Travelers With Cutaneous Leishmaniasis Cured Without Systemic Therapy

Guidelines recommend wound care and/or local therapy as first-line treatment for cutaneous leishmaniasis. An analysis of a referral treatment program in 135 travelers showed that this approach was feasible in 62% of patients, with positive outcome in 83% of evaluable patient

African tropical rainforest net carbon dioxide fluxes in the twentieth century

The African humid tropical biome constitutes the second largest rainforest region, significantly impacts global carbon cycling and climate, and has undergone major changes in functioning owing to climate and land-use change over the past century. We assess changes and trends in CO2 fluxes from 1901 to 2010 using nine land surface models forced with common driving data, and depict the inter-model variability as the uncertainty in fluxes. The biome is estimated to be a natural (no disturbance) net carbon sink (−0.02 kg C m−2 yr−1 or −0.04 Pg C yr−1, p < 0.05) with increasing strength fourfold in the second half of the century. The models were in close agreement on net CO2 flux at the beginning of the century (σ1901 = 0.02 kg C m−2 yr−1), but diverged exponentially throughout the century (σ2010 = 0.03 kg C m−2 yr−1). The increasing uncertainty is due to differences in sensitivity to increasing atmospheric CO2, but not increasing water stress, despite a decrease in precipitation and increase in air temperature. However, the largest uncertainties were associated with the most extreme drought events of the century. These results highlight the need to constrain modelled CO2 fluxes with increasing atmospheric CO2 concentrations and extreme climatic events, as the uncertainties will only amplify in the next century

Plasma exchange for disseminated cryptococcosis

Acute renal failure is frequent in HIV-infected patients and may be related to HIV-associated nephropathy, drugs, or opportunistic infections. We report a peculiar case of disseminated cryptococcosis complicated by acute renal failure associated with obstruction of intrarenal capillaries by Cryptococus neoformans dead bodies and successfully treated with plasma exchanges

Antibody responses to <i>Borrelia burgdorferi</i> detected by western blot vary geographically in Canada

<div><p>Lyme disease is emerging in eastern and central Canada, and most cases are diagnosed using the two-tier serological test (Enzyme Immuno Assay [EIA] followed by Western blot [WB]). Simplification of this algorithm would be advantageous unless it impacts test performance. In this study, accuracy of individual proteins of the IgG WB algorithm in predicting the overall test result in samples from Canadians was assessed. Because <i>Borrelia burgdorferi</i> strains vary geographically in Canada, geographic variations in serological responses were also explored. Metrics of relative sensitivity, specificity and the kappa statistic measure of concordance were used to assess the capacity of responses to individual proteins to predict the overall IgG WB result of 2524 EIA (C6)-positive samples from across Canada. Geographic and interannual variations in proportions of samples testing positive were explored by logistic regression. No one protein was highly concordant with the IgG WB result. Significant variations were found amongst years and geographic regions in the prevalence of samples testing positive using the overall IgG WB algorithm, and for individual proteins of the algorithm. In most cases the prevalence of samples testing positive were highest in Nova Scotia, and lower in samples from Manitoba westwards. These findings suggest that the current two tier test may not be simplified and continued use of the current two-tier test method and interpretation is recommended. Geographic and interannual variations in the prevalence of samples testing positive may be consistent with <i>B</i>. <i>burgdorferi</i> strain variation in Canada, and further studies are needed to explore this.</p></div

Variations amongst groups of provinces in the proportions of C6-positive/equivocal sera reactive to each protein of the IgG Western blot algorithm (red bars).

<p>For comparison, in each graph the proportions of C6-positive/equivocal sera that were positive for the IgG Western blot algorithm in the different groups of provinces are shown as blue bars. Asterisks indicate that these variations were significant accounting for interannual variations and either without or with accounting for the variations in overall positivity to the IgG Western blot result. Exact binomial 95% confidence intervals are shown. Gp = province group. Gp1 = Nova Scotia, Gp2 = Other Atlantic Provinces (Newfoundland & Labrador, Prince Edward Island and New Brunswick), Gp3 = Quebec and Ontario, Gp4 = Manitoba, Gp5 = Provinces west of Manitoba (Saskatchewan, Alberta and British Columbia).</p

Values for the kappa statistic, and relative sensitivity and relative specificity of responses to individual proteins in predicting the IgG Western blot result.

<p>The proteins are ordered on the x-axis with decreasing kappa statistic values from left to right. 95% confidence intervals for relative sensitivity, specificity and the kappa statistic are shown.</p

Variations in the prevalence (with 95% confidence intervals) of C6-positive/equivocal samples that tested positive using the IgG Western blot algorithm by groups of provinces (graph a) and by year (graph b).

<p>NS = Nova Scotia, OA = other Atlantic provinces (Newfoundland & Labrador, Prince Edward Island, and New Brunswick), QC = Quebec, ON = Ontario, MB = Manitoba, West = Saskatchewan, Alberta, and British Columbia.</p

The mean (+/- SE) number of bands positive in IgG Western blot positive and negative samples for each of the different provinces or groups of provinces from which the samples came.

<p>Province groups are 1 = Nova Scotia, 2 = Other Atlantic Provinces (Newfoundland & Labrador, Prince Edward Island and New Brunswick), 3 = Quebec and Ontario, 4 = Manitoba, 5 = Provinces west of Manitoba (Saskatchewan, Alberta and British Columbia).</p

Therapy of uncomplicated falciparum malaria in Europe: MALT

BACKGROUND: Malaria continues to be amongst the most frequent infectious diseases imported to Europe. Whilst European treatment guidelines are based on data from studies carried out in endemic areas, there is a paucity of original prospective treatment data. The objective was to summarize data on treatments to harmonize and optimize treatment for uncomplicated malaria in Europe. METHODS: A prospective observational multicentre study was conducted, assessing tolerance and efficacy of treatment regimens for imported uncomplicated falciparum malaria in adults amongst European centres of tropical and travel medicine. RESULTS: Between December 2003 and 2009, 504 patients were included in 16 centres from five European countries. Eighteen treatment regimens were reported,, the top three being atovaquone-proguanil, mefloquine, and artemether-lumefantrine. Treatments significantly differed with respect to the occurrence of treatment changes (p=0.005) and adverse events (p=0.001), parasite and fever clearance times (p<0.001), and hospitalization rates (p=0.0066) and durations (p=0.001). Four recrudescences and two progressions to severe disease were observed. Compared to other regimens, quinine alone was associated with more frequent switches to second line treatment, more adverse events and longer inpatient stays. Parasite and fever clearance times were shortest with artemether-mefloquine combination treatment. Vomiting was the most frequent cause of treatment change, occurring in 5.5% of all patients but 9% of the atovaquone-proguanil group. CONCLUSIONS: This study highlights the heterogeneity of standards of care within Europe. A consensus discussion at European level is desirable to foster a standardized management of imported falciparum malaria