Book Review: ‘FASH – Focused Assessment with Sonography for HIV/TB – a practical manual’

by Tom Heller. London, UK: Teaching-Aids at Low Cost (TALC), 2013. ISBN: 978-0-9558811-8-3

Malaria im Kindesalter: Beiträge zu Prävention und Behandlung

Malaria bleibt eine global bedeutende parasitäre Infektionskrankheit. Malaria-bedingte Morbidität und Mortalität betreffen vorallem junge Kinder. Präventive Maßnahmen sowie erfolgreiches Fallmanagement stellen Säulen bei den Eindämmungsbestrebungen der Malaria dar. Einem effektiven Malariaimpfstoff wird ein entscheidender Beitrag bei der Reduktion von Malaria-bedingter Krankheitslast und Sterblichkeit zugeschrieben. Der Malariaimpfstoffkandidat GMZ2 zeigte in einer pädiatrischen Phase I randomisiert kontrollierten Studie in Gabun eine gute Verträglichkeit, Sicherheit und Immunogenität. Eine reduzierte Antikörperantwort war mit einer Trichuris trichiura Infektion assoziiert. Die Ergebnisse dieser Studie bestätigten vorausgehende klinische Prüfungen von GMZ2 bei Erwachsenen und erlaubten die Fortführung der klinischen Prüfung von GMZ2 in einer Phase II Studie. Die Artemisinin-basierte Therapie ist heute Standardmalariatherapie. Artesunat/Pyronaridin, eine neue Artemisininkombinationstherapie, zeigte in einer pädiatrischen Phase II Dosisfindungsstudie in Gabun in allen Dosierungsgruppen sowie in Tabletten- als auch pädiatrischer Granulatdarreichungsform hohe Wirksamkeit, gute Verträglichkeit und Sicherheit. Die Ergebnisse dieser Studie erlaubten die Fortsetzung der klinischen Entwicklung von Artesunat/Pyronaridin. In einer ersten prospektiven Prüfung von Artemether/Lumefantrin für Non-Falciparum Malaria zeigte Artemether/Lumefantrin bei pädiatrischen und erwachsenen Patienten in Gabun mit P. malariae, P. ovale und Malariamischinfektionen eine hohe Heilungsrate sowie gute Sicherheit und Verträglichkeit. Die Daten dieser Studie unterstützten die gängige Praxis Blutstadien der Non-Falciparum Malaria mit Artemether/Lumefantrin zu behandeln. Pädiatrische Darreichungsformen Artemisinin-basierter Kombinationstherapie wurden entwickelt um die ambulante Therapie junger Kinder mit Malaria zu verbessern. Die systematische Übersichtsarbeit zeigte keinen Unterschied für Therapieversagen oder Sicherheit zwischen pädiatrischen und nicht-pädiatrischen Darreichungsformen. Kinder die lösliche pädiatrische Tabletten erhielten erlitten weniger Medikamenten-assoziierte unerwünsche Nebenwirkungen; pädiatrische lösliche Tabletten waren damit besser verträglich. Erstlinienempfehlung der Weltgesundheitsorganisation für die Therapie der schweren Malaria ist die Therapie mit intravenösem Artesunat. Der standardmäßige Einsatz von intravenösem Artesunat bei schwerer importierter Malaria ist jedoch aufgrund mangelnder Evidenz für Nichtendemiegebiete und fehlender Zulassung teilweise noch limitiert. Die retrospektive Studie zu intravenöser Artesunattherapie bei Kindern mit schwerer importierter Malaria in Deutschland zeigte eine hohe Wirksamkeit und unterstützt somit den Einsatz von intravenösem Artesunat bei importierter schwerer Malaria bei Kindern. Die vorliegende Arbeit umfasst mehrere Beiträge zur Prävention und Behandlung der Malaria im Kindesalter

New imaging approaches for improving diagnosis of childhood tuberculosis

In South Africa (SA), childhood tuberculosis (TB) still accounts for considerable morbidity and mortality. The incidence of TB disease and risk of progression to severe or disseminated forms are especially high in young children or those with HIV infection. Childhood TB presents most commonly as primary TB, often with non specific signs and symptoms; TB may also present as acute pneumonia. The clinical diagnosis can therefore be challenging. Furthermore, due to difficulty in obtaining good-quality specimens and the paucibacillary nature of childhood TB, microbiological confirmation is only achieved in a minority of children, especially in settings where there is limited capacity for microbiological confirmation

Prospective evaluation of artemether-lumefantrine for the treatment of non-falciparum and mixed-species malaria in Gabon

Background: The recommendation of artemisinin combination therapy (ACT) as first-line treatment for uncomplicated falciparum malaria is supported by a plethora of high quality clinical trials. However, their recommendation for the treatment of mixed-species malaria and the large-scale use for the treatment of non-falciparum malaria in endemic regions is based on anecdotal rather than systematic clinical evidence. Methods: This study prospectively observed the efficacy of artemether-lumefantrine for the treatment of uncomplicated non-falciparum or mixed-species malaria in two routine district hospitals in the Central African country of Gabon. Results: Forty patients suffering from uncomplicated Plasmodium malariae, Plasmodium ovale or mixed-species malaria (including Plasmodium falciparum) presenting at the hospital received artemether-lumefantrine treatment and were followed up. All evaluable patients (n = 38) showed an adequate clinical and parasitological response on Day 28 after oral treatment with artemether-lumefantrine (95% confidence interval: 0.91,1). All adverse events were of mild to moderate intensity and completely resolved by the end of study. Conclusions: This first systematic assessment of artemether-lumefantrine treatment for P. malariae, P. ovale and mixed-species malaria demonstrated a high cure rate of 100% and a favourable tolerability profile, and thus lends support to the practice of treating non-falciparum or mixed-species malaria, or all cases of malaria without definite species differentiation, with artemether-lumefantrine in Gabon. Trial Registration: ClinicalTrials.gov Identifier: NCT0072577

New imaging approaches for improving diagnosis of childhood tuberculosis

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Impact of Anti-Retroviral Treatment and Cotrimoxazole Prophylaxis on Helminth Infections in HIV-Infected Patients in Lambar�n�, Gabon

Background: Foci of the HIV epidemic and helminthic infections largely overlap geographically. Treatment options for helminth infections are limited, and there is a paucity of drug-development research in this area. Limited evidence suggests that antiretroviral therapy (ART) reduces prevalence of helminth infections in HIV-infected individuals. We investigated whether ART exposure and cotrimoxazole preventive therapy (CTX-P) is associated with a reduced prevalence of helminth infections. Methodology and Principal Findings: This cross-sectional study was conducted at a primary HIV-clinic in Lambaréné, Gabon. HIV-infected adults who were ART-naïve or exposed to ART for at least 3 months submitted one blood sample and stool and urine samples on 3 consecutive days. Outcome was helminth infection with intestinal helminths, Schistosoma haematobium, Loa loa or Mansonella perstans. Multivariable logistic regression was used to assess associations between ART or CTX-P and helminth infection. In total, 408 patients were enrolled. Helminth infection was common (77/252 [30.5%]). Filarial infections were most prevalent (55/310 [17.7%]), followed by infection with intestinal helminths (35/296 [11.8%]) and S. haematobium (19/323 [5.9%]). Patients on CTX-P had a reduced risk of Loa loa microfilaremia (adjusted odds ratio (aOR) 0.47, 95% CI 0.23-0.97, P = 0.04), also in the subgroup of patients on ART (aOR 0.36, 95% CI 0.13-0.96, P = 0.04). There was no effect of ART exposure on helminth infection prevalence. Conclusions/Significance: CTX-P use was associated with a decreased risk of Loa loa infection, suggesting an anthelminthic effect of antifolate drugs. No relation between ART use and helminth infections was established

Barriers and facilitators to the uptake of tuberculosis diagnostic and treatment services by hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review of qualitative literature

Summary Tuberculosis disproportionately affects hard-to-reach populations, such as homeless people, migrants, refugees, prisoners, or drug users. These people often face challenges in accessing quality health care. We did a systematic review of the qualitative literature to identify barriers and facilitators to the uptake of tuberculosis diagnostic and treatment services by people from hard-to-reach populations in all European Union (EU), European Economic Area, EU candidate, and Organisation for Economic Co-operation and Development countries. The 12 studies included in this review mainly focused on migrants. Views on perceived susceptibility to and severity of tuberculosis varied widely and included many misconceptions. Stigma and challenges regarding access to health care were identified as barriers to tuberculosis diagnosis and treatment uptake, whereas support from nurses, family, and friends was a facilitator for treatment adherence. Further studies are required to identify barriers and facilitators to the improved identification and management of tuberculosis in hard-to-reach populations to inform recommendations for more effective tuberculosis control programmes

Effectiveness of interventions for diagnosis and treatment of tuberculosis in hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review

Tuberculosis is over-represented in hard-to-reach (underserved) populations in high-income countries of low tuberculosis incidence. The mainstay of tuberculosis care is early detection of active tuberculosis (case finding), contact tracing, and treatment completion. We did a systematic review with a scoping component of relevant studies published between 1990 and 2015 to update and extend previous National Institute for Health and Care Excellence (NICE) reviews on the effectiveness of interventions for identifying and managing tuberculosis in hard-to-reach populations. The analyses showed that tuberculosis screening by (mobile) chest radiography improved screening coverage and tuberculosis identification, reduced diagnostic delay, and was cost-effective among several hard-to-reach populations. Sputum culture for pre-migration screening and active referral to a tuberculosis clinic improved identification. Furthermore, monetary incentives improved tuberculosis identification and management among drug users and homeless people. Enhanced case management, good cooperation between services, and directly observed therapy improved treatment outcome and compliance. Strong conclusions cannot be drawn because of the heterogeneity of evidence with regard to study population, methodology, and quality

Familia y sociedad: imágenes y representaciones en el mundo de los exvotos en México en las primeras décadas del siglo XX

El presente artículo analiza una serie de retablos populares o exvotos religiosos procedentes de dos de los santuarios más importantes de la república mexicana: la Basílica de Guadalupe en la ciudad de México, y San Juan de los Lagos en la zona centro occidental del país. Estos retablos contienen distintas representaciones de la niñez y cubren el período que va de 1880 a 1940. En este importante lapso de tiempo se registran las continuidades de un universo tradicional campesino y las rupturas modernas vinculadas a una sociedad urbana. Los dos ejes temáticos del texto tienen que ver con los accidentes y las enfermedades. En todo momento se considera al exvoto como un producto de un catolicismo popular que manifiesta distintas formas de resistencia frente al dicurso oficial de la doctrina cristiana.O presente artigo analisa uma série de retábulos populares ou ex-votos religiosos procedentes de dois dos santuários mais importantes da república mexicana: a Basílica de Guadalupe na cidade do México e San Juan de los Lagos na zona central ocidental do país. Estes retábulos contêm diferentes representações da infância e cobrem o período que vai de 1880 a 1940. Neste importante espaço de tempo se registraram a continuidade de um universo tradicional campesino e as rupturas modernas vinculadas a uma sociedade urbana. Os dois eixos temáticos do texto estão relacionados com acidentes e doenças. Considera-se o ex-voto como o produto de um catolicismo popular que manifesta distintas formas de resistência frente ao discurso oficial da doutrina cristã.The present article analyses a series of popular retables and religious ex-votos from one of the most important sanctuaries of the Mexican republic: The Guadalupe Basilica in Mexico City, and San Juan de los Lagos in the Mid-west region of the country. These retables contain distinct representations of childhood and stretch over the period between 1880 and 1940. The continuities of a traditional peasant universe are recorded over this important period of time, as well as the modern ruptures linked to an urban society. One of the thematic axis relate to accidents and to diseases. At every moment the ex-voto is considered a product of popular Catholicism that manifests distinct forms of resistance against the official discourse of the Christian faith