Prevention and control of neglected tropical diseases: overview of randomized trials, systematic reviews and meta-analyses

Objective To analyse evidence from randomized controlled trials (RCTs) on the prevention and control of neglected tropical diseases (NTDs) and to identify areas where evidence is lacking. Methods The Cochrane Central Register of Controlled Trials and PubMed were searched for RCTs and the Cochrane Database of Systematic Reviews and PubMed were searched for meta-analyses and systematic reviews, both from inception to 31 December 2012. Findings Overall, 258 RCTs were found on American trypanosomiasis, Buruli ulcer, dengue, geohelminth infection, leishmaniasis, leprosy, lymphatic filariasis, onchocerciasis, rabies, schistosomiasis or trachoma. No RCTs were found on cysticercosis, dracunculiasis, echinococcosis, foodborne trematodes, or human African trypanosomiasis. The most studied diseases were geohelminth infection (51 RCTs) and leishmaniasis (46 RCTs). Vaccines, chemoprophylaxis and interventions targeting insect vectors were evaluated in 113, 99 and 39 RCTs, respectively. Few addressed how best to deliver preventive chemotherapy, such as the choice of dosing interval (10) or target population (4), the population coverage needed to reduce transmission (2) or the method of drug distribution (1). Thirty-one publications containing 32 systematic reviews (16 with and 16 without meta-analyses) were found on American trypanosomiasis, dengue, geohelminths, leishmaniasis, leprosy, lymphatic filariasis, onchocerciasis, schistosomiasis or trachoma. Together, they included only 79 of the 258 published RCTs (30.6%). Of 36 interventions assessed, 8 were judged effective in more than one review. Conclusion Few RCTs on the prevention or control of the principal NTDs were found. Trials on how best to deliver preventive chemotherapy were particularly rare

Recurrent Multifocal Mycoplasma orale Infection in an Immunocompromised Patient: A Case Report and Review

A young woman with mixed connective tissue disease complicated by erosive arthritis, secondary hypogammaglobulinemia due to rituximab, and a history of many infectious complications developed multiple nonhealing wounds, polyarticular joint pain, and leukocytosis. Radiographic studies demonstrated multiple scattered areas of osteomyelitis and complex abscesses. Purulent fluid drained from multiple sites did not yield a microbiologic diagnosis by standard culture technique, but Mycoplasma orale was ultimately identified using 16 S ribosomal RNA gene amplification and sequencing. We describe this unique case and review the literature

Fatal Emmonsia sp. Infection and Fungemia after Orthotopic Liver Transplantation

We report a fatal case of disseminated Emmonsia sp. infection in a 55-year-old man who received an orthotopic liver transplant. The patient had pneumonia and fungemia, and multisystem organ failure developed. As human habitats and the number of immunocompromised patients increase, physicians must be aware of this emerging fungal infection

Monitoring Solitary Bees in Modified Wildland Habitats: Implications for Bee Ecology and Conservation

The long-term goal of this study was to use solitary bees to assess the impact of advancing Africanized honey bees (Apis mellifcra scutellata Lepeletier) on the native California bee fauna. Cavity-nesting, solitary bee species were systematically monitored in wooden trap nests at 6 sites in northern central California from 1990 to 1992. Three sites were in the San Joaquin Valley in wildlife refuges or preserves; 3 were in coastal mountain or Sierran foothill parks or reserves. Differences in frequencies of nesting bees were observed and recorded among sites and habitats through time. A Poisson regression indicated that all explanatory variables and their 1st order interactions were highly significant. There were significant differences among bee taxa, sites and years, and their interactions (bee X site; bee X year; site X year). Megachile species were the predominant cavity nesters in the 3 valley sites; Osmia species were the common group in coastal mountain I foothill sites. In a computer simulation, using a variation of the Poisson regression, several significant differences were also observed between yearly frequency counts for certain bee species at the same site. Possible reasons for year to year changes included differential natural mortality, extreme annual weather patterns, use of marginal habitats, and negative impacts from exotic solitary bee species. Three exotic megachilids (Megachile rotundata (F.), M. apicalis Spinola, and M. concinna Smith) have successfully invaded and become established in California. Possibly, M. apicalis has affected other cavity nesting bee species, including the exotic M. rotundata in our Central Valley sites

West Nile virus encephalitis in GATA2 deficiency

Abstract We report a male with longstanding warts who presented with severe West Nile virus encephalitis (WNVE) and recovered after interferon alfa-2b and intravenous immunoglobulin. He was later found to have GATA2 deficiency and underwent successful hematopoietic stem cell transplant