Sushi Delights and Parasites: The Risk of Fishborne and Foodborne Parasitic Zoonoses in Asia

Because of the worldwide popularization of Japanese cuisine, the traditional Japanese fish dishes sushi and sashimi that are served in Japanese restaurants and sushi bars have been suspected of causing fishborne parasitic zoonoses, especially anisakiasis. In addition, an array of freshwater and brackish-water fish and wild animal meats, which are important sources of infection with zoonotic parasites, are served as sushi and sashimi in rural areas of Japan. Such fishborne and foodborne parasitic zoonoses are also endemic in many Asian countries that have related traditional cooking styles. Despite the recent increase in the number of travelers to areas where these zoonoses are endemic, travelers and even infectious disease specialists are unaware of the risk of infection associated with eating exotic ethnic dishes. The aim of this review is to provide practical background information regarding representative fishborne and foodborne parasitic zoonoses endemic in Asian countrie

First case of ivermectin-induced severe hepatitis

Loiasis, caused by the filarial parasite Loa loa, is endemic in West and Central Africa. Ivermectin has been shown to be an effective treatment of loiasis. We report the case of a 20-year-old woman originally from Cameroon who was infected by the L. loa parasite and developed severe hepatitis, identified 1 month after a single dose of ivermectin. Liver biopsy showed intralobular inflammatory infiltrates, confluent necrosis and apoptosis, compatible with drug-induced liver disease. To our knowledge, this is the first case of ivermectin-induced severe liver disease published in the literatur

Successful Booster Antibody Response up to 54 Months after Single Primary Vaccination with Virosome-Formulated, Aluminum-Free Hepatitis A Vaccine

This study demonstrates that a booster dose of the virosome-formulated, aluminum-free hepatitis A vaccine Epaxal (Berna Biotech) is highly immunogenic in subjects who received a single primary dose of this vaccine 18-54 months earlier. There were no significant differences in geometric mean antibody titers (GMTs) among subjects who received the booster dose 18-29 months (GMT, 2330 mIU/mL), 30-41 months (GMT, 2395 mIU/mL), or 42-54 months (GMT, 2432 mIU/mL) after primary vaccination, indicating that delays in the administration of booster vaccination do not lead to a loss of immunogenicit

Medically Important Venomous Animals: Biology, Prevention, First Aid, and Clinical Management

Venomous animals are a significant health problem for rural populations in many parts of the world. Given the current level of the international mobility of individuals and the inquisitiveness of travelers, clinicians and travel clinics need to be able to give advice on the prevention, first aid, and clinical management of envenoming. Health professionals often feel overwhelmed by the taxonomy of venomous animals; however, venomous animals can be grouped, using a simple set of criteria, into cnidarians, venomous fish, sea snakes, scorpions, spiders, hymenoterans, and venomous terrestrial snakes. Geographic distribution, habitats, and circumstances of accidents further reduce the range of culprits that need to be considered in any single event. Clinical management of envenomed patients relies on supportive therapy and, if available, specific antivenoms. Supplies of life-saving antivenoms are scarce, and this scarcity particularly affects rural populations in resource-poor settings. Travel clinics and hospitals in highly industrialized areas predominantly see patients with injuries caused by accidents involving marine animals: in particular, stings by venomous fish and skin damage caused by jellyfish. However, globally, terrestrial venomous snakes are the most important group of venomous animal

Asylsuchende und Flüchtlinge in der Notfallstation

Zusammenfassung: Die vorliegende Querschnittsstudie beschreibt den Gesundheitszustand und die Gesundheitsversorgung von Asylsuchenden und Flüchtlingen aus der Sicht der in der Notfallstation des Kantonsspitals St. Gallen tätigen Ärzte. Die Datenerhebung erfolgte mit Fragebogen und der Dokumentation der Konsultationen von Asylsuchenden/Flüchtlingen und Vergleichspatienten während des elfwöchigen Untersuchungszeitraumes (je 98 Konsultationen entsprechend 3% der während der Studienperiode behandelten Notfälle). 76% dieser Konsultationen betrafen Patienten aus Ex-und Rest-Jugoslawien. Bezüglich der ICD-codierten Hauptdiagnosen war nach Alterskorrektur kein Unterschied zwischen Asylsuchenden/Flüchtlingen und der Vergleichsgruppe erkennbar. Im Vergleich zu dem hausärztlichen Patientenklientel überwogen die Verletzungen signifikant (37% vs. 8%). Asylsuchende/Flüchtlinge und die Vergleichsgruppe unterschieden sich nicht signifikant bezüglich der Frequenz, mit der ein Patient als Notfall klassifiziert wurde (58% vs. 65%), ebenso war kein signifikanter Unterschied in der Hospitalisationsrate (29% vs. 36%) festzustellen. Als Notfälle bewertete Konsultationen Wurden häufiger in der Nacht als am Tag registriert. Die Aufenthaltsdauer der Asylsuchenden/Flüchtlinge in der Schweiz war negativ mit der Verfügbarkeit eines Hausarztes und der Klassifikation eines Patienten als Notfall assoziiert. Mangelnde Erfahrung in der Betreuung von Asylsuchenden/Flüchtlingen und das Defizit an Ausbildung und Vertrautheit mit spezifischen administrativen Problemen wurden von den befragten Ärzten als Hauptschwierigkeiten genannt. Für die Verbesserung der Nutzung von Notfallstationen bietet sich an, möglichst frühzeitig die Kenntnisse von Asylsuchenden über das schweizerische Gesundheitswesen zu fördern und eine hausärztliche Betreuung in die Wege zu leite

A stable, oligosymptomatic malaria focus in Thailand

Blood from most of the 250 residents of a nonmigratory farming village in south-eastern Thailand was visually examined for malaria parasites monthly for 2 years. Nearly 97% of the population had at least one (median = 5) patent Plasmodium falciparum infection per year; 72% had one due to P. vivax (median = 1). This contrasted with a slide positivity rate of 17% calculated from 12 months of passive case detection before the study began. Children 1-9 years old had the highest mean monthly prevalence (51%) and highest geometric mean density (10/500 white blood cells) of P. falciparum. Fewer than half the expected number of mixed infections were found but these were more common at high densities of P. falciparum. Individuals over 19 years old comprised 52% of the population but accounted for only 18% of P. vivax and 32% of P. falciparum gametocytaemias. Fever rates were marginally higher in those below 10 years old (8%) but occurred with equal frequency in those with patent infections or negative. The spleen rate (89% stage 1) was 24% in those under 15 years old and 7% in those older. No malaria mortality was seen. P. falciparum cases treated for 10 d with quinine + tetracycline (QT) cleared the infection as often as those given one dose of mefloquine + sulfadoxine + pyrimethamine (MSP); both treatments reduced densities in cases not cured. Apparently unsupervised compliance was no better with MSP than with QT. The role played by hyperendemic, cryptic foci in Asian epidemics of malaria may have been underestimate

Immune reconstitution inflammatory syndrome associated with dermatophytoses in two HIV-1 positive patients in rural Tanzania: a case report

Immune reconstitution inflammatory syndrome associated with dermatophytoses (tinea-IRIS) may cause considerable morbidity. Yet, it has been scarcely reported and is rarely considered in the differential diagnosis of HIV associated cutaneous lesions in Africa. If identified, it responds well to antifungals combined with steroids. We present two cases of suspected tinea-immune reconstitution inflammatory syndrome from a large HIV clinic in rural Tanzania.; A first case was a 33 years-old female newly diagnosed HIV patient with CD4 count of 4 cells/μL (0 %), normal complete blood count, liver and renal function tests was started on co-formulated tenofovir/emtricitabine/efavirenz and prophylactic cotrimoxazole. Two weeks later she presented with exaggerated inflammatory hyperpigmented skin plaques with central desquamation, active borders and scratch lesions on the face, trunk and lower limbs. Tinea-IRIS was suspected and fluconazole (150 mg daily) and prednisolone (1 mg/Kg/day tapered down after 1 week) were given. Her symptoms subsided completely after 8 weeks of treatment, and her next CD4 counts had increased to 134 cells/μL (11 %). The second case was a 35 years-old female newly diagnosed with HIV. She had 1 CD4 cell/μL (0 %), haemoglobin 9.8 g/dl, and normal renal and liver function tests. Esophageal candidiasis and normocytic-normochromic anaemia were diagnosed. She received fluconazole, prophylactic cotrimoxazole and tenofovir/emtricitabine/efavirenz. Seven weeks later she presented with inflammatory skin plaques with elevated margins and central hyperpigmentation on the trunk, face and limbs in the frame of a good general recovery and increased CD4 counts (188 cells/μL, 6 %). Tinea-IRIS was suspected and treated with griseofulvin 500 mg daily and prednisolone 1 mg/Kg tapered down after 1 week, with total resolution of symptoms in 2 weeks.; The two cases had advanced immunosuppression and developed de-novo exaggerated manifestation of inflammatory lesions compatible with tinea corporis and tinea facies in temporal association with antiretroviral treatment initiation and good immunological response. This is compatible with unmasking tinea-IRIS, and reminds African clinicians about the importance of considering this entity in the differential diagnosis of patients with skin lesions developing after antiretroviral treatment initiation