanding of its characteristics as well as management. This review focuses on major cyclosporiasis outbreaks and potential molecular markers for tracing back investigations into cyclosporiasis outbreaks.
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Affiliation(s)
- Junqiang Li
- College of Veterinary Medicine, Henan Agricultural University, Zhengzhou, China.,Key Laboratory of Quality and Safety Control of Poultry Products (Zhengzhou), Ministry of Agriculture and Rural Affairs, Zhengzhou, China.,International Joint Research Laboratory for Zoonotic Diseases of Henan, Zhengzhou, China
| | - Feifei Xu
- College of Veterinary Medicine, Henan Agricultural University, Zhengzhou, China
| | - Md Robiul Karim
- Department of Medicine, Faculty of Veterinary Medicine and Animal Science, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur, Bangladesh
| | - Longxian Zhang
- College of Veterinary Medicine, Henan Agricultural University, Zhengzhou, China.,Key Laboratory of Quality and Safety Control of Poultry Products (Zhengzhou), Ministry of Agriculture and Rural Affairs, Zhengzhou, China.,International Joint Research Laboratory for Zoonotic Diseases of Henan, Zhengzhou, China
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4
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The Clinical Features and Immunological Signature of Cyclospora cayetanensis Co-Infection among People Living with HIV in Ghana. Microorganisms 2022; 10:microorganisms10071407. [PMID: 35889126 PMCID: PMC9316080 DOI: 10.3390/microorganisms10071407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 01/25/2023] Open
Abstract
Background: There is a paucity of information on the contemporary burden, disease patterns, and immunological profile of people living with HIV who are co-infected with C. cayetanensis in the post-antiretroviral therapy era. Methods: For this cross-sectional study, stool samples of 640 HIV-positive and 83 HIV-negative individuals in Ghana were tested for C. cayetanensis. Additionally, sociodemographic parameters, clinical symptoms, medical drug intake, and immunological parameters were assessed. Results: The prevalence of C. cayetanensis was 8.75% (n = 56) in HIV-positive and 1.20% (n = 1) in HIV-negative participants (p = 0.015). Within the group of HIV-positive participants, the prevalence reached 13.6% in patients with CD4+ T cell counts below 200 cells/µl. Frequencies of the clinical manifestations of weight loss and diarrheal disease were significantly higher in patients with C. cayetanensis compared to those without co-infection (36.36% vs. 22.59%, p = 0.034 and 20.00% vs. 4.90%, p < 0.001, respectively). The expression of markers of immune activation and exhaustion of T lymphocyte sub-populations was significantly elevated in patients colonized with C. cayetanensis. Conclusions: In the modern post-combined antiretroviral therapy (cART) era, the acquisition of C. cayetanensis among PLWH in Ghana is driven largely by the immunosuppression profile characterized by high expression of markers of immune activation and immune exhaustion.
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5
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Mathison BA, Pritt BS. Cyclosporiasis-Updates on Clinical Presentation, Pathology, Clinical Diagnosis, and Treatment. Microorganisms 2021; 9:microorganisms9091863. [PMID: 34576758 PMCID: PMC8471761 DOI: 10.3390/microorganisms9091863] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/30/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022] Open
Abstract
Cyclospora cayetanensis is an intestinal coccidian parasite transmitted to humans through the consumption of oocysts in fecally contaminated food and water. Infection is found worldwide and is highly endemic in tropical and subtropical regions with poor sanitation. Disease in developed countries is usually observed in travelers and in seasonal outbreaks associated with imported produce from endemic areas. Recently, summertime outbreaks in the United States have also been linked to locally grown produce. Cyclosporiasis causes a diarrheal illness which may be severe in infants, the elderly, and immunocompromised individuals. The increased adoption of highly sensitive molecular diagnostic tests, including commercially available multiplex panels for gastrointestinal pathogens, has facilitated the detection of infection and likely contributed to the increased reports of cases in developed countries. This manuscript reviews important aspects of the biology, epidemiology, and clinical manifestations of C. cayetanensis and provides an in-depth discussion of current laboratory diagnostic methods.
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Affiliation(s)
- Blaine A. Mathison
- ARUP Laboratories, Institute for Clinical and Experimental Pathology, Salt Lake City, UT 84108, USA;
| | - Bobbi S. Pritt
- Division of Clinical Microbiology, Mayo Clinic, Rochester, MN 55905, USA
- Correspondence:
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6
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Ohno M, Inatomi O, Imai T, Takahashi K, Bamba S, Konishi K, Sasaki M, Kushima R, Andoh A. Chronic cystoisosporiasis in an immunocompetent adult: A case report. Medicine (Baltimore) 2021; 100:e24890. [PMID: 33725845 PMCID: PMC7969258 DOI: 10.1097/md.0000000000024890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/04/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Cystoisosporiasis is an intestinal infectious disease caused by a coccidian protozoa, Cystoisospora belli (C. belli). It can cause prolonged and refractory diarrhea most commonly in immunocompromised patients, while immunocompetent individuals usually exhibit no symptoms or self-limited diarrhea. PATIENT CONCERNS We herein report a case of chronic cystoisosporiasis in an immunocompetent patient. A 62-year-old man, who had been first diagnosed with cystoisosporiasis 15 years ago and had been treated with oral administration of trimethoprim-sulfamethoxazole (TMP-SMX), complained of persistent watery diarrhea. He was negative for anti-human immunodeficiency virus antibody and anti-human T-cell leukemia virus type 1 (HTLV-1) antibody. DIAGNOSIS Biopsy specimens from the duodenum revealed oocysts in the atrophic absorptive epithelium and protozoa were detected through stool examination, indicating the recurrence of cystoisosporiasis. Capsule endoscopy showed diffuse atrophic mucosa with white villi in the entire small intestine. We diagnosed him with chronic cystoisosporiasis that occurred in an immunocompetent adult. INTERVENTIONS Since oral administration of TMP-SMX and ciprofloxacin were ineffective, the intravenous administration of TMP-SMX was initiated. OUTCOMES Intravenous TMP-SMX exhibited a significant improvement. LESSONS This case indicates that even immunocompetent individuals may develop recurrent and refractory cystoisosporiasis. Furthermore, intravenous treatment of antibiotic agents should be considered when the impaired absorptive ability from the small intestine is suspected.
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Affiliation(s)
| | | | | | | | | | - Keiji Konishi
- Department of Infectious Disease, Osaka City General Hospital, Japan
| | | | - Ryoji Kushima
- Department of Pathology, Shiga University of Medical Science
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7
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Chadwick DR, Sutherland RK, Raffe S, Pool E, Beadsworth M. British HIV Association guidelines on the management of opportunistic infection in people living with HIV: the clinical management of gastrointestinal opportunistic infections 2020. HIV Med 2020; 21 Suppl 5:1-19. [PMID: 33271637 DOI: 10.1111/hiv.13004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- D R Chadwick
- Centre for Clinical Infection, James Cook University Hospital, Middlesbrough, UK
| | - R K Sutherland
- Regional Infectious Diseases Unit, NHS Lothian, Edinburgh, UK
| | - S Raffe
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Erm Pool
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Mbj Beadsworth
- Tropical and Infectious Disease Unit, Royal Liverpool University Hospital (Liverpool University Hospitals Foundation Trust), Liverpool, UK
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8
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Lugo R, Angulo-Várguez F, Ávila-Nava A, Gutiérrez-Solis AL, Reyes-Sosa M, Medina-Escobedo M. Acute kidney injury associated with intestinal infection by Cyclospora cayetanensis in a kidney transplant patient. A case report. Parasitol Int 2020; 80:102212. [PMID: 33122029 DOI: 10.1016/j.parint.2020.102212] [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: 07/27/2020] [Revised: 09/20/2020] [Accepted: 09/27/2020] [Indexed: 10/23/2022]
Abstract
This study shows a clinical case report of a kidney transplant patient who traveled from Mexico to The Netherlands and ate green vegetables in an international food restaurant. After 5 days, he started having diarrhea, nausea, colic, and a physical feeling of malaise. The patient only received symptomatic treatment after showing the characteristic symptoms of traveler's diarrhea. When he returned to Mexico, the clinical picture worsened, and he was hospitalized. Clinical analyses indicated dehydration and acute kidney injury stage II. Coproparasitoscopic study showed the presence of Cyclospora cayetanensis. Parenteral solutions, gastric mucosal protector, ciprofloxacin, and a soft diet were administrated as treatment. The patient was discharged 72 h later with an improvement of the kidney function.
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Affiliation(s)
- Roberto Lugo
- Research Unit, Regional High Specialty Hospital of the Yucatan Peninsula, Calle 22, Fracc. Altabrisa, 97133 Merida, Yucatan, Mexico.
| | - Felipe Angulo-Várguez
- Department of Gastroenterology, Regional High Specialty Hospital of the Yucatan Peninsula, Calle 22, Fracc. Altabrisa, 97133 Merida, Yucatan, Mexico
| | - Azalia Ávila-Nava
- Research Unit, Regional High Specialty Hospital of the Yucatan Peninsula, Calle 22, Fracc. Altabrisa, 97133 Merida, Yucatan, Mexico
| | - Ana Ligia Gutiérrez-Solis
- Research Unit, Regional High Specialty Hospital of the Yucatan Peninsula, Calle 22, Fracc. Altabrisa, 97133 Merida, Yucatan, Mexico
| | - Mariela Reyes-Sosa
- Catedra CONACYT, Universidad Autónoma de Chiapas, Carr. Villaflores-Ocozocoautla km 7.5, 30470 Villaflores, Chiapas, Mexico
| | - Martha Medina-Escobedo
- Research Unit, Regional High Specialty Hospital of the Yucatan Peninsula, Calle 22, Fracc. Altabrisa, 97133 Merida, Yucatan, Mexico
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9
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Li J, Cui Z, Qi M, Zhang L. Advances in Cyclosporiasis Diagnosis and Therapeutic Intervention. Front Cell Infect Microbiol 2020; 10:43. [PMID: 32117814 PMCID: PMC7026454 DOI: 10.3389/fcimb.2020.00043] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 01/22/2020] [Indexed: 12/22/2022] Open
Abstract
Cyclosporiasis is caused by the coccidian parasite Cyclospora cayetanensis and is associated with large and complex food-borne outbreaks worldwide. Associated symptoms include severe watery diarrhea, particularly in infants, and immune dysfunction. With the globalization of human food supply, the occurrence of cyclosporiasis has been increasing in both food growing and importing countries. As well as being a burden on the health of individual humans, cyclosporiasis is a global public health concern. Currently, no vaccine is available but early detection and treatment could result in a favorable clinical outcome. Clinical diagnosis is based on cardinal clinical symptoms and conventional laboratory methods, which usually involve microscopic examination of wet smears, staining tests, fluorescence microscopy, serological testing, or DNA testing for oocysts in the stool. Detection in the vehicle of infection, which can be fresh produce, water, or soil is helpful for case-linkage and source-tracking during cyclosporiasis outbreaks. Treatment with trimethoprim-sulfamethoxazole (TMP-SMX) can evidently cure C. cayetanensis infection. However, TMP-SMX is not suitable for patients having sulfonamide intolerance. In such case ciprofloxacin, although less effective than TMP-SMX, is a good option. Another drug of choice is nitazoxanide that can be used in the cases of sulfonamide intolerance and ciprofloxacin resistance. More epidemiological research investigating cyclosporiasis in humans should be conducted worldwide, to achieve a better understanding of its characteristics in this regard. It is also necessary to establish in vitro and/or in vivo protocols for cultivating C. cayetanensis, to facilitate the development of rapid, convenient, precise, and economical detection methods for diagnosis, as well as more effective tracing methods. This review focuses on the advances in clinical features, diagnosis, and therapeutic intervention of cyclosporiasis.
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Affiliation(s)
- Junqiang Li
- Academy of Chinese Medical Sciences, Henan University of Chinese Medicine, Zhengzhou, China.,College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou, China
| | - Zhaohui Cui
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou, China
| | - Meng Qi
- College of Animal Science, Tarim University, Alar, China
| | - Longxian Zhang
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou, China
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10
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Marques J, Menezes M, Mendes F, Dutra E, Saiote J, Santos S, Cotovio P, Caeiro F, Carvalho D, Nolasco F. A rare diarrheic parasite in a kidney transplant patient: Cystoisospora belli. Transpl Infect Dis 2020; 22:e13237. [PMID: 31884694 DOI: 10.1111/tid.13237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/22/2019] [Accepted: 12/15/2019] [Indexed: 11/30/2022]
Abstract
Cystoisospora belli colitis is a rare complication of immunosuppression in solid organ transplant recipients. We describe a case of Cystoisospora belli infection with colitis following renal transplantation.
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Affiliation(s)
- Joana Marques
- Department of Nephrology, Centro Hospitalar e Universitário Lisboa Central, Lisbon, Portugal
| | - Maria Menezes
- Department of Nephrology, Centro Hospitalar e Universitário Lisboa Central, Lisbon, Portugal
| | - Filipa Mendes
- Department of Nephrology, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Eduardo Dutra
- Department of Pathology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Joana Saiote
- Department of Gastroenterology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Sara Santos
- Department of Gastroenterology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Patrícia Cotovio
- Department of Nephrology, Centro Hospitalar e Universitário Lisboa Central, Lisbon, Portugal
| | - Fernando Caeiro
- Department of Nephrology, Centro Hospitalar e Universitário Lisboa Central, Lisbon, Portugal
| | - Dulce Carvalho
- Department of Nephrology, Centro Hospitalar e Universitário Lisboa Central, Lisbon, Portugal
| | - Fernando Nolasco
- Department of Nephrology, Centro Hospitalar e Universitário Lisboa Central, Lisbon, Portugal
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11
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Cyclospora cayetanensis infection in humans: biological characteristics, clinical features, epidemiology, detection method and treatment. Parasitology 2019; 147:160-170. [PMID: 31699163 DOI: 10.1017/s0031182019001471] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cyclospora cayetanensis, a coccidian parasite that causes protracted and relapsing gastroenteritis, has a short recorded history. At least 54 countries have documented C. cayetanensis infections and 13 of them have recorded cyclosporiasis outbreaks. Cyclospora cayetanensis infections are commonly reported in developing countries with low-socioeconomic levels or in endemic areas, although large outbreaks have also been documented in developed countries. The overall C. cayetanensis prevalence in humans worldwide is 3.55%. Among susceptible populations, the highest prevalence has been documented in immunocompetent individuals with diarrhea. Infections are markedly seasonal, occurring in the rainy season or summer. Cyclospora cayetanensis or Cyclospora-like organisms have also been detected in food, water, soil and some other animals. Detection methods based on oocyst morphology, staining and molecular testing have been developed. Treatment with trimethoprim-sulfamethoxazole (TMP-SMX) effectively cures C. cayetanensis infection, whereas ciprofloxacin is less effective than TMP-SMX, but is suitable for patients who cannot tolerate co-trimoxazole. Here, we review the biological characteristics, clinical features, epidemiology, detection methods and treatment of C. cayetanensis in humans, and assess some risk factors for infection with this pathogen.
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12
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Gaafar MR, El-Zawawy LA, El-Temsahy MM, Shalaby TI, Hassan AY. Silver nanoparticles as a therapeutic agent in experimental cyclosporiasis. Exp Parasitol 2019; 207:107772. [PMID: 31610183 DOI: 10.1016/j.exppara.2019.107772] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/02/2019] [Accepted: 10/05/2019] [Indexed: 11/24/2022]
Abstract
Cyclosporiasis is an emerging worldwide infection caused by an obligate intracellular protozoan parasite, Cyclospora cayetanensis. In immunocompetent patients, it is mainly manifested by self-limited diarrhea, which is persistent and may be fatal in immunocompromised patients. The standard treatment for cyclosporiasis is a combination of two antibiotics, trimethoprim and sulfamethoxazole. Gastrointestinal, haematologic and renal side effects were reported with this combination. Moreover, sulfa allergy, foetal anomalies and recurrence were recorded with no alternative drug treatment option. In this study, silver nanoparticles were chemically synthesized to be evaluated for the first time for their anti-cyclospora effects in both immunocompetent and immunosuppressed experimental mice in comparison to the standard treatment. The effect of silver nanoparticles was assessed through studying stool oocyst load, oocyst viability, ultrastructural changes in oocysts, and estimation of serum gamma interferon. Toxic effect of the therapeutic agents was evaluated by measuring liver enzymes, urea and creatinine in mouse sera. Results showed that silver nanoparticles had promising anti-cyclospora potentials. The animals that received these nanoparticles showed a statistically significant decrease in the oocyst burden and number of viable oocysts in stool and a statistically significant increase in serum gamma interferon in comparison to the corresponding group receiving the standard treatment and to the infected non-treated control group. Scanning electron microscopic examination revealed mutilated oocysts with irregularities, poring and perforations. Biochemical results showed no evidence of toxicity of silver nanoparticles, as the sera of the mice showed a statistically non-significant decrease in liver enzymes in immunocompetent subgroups, and a statistically significant decrease in immunosuppressed subgroups. Furthermore, a statistically non-significant decrease in urea and creatinine was recorded in all subgroups. Thus, silver nanoparticles proved their effectiveness against Cyclospora infection, and this will draw the attention to its use as an alternative to the standard therapy.
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Affiliation(s)
- M R Gaafar
- Department of Medical Parasitology, Faculty of Medicine, Alexandria University, Egypt.
| | - L A El-Zawawy
- Department of Medical Parasitology, Faculty of Medicine, Alexandria University, Egypt
| | - M M El-Temsahy
- Department of Medical Parasitology, Faculty of Medicine, Alexandria University, Egypt
| | - Th I Shalaby
- Department of Medical Biophysics, Medical Research Institute, Alexandria University, Egypt
| | - A Y Hassan
- Department of Medical Parasitology, Faculty of Medicine, Alexandria University, Egypt
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13
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Abstract
Cystoisospora belli is a coccidian parasite of humans, with a direct fecal-oral transmission cycle. It is globally distributed, but mainly found in tropical and subtropical areas. Many cases of C. belli infections have been reported in patients with HIV, and in patients undergoing immunosuppressive therapy for organ transplants or those treated for tumours worldwide. Unsporulated or partially sporulated oocysts of C. belli are excreted in feces. When sporulated oocysts in contaminated water or food are ingested, asexual and sexual stages of C. belli are confined to the epithelium of intestines, bile ducts and gallbladder. Monozoic tissue cysts are present in extra-intestinal organs (lamina propria of the small and large intestine, lymph nodes, spleen, and liver) of immunosuppressed humans. However, a paratenic host has not been demonstrated. Cystoisospora belli infections can be persistent, lasting for months, and relapses are common; the mechanism of relapse is unknown. Recently, the endogenous stages of C. belli were re-examined and attention was drawn to cases of misidentification of non-protozoal structures in the gallbladder of patients as C. belli. Here, we review all aspects of the biology of C. belli, including morphology, endogenous stages, prevalence, epidemiology, symptoms, diagnosis and control.
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Affiliation(s)
- J P Dubey
- United States Department of Agriculture, Agricultural Research Service, Beltsville Agricultural Research Service, Animal Parasitic Disease Laboratory, Building 1001, BARC-East, Beltsville, MD 20705-2350, USA
| | - S Almeria
- Departmentof Health and Human Services, Food and Drug Administration, Center for Food Safety and Nutrition, Office of Applied Research and Safety Assessment, Division of Virulence Assessment, Laurel, MD 20708, USA
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14
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Almeria S, Cinar HN, Dubey JP. Cyclospora cayetanensis and Cyclosporiasis: An Update. Microorganisms 2019; 7:E317. [PMID: 31487898 PMCID: PMC6780905 DOI: 10.3390/microorganisms7090317] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/28/2019] [Accepted: 09/02/2019] [Indexed: 12/18/2022] Open
Abstract
Cyclospora cayetanensis is a coccidian parasite of humans, with a direct fecal-oral transmission cycle. It is globally distributed and an important cause of foodborne outbreaks of enteric disease in many developed countries, mostly associated with the consumption of contaminated fresh produce. Because oocysts are excreted unsporulated and need to sporulate in the environment, direct person-to-person transmission is unlikely. Infection by C. cayetanensis is remarkably seasonal worldwide, although it varies by geographical regions. Most susceptible populations are children, foreigners, and immunocompromised patients in endemic countries, while in industrialized countries, C. cayetanensis affects people of any age. The risk of infection in developed countries is associated with travel to endemic areas and the domestic consumption of contaminated food, mainly fresh produce imported from endemic regions. Water and soil contaminated with fecal matter may act as a vehicle of transmission for C. cayetanensis infection. The disease is self-limiting in most immunocompetent patients, but it may present as a severe, protracted or chronic diarrhea in some cases, and may colonize extra-intestinal organs in immunocompromised patients. Trimetoprim-sulfamethoxazole is the antibiotic of choice for the treatment of cyclosporiasis, but relapses may occur. Further research is needed to understand many unknown epidemiological aspects of this parasitic disease. Here, we summarize the biology, epidemiology, outbreaks, clinical symptoms, diagnosis, treatment, control and prevention of C. cayetanensis; additionally, we outline future research needs for this parasite.
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Affiliation(s)
- Sonia Almeria
- Department of Health and Human Services, Food and Drug Administration, Center for Food Safety and Nutrition (CFSAN), Office of Applied Research and Safety Assessment (OARSA), Division of Virulence Assessment, Laurel, MD 20708, USA
| | - Hediye N Cinar
- Department of Health and Human Services, Food and Drug Administration, Center for Food Safety and Nutrition (CFSAN), Office of Applied Research and Safety Assessment (OARSA), Division of Virulence Assessment, Laurel, MD 20708, USA
| | - Jitender P Dubey
- Animal Parasitic Disease Laboratory, United States Department of Agriculture, Agricultural Research Service, Beltsville Agricultural Research Center, Building 1001, BARC-East, Beltsville, MD 20705-2350, USA.
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15
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La Hoz RM, Morris MI. Intestinal parasites including Cryptosporidium, Cyclospora, Giardia, and Microsporidia, Entamoeba histolytica, Strongyloides, Schistosomiasis, and Echinococcus: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13618. [PMID: 31145496 DOI: 10.1111/ctr.13618] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 05/20/2019] [Indexed: 01/08/2023]
Abstract
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of intestinal parasites in the pre- and post-transplant period. Intestinal parasites are prevalent in the developing regions of the world. With increasing travel to and from endemic regions, changing immigration patterns, and the expansion of transplant medicine in developing countries, they are increasingly recognized as a source of morbidity and mortality in solid-organ transplant recipients. Parasitic infections may be acquired from the donor allograft, from reactivation, or from de novo acquisition post-transplantation. Gastrointestinal multiplex assays have been developed; some of the panels include testing for Cryptosporidium, Cyclospora, Entamoeba histolytica, and Giardia, and the performance is comparable to conventional methods. A polymerase chain reaction test, not yet widely available, has also been developed to detect Strongyloides in stool samples. New recommendations have been developed to minimize the risk of Strongyloides donor-derived events. Deceased donors with epidemiological risk factors should be screened for Strongyloides and recipients treated if positive as soon as the results are available. New therapeutic agents and studies addressing the optimal treatment regimen for solid-organ transplant recipients are unmet needs.
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Affiliation(s)
- Ricardo M La Hoz
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michele I Morris
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida
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Susceptibility to Various Coccidiostats in the Murine Coccidian Parasite Eimeria krijgsmanni. Acta Parasitol 2019; 64:418-422. [PMID: 30977052 DOI: 10.2478/s11686-019-00052-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 03/29/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Murine Eimeria spp. have been used as effective experimental models of disease instead of large mammalian hosts such as cattle. We here examine drug susceptibility of the uncharacterized murine intestinal protozoan parasite, Eimeria krijgsmanni. MATERIALS AND METHODS The effectiveness of different treatments against infection of E. krijgsmanni was examined for suppression of oocyst shedding: ST mixture ST mixture, pyrimethamine, Ektecin and toltrazuril. RESULTS ST mixture and pyrimethamine did not suppress oocyst shedding effectively. Although therapeutic efficacy of Ektecin was demonstrated, the dose required was larger than that for cattle and chickens. Oocyst shedding was only completely suppressed completely by continuous administration of toltrazuril. Furthermore, it was confirmed through morphological examination that early developmental stage zoites appeared in host epithelial cells during and following treatment by toltrazuril, and toltrazuril could not eliminate residual zoites in epithelial cells. CONCLUSION E. krijgsmanni may be relatively resistant to these anti-coccidian agents and might therefore have different characteristics that differ from other coccidia with regard to drug susceptibility.
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Human cyclosporiasis. THE LANCET. INFECTIOUS DISEASES 2019; 19:e226-e236. [PMID: 30885589 DOI: 10.1016/s1473-3099(18)30789-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 12/03/2018] [Accepted: 12/06/2018] [Indexed: 01/10/2023]
Abstract
Cyclospora species are socioeconomically important protistan pathogens. Cyclospora cayetanensis is usually transmitted via food or water to a human host via the faecal-oral route and can cause the gastrointestinal disease cyclosporiasis, which can be complicated by extra-intestinal disorders, particularly in immune-compromised people. Although more than 2 million children die each year from diarrhoeal diseases worldwide, it is not known to what extent cyclosporiasis is involved. Few epidemiological data are available on Cyclospora as a water-borne and food-borne pathogen in both underprivileged communities and developed countries. To gain an improved understanding of human cyclosporiasis, this Review describes the background of Cyclospora, summarises salient aspects of the pathogenesis, epidemiology, diagnosis, treatment, and control of cyclosporiasis, and explores what is known about its prevalence and geographical distribution. The findings show that the effect on human health of cyclosporiasis is likely underestimated, and recommendations are made about areas of future research and the prevention and control of this disease within an international collaborative context.
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Severe diarrhoea due to Cystoisospora belli infection in a Good syndrome patient. Parasitol Int 2018; 67:413-414. [PMID: 29625163 DOI: 10.1016/j.parint.2018.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 03/24/2018] [Accepted: 03/28/2018] [Indexed: 11/21/2022]
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Uhlemann T, Seidel S, Müller CW. Site-specific binding of a water molecule to the sulfa drugs sulfamethoxazole and sulfisoxazole: a laser-desorption isomer-specific UV and IR study. Phys Chem Chem Phys 2018; 20:6891-6904. [DOI: 10.1039/c7cp08579f] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Using isomer-specific IR spectroscopy, we show that sulfamethoxazole and sulfisoxazole exhibit distinct site specificities for binding a water molecule.
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Affiliation(s)
- Thomas Uhlemann
- Ruhr-Universität Bochum
- Fakultät für Chemie und Biochemie
- D-44780 Bochum
- Germany
| | - Sebastian Seidel
- Ruhr-Universität Bochum
- Fakultät für Chemie und Biochemie
- D-44780 Bochum
- Germany
| | - Christian W. Müller
- Ruhr-Universität Bochum
- Fakultät für Chemie und Biochemie
- D-44780 Bochum
- Germany
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Schmidt-Hieber M, Bierwirth J, Buchheidt D, Cornely OA, Hentrich M, Maschmeyer G, Schalk E, Vehreschild JJ, Vehreschild MJGT. Diagnosis and management of gastrointestinal complications in adult cancer patients: 2017 updated evidence-based guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol 2018; 97:31-49. [PMID: 29177551 PMCID: PMC5748412 DOI: 10.1007/s00277-017-3183-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/11/2017] [Indexed: 12/15/2022]
Abstract
Cancer patients frequently suffer from gastrointestinal complications. In this manuscript, we update our 2013 guideline on the diagnosis and management of gastrointestinal complications in adult cancer patients by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). An expert group was put together by the AGIHO to update the existing guideline. For each sub-topic, a literature search was performed in PubMed, Medline, and Cochrane databases, and strengths of recommendation and the quality of the published evidence for major therapeutic strategies were categorized using the 2015 European Society for Clinical Microbiology and Infectious Diseases (ESCMID) criteria. Final recommendations were approved by the AGIHO plenary conference. Recommendations were made with respect to non-infectious and infectious gastrointestinal complications. Strengths of recommendation and levels of evidence are presented. A multidisciplinary approach to the diagnosis and management of gastrointestinal complications in cancer patients is mandatory. Evidence-based recommendations are provided in this updated guideline.
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Affiliation(s)
- M Schmidt-Hieber
- Clinic for Hematology, Oncology, Tumor Immunology and Palliative Care, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - J Bierwirth
- Deutsches Beratungszentrum für Hygiene, BZH GmbH, Freiburg, Germany
| | - D Buchheidt
- 3rd Department of Internal Medicine - Hematology and Oncology - Mannheim University Hospital, University of Heidelberg, Heidelberg, Germany
| | - O A Cornely
- 1st Department of Internal Medicine, University of Cologne, Cologne, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
- Clinical Trials Centre Cologne, ZKS Köln, University of Cologne, Cologne, Germany
| | - M Hentrich
- Department III for Internal Medicine, Hematology and Oncology, Rotkreuzklinikum München, Munich, Germany
| | - G Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Ernst-von-Bergmann Klinikum, Potsdam, Germany
| | - E Schalk
- Department of Hematology and Oncology, Medical Center, Otto-von-Guericke University, Magdeburg, Germany
| | - J J Vehreschild
- 1st Department of Internal Medicine, University of Cologne, Cologne, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Maria J G T Vehreschild
- 1st Department of Internal Medicine, University of Cologne, Cologne, Germany.
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany.
- 1st Department of Internal Medicine, Hospital of the University of Cologne, Kerpener Str. 62, 50937, Köln, Germany.
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Thapa SS, Basnyat B. Chronic Diarrhea in a Traveler: Cyclosporiasis. Am J Med 2017; 130:e535-e536. [PMID: 28716461 DOI: 10.1016/j.amjmed.2017.06.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 06/06/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Simant Singh Thapa
- Department of Internal Medicine, Saint Vincent Hospital, University Of Massachusetts Medical School, Worcester.
| | - Buddha Basnyat
- Travel and Mountain Medicine Center, Nepal International Clinic, Kathmandu, Nepal; Oxford University Clinical Research Unit-Nepal, Center for Tropical Medicine and Global Health, University of Oxford, UK
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Kelly P, Mutengo M. Parasitic Infections of the Gastrointestinal Tract. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00114-3] [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: 11/27/2022] Open
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Weber R. Intestinal Coccidia and Microsporidia. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00192-1] [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: 11/28/2022] Open
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Abstract
ABSTRACT
Parasites are an important cause of human disease worldwide. The clinical severity and outcome of parasitic disease is often dependent on the immune status of the host. Specific parasitic diseases discussed in this chapter are amebiasis, giardiasis, cryptosporidiosis, cyclosporiasis, cystoisosporiasis, microsporidosis, granulomatous amebic encephalitis, toxoplasmosis, leishmaniasis, Chagas disease, malaria, babesiosis, strongyloidiasis, and scabies.
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Azam A, Peerzada MN, Ahmad K. Parasitic diarrheal disease: drug development and targets. Front Microbiol 2015; 6:1183. [PMID: 26617574 PMCID: PMC4621754 DOI: 10.3389/fmicb.2015.01183] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 10/12/2015] [Indexed: 12/23/2022] Open
Abstract
Diarrhea is the manifestation of gastrointestinal infection and is one of the major causes of mortality and morbidity specifically among the children of less than 5 years age worldwide. Moreover, in recent years there has been a rise in the number of reports of intestinal infections continuously in the industrialized world. These are largely related to waterborne and food borne outbreaks. These occur by the pathogenesis of both prokaryotic and eukaryotic organisms like bacteria and parasites. The parasitic intestinal infection has remained mostly unexplored and under assessed in terms of therapeutic development. The lack of new drugs and the risk of resistance have led us to carry out this review on drug development for parasitic diarrheal diseases. The major focus has been depicted on commercially available drugs, currently synthesized active heterocyclic compounds and unique drug targets, that are vital for the existence and growth of the parasites and can be further exploited for the search of therapeutically active anti-parasitic agents.
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Affiliation(s)
- Amir Azam
- Medicinal Chemistry Laboratory, Department of Chemistry, Jamia Millia IslamiaNew Delhi, India
| | - Mudasir N. Peerzada
- Medicinal Chemistry Laboratory, Department of Chemistry, Jamia Millia IslamiaNew Delhi, India
| | - Kamal Ahmad
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia IslamiaNew Delhi, India
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Bednarska M, Bajer A, Welc-Falęciak R, Pawełas A. Cyclospora cayetanensis infection in transplant traveller: a case report of outbreak. Parasit Vectors 2015; 8:411. [PMID: 26249024 PMCID: PMC4528381 DOI: 10.1186/s13071-015-1026-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 07/29/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cyclospora cayetanensis is a protozoan parasite causing intestinal infections. A prolonged course of infection is often observed in immunocompromised individuals. In Europe, less than 100 cases of C. cayetanensis infection have been reported to date, almost all of which being diagnosed in individuals after travelling abroad. FINDINGS We described cases of three businessmen who developed acute traveller's diarrhoea after they returned to Poland from Indonesia. One of the travellers was a renal transplant recipient having ongoing immunosuppressive treatment. In each case, acute and prolonged diarrhoea and other intestinal disorders occurred. Oocysts of C. cayetanensis were identified in faecal smears of two of the travellers (one immunosuppressed and one immunocompetent). Diagnosis was confirmed by the successful amplification of parasite DNA (18S rDNA). A co-infection with Blastocystis hominis was identified in the immunocompetent man. CONCLUSIONS Infection of C. cayetanensis shall be considered as the cause of prolonged acute diarrhoea in immunocompromised patients returning from endemic regions.
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Affiliation(s)
- Małgorzata Bednarska
- Department of Parasitology, Faculty of Biology, University of Warsaw, Miecznikowa Street, 02-096, Warsaw, Poland.
| | - Anna Bajer
- Department of Parasitology, Faculty of Biology, University of Warsaw, Miecznikowa Street, 02-096, Warsaw, Poland.
| | - Renata Welc-Falęciak
- Department of Parasitology, Faculty of Biology, University of Warsaw, Miecznikowa Street, 02-096, Warsaw, Poland.
| | - Andrzej Pawełas
- Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Center for Postgraduate Education, Roentgena Street 5, 02-781, Warsaw, Poland.
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El-Taweel HA. Understanding drug resistance in human intestinal protozoa. Parasitol Res 2015; 114:1647-59. [DOI: 10.1007/s00436-015-4423-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 03/05/2015] [Indexed: 01/07/2023]
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Rouzier V, Farmer PE, Pape JW, Jerome JG, Van Onacker JD, Morose W, Joseph P, Leandre F, Severe P, Barry D, Deschamps MM, Koenig SP. Factors impacting the provision of antiretroviral therapy to people living with HIV: the view from Haiti. Antivir Ther 2014; 19 Suppl 3:91-104. [PMID: 25310257 DOI: 10.3851/imp2904] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2014] [Indexed: 10/24/2022]
Abstract
Haiti is the poorest country in the Western Hemisphere and has the highest number of people living with HIV in the Caribbean, the region most impacted by HIV outside of Africa. Despite continuous political, socioeconomic and natural catastrophes, Haiti has mounted a very successful response to the HIV epidemic. Prevention and treatment strategies implemented by the government in collaboration with non-governmental organizations have been instrumental in decreasing the national HIV prevalence from a high of 6.2% in 1993 to 2.2% in 2012. We describe the history and epidemiology of HIV in Haiti and the expansion of antiretroviral therapy (ART) over the past decade, with the achievement of universal access to ART for patients meeting the 2010 World Health Organization guidelines. We also describe effective models of care, successes and challenges of international funding, and current challenges in the provision of ART. We are optimistic that the goal of providing ART for all in need remains in reach.
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Affiliation(s)
- Vanessa Rouzier
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti.
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Protozoan Parasites. Food Microbiol 2014. [DOI: 10.1128/9781555818463.ch28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Showler AJ, Wilson ME, Kain KC, Boggild AK. Parasitic diseases in travelers: a focus on therapy. Expert Rev Anti Infect Ther 2014; 12:497-521. [DOI: 10.1586/14787210.2014.892827] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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The Haiti research-based model of international public health collaboration: the GHESKIO Centers. J Acquir Immune Defic Syndr 2014; 65 Suppl 1:S5-9. [PMID: 24321987 DOI: 10.1097/qai.0000000000000031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
For 3 decades, GHESKIO (the Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes), the Haitian Ministry of Health, and Weill Cornell have pursued a tripartite mission of service, training, and translational research. The initial focus was on AIDS and tuberculosis. The mission has expanded to include the local community and now provides maternal-child health, family planning, cancer prevention and treatment, immunizations (including human papillomavirus, cholera), and primary education through vocational and microcredit programs. Outcome measures include a reduction in HIV prevalence from 6.2% to the current 2.2%, extensive tuberculosis and cholera prevention and treatment programs, and national training programs for biomedical and community health workers.
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Sánchez-Vega JT, Cabrera-Fuentes HA, Romero-Olmedo AJ, Ortiz-Frías JL, Sokolina F, Barreto G. Cyclospora cayetanensis: this emerging protozoan pathogen in Mexico. Am J Trop Med Hyg 2013; 90:351-3. [PMID: 24379243 DOI: 10.4269/ajtmh.12-0782] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A Mexican airline pilot had clinical manifestations of illness after a five-day stay in Lima, Peru. Six months later in Mexico, he was given a diagnosis of infection with Cyclospora cayetanensis by using coproparasitoscopic serial tests. He was treated twice with nitazoxadine successfully.
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Affiliation(s)
- José T Sánchez-Vega
- Parasitology Laboratory, Department of Microbiology and Parasitology, Faculty of Medicine, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico; Faculty of Chemical Sciences, Universidad Autonoma Benito Juarez de Oaxaca, Oaxaca, Mexico; LOEWE Research Group Lung Cancer Epigenetics, Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany; Unidad Medica Familiar, Delegacion Sur, Unidad 21 Valle de Mexico, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Institute of Fundamental Medicine and Biology, Kazan Federal University, Tatarstan, Russia; Biochemistry Institute, Medical School, Justus-Liebig University, Giessen, Germany
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Tsang OTY, Wong RWC, Lam BHS, Chan JMC, Tsang KY, Leung WS. Cyclospora infection in a young woman with human immunodeficiency virus in Hong Kong: a case report. BMC Res Notes 2013; 6:521. [PMID: 24321705 PMCID: PMC4028803 DOI: 10.1186/1756-0500-6-521] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 12/04/2013] [Indexed: 11/23/2022] Open
Abstract
Background Cyclospora is an uncommon pathogen. The diagnosis of Cyclospora infection can be difficult because of its scarcity in developed countries, intracellular mode of life, small size of the parasite and its inability to take up routine microscopic stains. However, it is endemic in many countries in Asia, Africa, Central and South America. With the increase in travels to these areas, the number of cases is expected to increase. Moreover, it is found to be associated with numerous food-borne outbreaks. Case presentation We encountered a patient with human immunodeficiency virus presented with 6 months of diarrhoea. The initial investigation was unrevealing. The diagnosis of Cyclospora infection was finally made on the histological sample obtained by colonoscopy. Moreover, the initial therapy with ciprofloxacin was not effective, while trimethoprim/sulfamethoxazole resulted in final cure of the disease. Conclusion Travel and food histories are important for the suspicion of Cyclospora infection. Histological examination is more sensitive in making a diagnosis of Cyclospora infection of the gut than fecal microscopic examination. Trimethoprim/sulfamethoxazole is a more reliable therapy for Cyclospora infection in patients with human immunodeficiency virus.
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Affiliation(s)
- Owen Tak-yin Tsang
- Hospital Authority Infectious Disease Centre at Princess Margaret Hospital, 2-10 Princess Rm 313, Blk S, Margaret Hospital Rd, Lai Chi Kok, Hong Kong, SAR, China.
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Llanes R, Velázquez B, Reyes Z, Somarriba L. Co-infection with Cyclospora cayetanensis and Salmonella typhi in a patient with HIV infection and chronic diarrhoea. Pathog Glob Health 2013; 107:38-9. [PMID: 23432863 DOI: 10.1179/2047773212y.0000000065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
A 45-year-old-Haitian male patient with fever, abdominal cramping, chronic diarrhoea and weight loss of about 3 kg was investigated. Stool examination revealed Salmonella typhi and Cyclospora cayetanensis. The HIV test was positive with a CD4 count of 130 cells/mm(3). We provided the first report of co-infection Cyclospora cayetanensis and Salmonella typhi in a HIV patient with chronic diarrhoea. The patient was treated with oral ciprofloxacin, 500 mg, twice daily for two weeks, with a good clinical outcome.
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Affiliation(s)
- Rafael Llanes
- Brigada Médica Cubana en Haití. Puerto Príncipe, Departamento Oeste, Haití.
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Vehreschild MJGT, Vehreschild JJ, Hübel K, Hentrich M, Schmidt-Hieber M, Christopeit M, Maschmeyer G, Schalk E, Cornely OA, Neumann S. Diagnosis and management of gastrointestinal complications in adult cancer patients: evidence-based guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO). Ann Oncol 2013; 24:1189-202. [PMID: 23401037 DOI: 10.1093/annonc/mdt001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cancer patients frequently suffer from gastrointestinal complications. However, a comprehensive, practical and evidence-based guideline on this issue is not yet available. PATIENTS AND METHODS An expert group was put together by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO) to develop a guideline on gastrointestinal complications in cancer patients. For each subtopic, a literature search was carried out in PubMed, Medline and Cochrane databases and the strength of recommendation and the quality of the published evidence for major therapeutic strategies were categorized using a modification of the 'Infectious Diseases Society of America' criteria. Consensus discussions were held on each of the topics. RESULTS Recommendations were made with respect to non-infectious and infectious gastrointestinal complications. For all recommendations, the strength of the recommendation and the level of evidence are presented. CONCLUSION This guideline is an evidence-based approach to the diagnosis and management of gastrointestinal complications in cancer patients.
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Abstract
Diarrhea is a common problem in patients with immunocompromising conditions. The etiologic spectrum differs from patients with diarrhea who have a normal immune system. This article reviews the most important causes of diarrhea in immunocompromised patients, ranging from infectious causes to noninfectious causes of diarrhea in the setting of HIV infection as a model for other conditions of immunosuppression. It also deals with diarrhea in specific situations, eg, after hematopoietic stem cell or solid organ transplantation, diarrhea induced by immunosuppressive drugs, and diarrhea in congenital immunodeficiency syndromes.
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Affiliation(s)
- Elisabeth Krones
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Severe Isospora (Cystoisospora) belli Diarrhea Preceding the Diagnosis of Human T-Cell-Leukemia-Virus-1-Associated T-Cell Lymphoma. Case Rep Infect Dis 2012; 2012:640104. [PMID: 22953083 PMCID: PMC3431052 DOI: 10.1155/2012/640104] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 07/25/2012] [Indexed: 11/17/2022] Open
Abstract
Isospora (Cystoisospora) belli diarrhea can sometimes be fulminant in immunocompromised patients. It is endemic in tropical and subtropical areas, and sporadic episodes have been reported in nonendemic areas in nursing homes, day-care centers, and psychiatric institutions. We describe isosporiasis in an HIV-negative Sudanese-American female who presented with a debilitating diarrheal illness and profound weight loss. Isospora belli was detected in her stool by modified acid-fast staining. Serologic testing was negative for HIV but positive for HTLV-1 infection. Treatment with TMP-SMZ led to improvement in her diarrhea which recurred after stopping antibiotics. Subsequently, she developed generalized lymphadenopathy which was diagnosed as ATLL on immunohistochemical staining. Chemotherapy was initiated, but her condition continued to worsen due to persistent diarrhea and resulting profound electrolyte abnormalities. The patient opted for comfort measures and died a few weeks later at a nursing facility. This case emphasizes that the detection of I. belli should trigger testing for HIV, HTLV-1, and other causes of immunocompromise. We suggest that treatment with TMP-SMZ should be initiated and continued for a prolonged period of time in immunocompromised patients with I. belli diarrhea.
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Boyles TH, Black J, Meintjes G, Mendelson M. Failure to eradicate Isospora belli diarrhoea despite immune reconstitution in adults with HIV--a case series. PLoS One 2012; 7:e42844. [PMID: 22880120 PMCID: PMC3412810 DOI: 10.1371/journal.pone.0042844] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 07/11/2012] [Indexed: 11/19/2022] Open
Abstract
Isospora belli causes diarrhoea in patients with AIDS. Most respond to targeted therapy and recommendations are that secondary prophylaxis can be stopped following immune reconstitution with ART. We report eight cases of chronic isosporiasis that persisted despite standard antimicrobial therapy, secondary prophylaxis, and good immunological and virological response to ART. Median CD4 nadir was 175.5 cells/mm(3) and median highest CD4 while symptomatic was 373 cells/mm(3). Overall 34% of stool samples and 63% of duodenal biopsy specimens were positive for oocytes. Four patients died, two remain symptomatic and two recovered. Possible explanations for persistence of symptoms include host factors such as antigen specific immune deficiency or generalised reduction in gut immunity. Parasite factors may include accumulating resistance to co-trimoxazole. Research is required to determine the optimum dose and duration of co-trimoxazole therapy and whether dual therapy may be necessary. Mortality was high and pending more data we recommend extended treatment with high-dose co-trimoxazole in similar cases.
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Affiliation(s)
- Tom H Boyles
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
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Navaneethan U, Venkatesh PGK, Downs-Kelly E, Shen B. Isospora belli superinfection in a patient with eosinophilic gastroenteritis--a diagnostic challenge. J Crohns Colitis 2012; 6:236-9. [PMID: 22325178 DOI: 10.1016/j.crohns.2011.08.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 08/11/2011] [Indexed: 02/08/2023]
Abstract
Isospora belli infection, characterized by peripheral blood eosinophilia, is often seen as an opportunistic infection in patients with acquired immunodeficiency syndrome (AIDS). It is also reported in patients with underlying lymphoproliferative disorders including lymphoma and leukemia. Eosinophil-associated gastrointestinal disorders (EGID), including eosinophilic gastroenteritis (EGE), is characterized by eosinophilic infiltration of the gastrointestinal (GI) tract with various GI symptoms. We report a case of a 50-year-old male who developed Isospora superinfection of the small bowel while receiving systemic corticosteroids for EGE. He presented with worsening diarrhea, abdominal pain, nausea and vomiting with worsening peripheral eosinophilia. I. belli infection was diagnosed by the detection of oocysts in stool samples and by the presence of the parasite on duodenal biopsy in the background of tissue eosinophilia. I. belli can cause severe chronic diarrhea in immunocompromised patients on corticosteroids. Trimethoprim-sulfamethoxazole often provided rapid cure. Even though peripheral blood eosinophilia was seen in both EGE and Isospora infection, the identification of subnuclear protozoal inclusions as a new histologic finding, as well as the absence of this finding in previous duodenal biopsies coupled with the continued presence of tissue eosinophilia, favored a parasitic superinfection in the setting of underlying EGE.
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Goldberg E, Bishara J. Contemporary unconventional clinical use of co-trimoxazole. Clin Microbiol Infect 2012; 18:8-17. [DOI: 10.1111/j.1469-0691.2011.03613.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Clinical Guidelines for the Treatment and Prevention of Opportunistic Infections in HIV-infected Koreans. Infect Chemother 2012. [DOI: 10.3947/ic.2012.44.3.93] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Feasey NA, Healey P, Gordon MA. Review article: the aetiology, investigation and management of diarrhoea in the HIV-positive patient. Aliment Pharmacol Ther 2011; 34:587-603. [PMID: 21777262 DOI: 10.1111/j.1365-2036.2011.04781.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Diarrhoea is a common presentation throughout the course of HIV disease. AIM To review the literature relating to aetiology, investigation and management of diarrhoea in the HIV-infected adult. METHODS The PubMed database was searched using major subject headings 'AIDS' or 'HIV' and 'diarrhoea' or 'intestinal parasite'. The search was limited to adults and to studies with >10 patients. RESULTS Diarrhoea affects 40-80% of HIV-infected adults untreated with antiretroviral therapy (ART). First-line investigation is by stool microbiology. Reported yield varies with geography and methodology. Molecular and immunological methods and special stains have improved diagnostic yield. Endoscopy is diagnostic in 30-70% of cases of pathogen-negative diarrhoea and evidence supports flexible sigmoidoscopy as a first line screening procedure (80-95% sensitive for CMV colitis), followed by colonoscopy and terminal ileoscopy. Radiology is useful to assess severity, distribution, complications and to diagnose HIV-related malignancies. Side effects and compliance with ART are important considerations in assessment. There is a good evidence base for many specific therapies, but optimal treatment of cryptosporidiosis is unclear and only limited data support symptomatic treatments. CONCLUSIONS The immunological response to HIV infection and Antiretroviral therapy remains incompletely understood. Antiretroviral therapy regimens need to be optimised to suppress HIV while minimising side effects. Effective agents for management of cryptosporidiosis are lacking. There is an urgent need for enhanced regional diagnostic facilities in countries with a high prevalence of HIV. The ongoing roll-out of Antiretroviral therapy in low-resource settings will continue to change the aetiology and management of this problem, necessitating ongoing surveillance and study.
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Affiliation(s)
- N A Feasey
- Department of Gastroenterology, University of Liverpool, Liverpool, UK
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Abstract
Parasitic diseases affect more than 2 billion people globally and cause substantial morbidity and mortality, particularly among the world's poorest people. This overview focuses on the treatment of the major protozoan and helminth infections in humans. Recent developments in antiparasitic therapy include the expansion of artemisinin-based therapies for malaria, new drugs for soil-transmitted helminths and intestinal protozoa, expansion of the indications for antiparasitic drug treatment in patients with Chagas disease, and the use of combination therapy for leishmaniasis and human African trypanosomiasis.
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Affiliation(s)
| | | | - Brian G. Blackburn
- Address correspondence to Brian G. Blackburn, MD, Stanford University School of Medicine, Division of Infectious Diseases and Geographic Medicine, 300 Pasteur Dr, Grant Bldg, Room S-101, Stanford, CA 94305-5107 (). Individual reprints of this article and a bound reprint of the entire Symposium on Antimicrobial Therapy will be available for purchase from our Web site www.mayoclinicproceedings.com
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Miller TL, Cushman LL. Gastrointestinal Complications of Secondary Immunodeficiency Syndromes. PEDIATRIC GASTROINTESTINAL AND LIVER DISEASE 2011. [PMCID: PMC7158192 DOI: 10.1016/b978-1-4377-0774-8.10042-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abdu Misau Y, Sanda RB, Bakari A, Turaki M, Ashfaq K. Antimicrobials for chronic AIDS-associated diarrhoea in Adults. Hippokratia 2010. [DOI: 10.1002/14651858.cd008499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yusuf Abdu Misau
- University of Malaya; Dept. of Social and Preventive Medicine, Faculty of Medicine; Kuala Lumpur Malaysia 50603
| | - Robert B Sanda
- Hail General Hospital; Surgery; 1, ibn Senna Street Hail Saudi Arabia 81451
| | - Adamu Bakari
- Ahmadu Bello University Teaching Hospital; Medicine; Giwa Road Zaria Nigeria 234
| | - Mohammed Turaki
- Ahmadu Bello University Teaching Hospital; Medicine; Giwa Road Zaria Nigeria 234
| | - Khalid Ashfaq
- National Collaborating Centre for Women's and Children's Health; Clinical Guidelines Development; 4th Floor, King's Court, 2-16 Goodge Street London UK W1T 2QA
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Abstract
The coccidian parasite Cyclospora cayetanensis is recognized as an emerging pathogen that causes protracted diarrhea in humans. The first cases of Cyclospora infection were reported in the late 1970s and were observed among expatriates and travelers in regions where infections are endemic. Since then, Cyclospora has been considered a cause of traveler's diarrhea. Epidemiological investigations were reported and examined in areas of endemicity even before the true identity of Cyclospora was elucidated. Cyclospora was fully characterized in the early 1990s, but it was not until the 1995 Cyclospora outbreak in the United States and Canada that it caught the attention of the public and physicians. The biology, clinical presentation, epidemiology, diagnosis, treatment, and control of cyclosporiasis are reviewed, with a focus on diagnostic assays currently being used for clinical and environmental samples. Challenges and limitations in working with Cyclospora are also discussed.
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Koenig S, Ivers L, Pace S, Destine R, Leandre F, Grandpierre R, Mukherjee J, Farmer P, Pape J. Successes and challenges of HIV treatment programs in Haiti: aftermath of the earthquake. ACTA ACUST UNITED AC 2010; 4:145-160. [PMID: 21197385 DOI: 10.2217/hiv.10.6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Haiti's HIV/AIDS program is one of the most successful in the world, with a declining HIV prevalence, and treatment outcomes that rival those of industrialized nations. It is now on the way to providing universal treatment for HIV/AIDS nationwide. This success is tied to a strong foundation for HIV care that was in place before external funding became available that includes national guidelines prepared by the Ministry of Health, political commitment at the highest levels of government, non-governmental organizations that had been providing high quality care in Haiti for decades, and the assistance of the Global Fund to Fight AIDS, TB, and Malaria, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and other private donors.While the challenges of human resource shortages, widespread poverty, and limited infrastructure cannot be overstated, these are being addressed through the provision of integrated, comprehensive services. Haiti's successful treatment models are being duplicated around the world.
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Affiliation(s)
- S Koenig
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA; Partners In Health, Boston, MA; the Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti; and the Department of Medicine of Weill Cornell Medical College, New York, NY
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Gruz F, Fuxman C, Errea A, Tokumoto M, Fernandez A, Velasquez J, Nagel C, Ruf A, Mauriño E, Nachman F, Rumbo M, Gondolesi G. Isospora belli infection after isolated intestinal transplant. Transpl Infect Dis 2010; 12:69-72. [DOI: 10.1111/j.1399-3062.2009.00439.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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