Diagnostik von Parasiteninfektionen: Stellenwert der Serologie

Zusammenfassung: Die Attraktivität tropischer und subtropischer Feriendestinationen für europäische Touristen und der anhaltende Zustrom von Immigranten aus solchen Gebieten führen in der ärztlichen Praxis immer öfter zur Differenzialdiagnose einer Parasiteninfektion. Neben den klassischen mikroskopischen Untersuchungen für den Direktnachweis hat die Serologie ihren Stellenwert vor allem beim Nachweis von Gewebeparasiten, in der Präpatenz bis zur Nachweisbarkeit von Vermehrungsprodukten und als Suchtest bei einer Bluteosinophilie nach bekanntem Expositionsrisiko. Der vorliegende Beitrag zeigt mögliche Abklärungsstrategien unter besonderer Berücksichtigung des Stellenwerts der Serologie au

Aktueller Malariaschutz bei Kurzzeitaufenthalt

Zusammenfassung: In Deutschland werden jährlich ca. 800Malariafälle gemeldet. Für ca.1% der nicht immunen Reisenden endet die Krankheit tödlich. Um diese Situation zu verbessern, ist die Information durch die beratenden Ärzte entscheidend: das Risikobewusstsein der Reisenden vor, während und nach einer Reise in endemische Gebiete muss geschärft werden. Ein konsequenter Mückenschutz vermindert das Infektionsrisiko der Malaria sowie anderer durch Arthropoden übertragener Krankheiten zusätzlich. Die regelmäßige Einnahme von Medikamenten zur Malariachemoprophylaxe in Hochrisikogebieten sowie das rasche Handeln im Falle von Fieber in Gebieten mit mäßigem oder kleinem Malariarisiko (Aufsuchen eines Arztes zur Diagnosestellung, notfalls Selbsttherapie) tragen wesentlich zur Reduktion schwerer Malariaerkrankungen be

Human African trypanosomiasis in endemic populations and travellers

Human African trypanosomiasis (HAT) or sleeping sickness is caused by the protozoan parasites Trypanosoma brucei (T.b.) gambiense (West African form) and T.b. rhodesiense (East African form) that are transmitted by the bite of the tsetse fly, Glossina spp.. Whereas most patients in endemic populations are infected with T.b. gambiense, most tourists are infected with T.b. rhodesiense. In endemic populations, T.b. gambiense HAT is characterized by chronic and intermittent fever, headache, pruritus, and lymphadenopathy in the first stage and by sleep disturbances and neuro-psychiatric disorders in the second stage. Recent descriptions of the clinical presentation of T.b. rhodesiense in endemic populations show a high variability in different foci. The symptomatology of travellers is markedly different from the usual textbook descriptions of African HAT patients. The onset of both infections is almost invariably an acute and febrile disease. Diagnosis and treatment are difficult and rely mostly on old methods and drugs. However, new molecular diagnostic technologies are under development. A promising new drug combination is currently evaluated in a phase 3 b study and further new drugs are under evaluatio

Parasiten als Ursache von Urtikaria: Helminthen und Protozooen als Auslöser der Nesselsucht?

Zusammenfassung: Die Urtikaria ist eine der häufigsten Erkrankungen im dermatologischen Alltag. Die Beschwerden sind für die Betroffenen oft sehr einschränkend. Es gibt deutliche pathophysiologische und epidemiologische Hinweise, dass Helminthen und Protozoen zwar seltene, aber behandelbare Auslöser von akuter und chronischer Urtikaria sein können. Oftmals fehlt allerdings das Bewusstsein, dass Parasitosen auch in der industrialisierten Gesellschaft, bedingt durch einen steilen Anstieg von Migration und weltweiter Reisetätigkeit, mit zunehmender Prävalenz vorkommen. Der vorliegende Beitrag stellt die häufigsten parasitären Ursachen von Urtikaria vor und erläutert wichtige Aspekte von Anamnese, Klinik, Diagnostik und Therapi

Status febrilis mit Bewusstlosigkeit

Zusammenfassung: Eine zerebrale Beteiligung bei Malaria mit Plasmodium vivax ist ungewöhnlich. Diese schwere Form der Malaria ist üblicherweise durch Plasmodium falciparum bedingt. Wir berichten über eine 18-jährige Patientin aus Pakistan mit langjähriger intermittierender Fieberanamnese, welche 4Monate nach Einreise in die Schweiz erstmals an einer zerebralen Vivax-Malaria erkrankt. Die eindrückliche neurologische Symptomatik mit Amaurosis und Bewusstseinsstörung bildete sich in diesem Fall unter Therapie in wenigen Tagen zurück. Jedoch sind Todesfälle bei zerebraler Malaria durch Plasmodium vivax beschriebe

Treatment of cutaneous leishmaniasis among travellers

Leishmaniasis is endemic in 88 countries on five continents. There are 1-1.5 million cases of cutaneous leishmaniasis reported yearly worldwide. There has been a sharp increase in recorded cases over the last 10 years. Based on geographical distribution, cutaneous leishmaniasis is divided into Old World and New World leishmaniasis. In the past, species could be inferred from geographical setting or determined by performing culture and isoenzyme analysis. The recently developed and now widely available PCR technology allows a rapid diagnosis with determination of most species, and thus enables a species-orientated treatment. While the Old World species mostly cause benign and often self-limiting cutaneous disease, the American species cause a broad spectrum of conditions from benign to severe manifestations, including mucosal involvement. The response to treatment varies according to the species. Therefore, a species-specific approach is proposed. Drugs for systemic and topical treatment are presented and discussed with regard to their application, use and adverse effects. Indications for local or systemic treatment are proposed. Drugs under investigation are also mentioned. An overview of published treatment options and a treatment recommendation is given for each of the most important species. The level of evidence of the studies leading to these recommendations is give

Liver morbidity due to Schistosoma mekongi in Cambodia after seven rounds of mass drug administration

Severe liver disease due to Schistosoma mekongi was frequent in northern Cambodia. Between 1995 and 2002, seven rounds of mass chemotherapy (praziquantel) reduced infection from 50% to below 3%. In 2002, we assessed hepatosplenic morbidity by historical, clinical and ultrasonographic investigations in adults (older than 14 years) from endemic (n = 342) and non-endemic (n = 103) areas (Kratie province). Clinical hepatomegaly (25 vs. 0%), splenomegaly (55 vs. 0%), reported blood in stool (41 vs. 20%) and abdominal pain (78 vs. 57%) were significantly higher in the endemic area. In this area, significantly more subjects reported a family history of death due to schistosomiasis (12 vs. 0%); 63% (vs. 0%) reported having at least three treatments of praziquantel in previous years; and only 11% (vs. 99%) had normal liver ultrasonographic examination. Periportal fibrosis with portal hypertension was diagnosed in 46% (vs. 0%) of people in this area; 18% (vs. 0%) and 5% (vs. 0%) of portal hypertension was classified as moderate and severe, respectively. People aged between 24 and 35 years were mostly affected. There was no gender difference. The pathology in the endemic district is most probably residual morbidity of S. mekongi infections. Contributions of co-infections (hepatitis) cannot be excluded. Careful monitoring of the affected communities is require

Ultrasound scanning for detecting morbidity due to Schistosoma haematobium and its resolution following treatment with different doses of praziquantel

A study to assess the resolution of urinary tract morbidity due to Schistosoma haematobium was conducted on 2 cohorts of schoolchildren attending neighbouring schools in Kilombero District, southern Tanzania. Schoolchildren were screened for S. haematobium infection using the standard World Health Organization filtration technique and subsequently examined for urinary tract pathology using a portable 3·0 MHz sector scanner (Siemens Sonoline 1300). Treatment with praziquantel was given to all infected children. Children with observed urinary tract pathology received either 20 (n = 52) or 40 (n = 79) mg/kg body weight and were sonographically re-examined one, 2, 3 and 6 months following treatment. Geometric mean outputs of 21 and 19 eggs/ml of urine were detected in the 2 cohorts before treatment. Urinary tract pathology correlated positively with egg output (χ2, P = 0·02) and microhaematuria (P = 0·0001). Bladder (wall irregularities and polyps) and kidney (congestive changes) pathologies were found in 81% and 36%, respectively, of the group that received 20 mg/kg of praziquantel, and in 78% and 46% of the group that received 40 mg/kg. Six months after treatment, 90·4% and 88·0% parasitological cure rates were obtained using 20 or 40 mg praziquantel/kg body weight. The respective pathology clearances were 88% and 91%. 20 mg/kg of praziquantel was as effective with regard to cure rates and reversibility of morbidity as 40 mg/k

Vaccination recommendations for adult patients with autoimmune inflammatory rheumatic diseases

BACKGROUND: The number of individuals with autoimmune inflammatory rheumatic diseases (AIIRDs) treated with immunosuppressive drugs is increasing steadily. The variety of immunosuppressive drugs and, in particular, biological therapies is also rising. The immunosuppressants, as well as the AIIRD itself, increase the risk of infection in this population. Thus, preventing infections by means of vaccination is of utmost importance. New Swiss vaccination recommendations for AIIRD patients were initiated by the Swiss Federal Office of Public Health and prepared by a working group of the Federal Commission for Vaccination Issues as well as by consultation of international experts. METHODS: A literature search was performed in electronic databases (Cochrane, Medline, PubMed, Embase). In addition, unpublished literature was identified through a targeted website search of relevant organisations and international conferences dealing with vaccination, infectious diseases and rheumatology. RESULTS: Although data are scarce, the following main points were retrieved from the literature. Inactivated vaccines are safe, but their immunogenicity may be reduced in AIIRD patients, especially if they are under immunosuppressive therapy. Rituximab and abatacept appear to reduce significantly immune responses after vaccination. Live vaccines are generally contraindicated under immunosuppressive therapy owing to safety concerns. Specific exceptions, as well as time intervals for the administration of live vaccines after interruption of an immunosuppressive therapy, have been formulated in this article. CONCLUSION: More evidence regarding the immunogenicity and safety of vaccinations in AIIRD patients under various therapies is needed. Vaccination recommendations should be updated on a regular basis, as more scientific data will become available