29 research outputs found
The Role of Medical Students in the Fight to Control Neglected Tropical Diseases: A View from Peru
Multi-Locus Sequence Analysis Reveals Profound Genetic Diversity among Isolates of the Human Pathogen Bartonella bacilliformis
Bartonella bacilliformis is the aetiological agent of human bartonellosis, a potentially life threatening infection of significant public health concern in the Andean region of South America. Human bartonellosis has long been recognised in the region but a recent upsurge in the number of cases of the disease and an apparent expansion of its geographical distribution have re-emphasized its contemporary medical importance. Here, we describe the development of a multi-locus sequence typing (MLST) scheme for B. bacilliformis and its application to an archive of 43 isolates collected from patients across Peru. MLST identified eight sequence types among these isolates and the delineation of these was generally congruent with those of the previously described typing scheme. Phylogenetic analysis based on concatenated sequence data derived from MLST loci revealed that seven of the eight sequence types were closely related to one another; however, one sequence type, ST8, exhibited profound evolutionary divergence from the others. The extent of this divergence was akin to that observed between other members of the Bartonella genus, suggesting that ST8 strains may be better considered as members of a novel Bartonella genospecies
The Neglected Tropical Diseases of Latin America and the Caribbean: A Review of Disease Burden and Distribution and a Roadmap for Control and Elimination
The neglected tropical diseases (NTDs) represent some of the most common infections of the poorest people living in the Latin American and Caribbean region (LAC). Because they primarily afflict the disenfranchised poor as well as selected indigenous populations and people of African descent, the NTDs in LAC are largely forgotten diseases even though their collective disease burden may exceed better known conditions such as of HIV/AIDS, tuberculosis, or malaria. Based on their prevalence and healthy life years lost from disability, hookworm infection, other soil-transmitted helminth infections, and Chagas disease are the most important NTDs in LAC, followed by dengue, schistosomiasis, leishmaniasis, trachoma, leprosy, and lymphatic filariasis. On the other hand, for some important NTDs, such as leptospirosis and cysticercosis, complete disease burden estimates are not available. The NTDs in LAC geographically concentrate in 11 different sub-regions, each with a distinctive human and environmental ecology. In the coming years, schistosomiasis could be eliminated in the Caribbean and transmission of lymphatic filariasis and onchocerciasis could be eliminated in Latin America. However, the highest disease burden NTDs, such as Chagas disease, soil-transmitted helminth infections, and hookworm and schistosomiasis co-infections, may first require scale-up of existing resources or the development of new control tools in order to achieve control or elimination. Ultimately, the roadmap for the control and elimination of the more widespread NTDs will require an inter-sectoral approach that bridges public health, social services, and environmental interventions
Carbapenem-resistant Klebsiella pneumoniae infections in a Greek intensive care unit: Molecular characterisation and treatment challenges
Acquisition of carbapenemase-producing Klebsiella pneumoniae (CP-Kp)
strains poses a major threat to critically ill patients. The objectives
of this study were to describe the epidemiology of CP-Kp isolates as
well as the clinical outcome associated with the corresponding
infections and to identify risk factors for mortality of intensive care
unit (ICU) patients in a Greek hospital. A prospective, observational
study was conducted in a nine-bed general ICU over a 2-year period
(April 2010-March 2012). Imipenem-resistant K. pneumoniae isolates
recovered from clinical samples of ICU patients were prospectively
collected and studied for the presence of carbapenemases. Isolates were
submitted to molecular typing using pulsed-field gel electrophoresis
(PFGE). In total, 61 CP-Kp isolates (48 KPC-producers and 13
VIM-producers) were recovered from 58 ICU patients. The majority of
KPC-producers were classified into a single PFGE type, indicating potent
clonal dissemination. Among the 32 infected patients, bacteraemia was
diagnosed in 16. Tigecycline + colistin was the most common combination
antimicrobial regimen. Infection-attributable mortality was 43.8%.
Regarding mortality risk factors, non-survivors were older (P = 0.080),
all of them presented with septic shock (P = 0.010) and they had higher
Sepsis-related rim Failure Assessment (SOFA) scores at infection onset
(P = 0.004) compared with survivors. Appropriate definitive treatment
and combination regimens were not associated with patient survival. In
conclusion, CP-Kp infections are associated with limited treatment
options and high in-hospital mortality. Effective measures for
preventing dissemination of respective isolates in the hospital setting
are required. (C) 2015 International Society for Chemotherapy of
Infection and Cancer. Published by Elsevier Ltd. All rights reserved
Comparison of single-dose treatment with norfloxacin and standard 5-day treatment with trimethoprim-sulfamethoxazole for acute shigellosis in adults.
Immunological response in cases of complicated and uncomplicated bartonellosis during pregnancy Respuesta inmunologica en casos de bartonelosis con y sin complicaciones durante el embarazo
Bartonellosis (Carrion's Disease) during pregnancy is associated with high rates of maternal and perinatal mortality. We report the immunological patterns in two cases of human bartonellosis during pregnancy. One patient had an uncomplicated course while the second patient developed life threatening anasarca and cardiac tamponade. The patient with a complicated course had a Th1 response with a higher elevation of IL-10. This elevation has been associated with poor outcome pregnancies during bacterial infections.<br>Bartonelosis (Enfermedad de Carrión) durante el embarazo esta asociado a una alta tasa de mortalidad maternal y perinatal. Reportamos el perfil inmunológico de dos casos de Bartonelosis humana en el embarazo. Una paciente tuvo un curso sin complicaciones, mientras la segunda presento complicaciones severas de anasarca y tamponamiento cardiaco. La paciente con curso complicado tuvo un patrón de repuesta Th1, con una elevación de IL-10, que se ha asociado a mal pronóstico en infecciones durante embarazo