Tropical Illness Research Articles

A Clinical Study of Acute Kidney Injury in Tropical Acute Febrile Illness.

Tropical Acute Febrile Illness (TAFI) is one of the most common causes of morbidity within the community. Acute Kidney Injury (AKI) due to infective and non infective causes is a major complication. Presence of AKI is a major cause of mortality among patients with TAFI. To study the spectrum of tropical acute febrile illness; the proportion, spectrum and staging of acute kidney injury; Renal Replacement Therapy (RRT) initiation and in-hospital mortality. A total of 600 TAFI patients were prospectively studied at a tertiary care centre in coastal Karnataka between September 2012 and September 2014 for the aetiology of TAFI; the development and staging of AKI based on Kidney disease: Improving global outcomes (KDIGO) guidelines; the initiation of RRT and in-hospital mortality. Data analysis was done using SPSS version 17.0 with statistical significance calculated using chi-square and Fisher's exact t-test for which p-value <0.05 was considered significant. The spectrum of TAFI, in decreasing order, was vivax malaria, leptospirosis, dengue fever, falciparum malaria, mixed malaria, enteric fever, scrub typhus and the most common aetiology was malaria. The proportion of AKI was 54%. The most common cause of AKI, its stages 2 and 3, RRT initiation and in-hospital mortality was leptospirosis; and AKI stage 1 was dengue fever. KDIGO AKI stage 1, 2 and 3 was seen in 46.9%, 31.2% and 21.9% of AKI patients, respectively. RRT initiation was required in 10.2% of AKI patients and in-hospital mortality was 3% among all patients. AKI, RRT initiationand in-hospital mortality were significantly associated with older age, fever duration and other presenting complaints, examination findings, renal function and other parameters, leptospirosis, dengue fever, falciparum malaria. The aetiology in about half of TAFI patients in coastal Karnataka was malaria. More than 50% develop AKI with greater than one-fifth of them progressing to AKI stage 3 and one-tenth requiring RRT. The most common cause of AKI, AKI stage 2, 3, RRT initiation and in-hospital mortality was leptospirosis. AKI was present in almost all patients with leptospirosis. Therefore leptospirosis was the most nephrotoxic acute febrile illness in the present study population. Dengue fever was the most common cause of AKI stage 1. Vivax malaria was the third most common cause of AKI. The factors like age, presenting complaints, examination findings, renal function and other parameters, aetiology and RRT initiation may be used to predict AKI and in-hospital mortality.

Recognition of Imported Tropical Infectious Disease in Returned Travelers in a University Hospital Emergency Department

Objective: Healthcare workers practising in Ireland may encounter tropical illness in the re- turned traveler. This study aimed to establish the awareness of tropical diseases in front-line healthcare professionals working in an Irish hospital. Methods: A questionnaire was administered to doctors and nurses working in an Irish univer- sity teaching hospital. The respondents' ability to obtain a travel history, to recognize tropical illness in returned travelers and to demonstrate awareness of the geographical distribution of tropical diseases was evaluated. Results: Fifty clinicians completed the survey (29 doctors and 21 nurses), most of whom had not previously worked in the tropics and had not received formal training in tropical or travel medicine. The following items were not routinely included in their travel histories: illness in traveling companions, water and food consumption, insect and animal bites. Tropical illness was infrequently considered in patients presenting with a variety of common symptoms. There was a poor level of familiarity of several tropical infectious diseases. There was a tendency for doctors to underestimate the prevalence of dengue infection. A substantial proportion of doctors were not confident in their ability to manage a patient with malaria. The educational activities preferred by the majority of respondents were tropical disease manuals, workshops and wall charts. Conclusion: This study highlights a low level of knowledge of tropical medicine among a sample of healthcare workers who may be called upon to assess the returned tropical traveler. Opportunities for training in tropical medicine should be provided to emergency department clinicians.

An overview on the ecology of Triatominae (Hemiptera:Reduviidae)

Chagas disease, the American trypanosomiasis, is an important neglected tropical illness caused by the flagellate protozoan Trypanosoma cruzi (Kinetoplastida, Trypanosomatidae) and transmitted by insects of the subfamily Triatominae (Hemiptera: Reduviidae). Here we provide an overview on the current knowledge about Triatominae ecology, its association with human, T. cruzi infection and the immediate consequences of habitat fragmentation. We also discuss the geographic distribution of the species and the importance of predicting their distributions to control programs.

Underrecognized Arthropod-Borne and Zoonotic Pathogens in Northern and Northwestern Thailand: Serological Evidence and Opportunities for Awareness

Although scrub typhus and murine typhus are well-described tropical rickettsial illnesses, especially in Southeast Asia, only limited evidence is available for rickettsia-like pathogens contributing to the burden of undifferentiated febrile illness. Using commercially available kits, this study measured immunoglobulin G (IgG) antibody seroprevalence for Coxiella burnetii, Ehrlichia chaffeensis, Bartonella henselae, Anaplasma phagocytophilum, and spotted fever group rickettsiae (SFGR) in 375 patients enrolled in undifferentiated febrile illness studies at Chiangrai (northern Thailand) and Mae Sot (Thai–Myanmar border). Ehrlichia and SFGR were the most common causes of IgG seropositivity. A distinct relationship between age and seropositivity was found in Chiangrai with acquisition of IgG titers against Ehrlichia, Bartonella, Anaplasma, and SFGR in young adulthood, suggesting cumulative exposure to these pathogens. At Mae Sot, high early IgG titers against Ehrlichia and SFGR were common, whereas Anaplasma and Bartonella IgG titers increased at 50–60 years. Q fever associated with low IgG positivity at both study sites, with significantly higher prevalence at 30 years of age in Chiangrai. These data suggest that other rickettsial illnesses could contribute to the burden of febrile illness in Thailand and possibly adjacent regions. Improved diagnostics and better understanding of antibody longevity and cross-reactivity will improve identification and management of these easily treatable infectious diseases.

Neuropsychiatric manifestations of some tropical diseases.

Some tropical diseases are the direct cause of severe disturbances of cerebral function while others affect only finer cerebral systems controlling fears, anxiety and personality traits. The mechanisms by which psychiatric symptoms are produced in tropical disorders are not any different from the mechanisms that relate to any physical disorders. Neuropsychiatric symptoms may be caused by a number of different mechanisms including bacterial toxins, release of cytokines, hyperthermia, shock (poor perfusion), acute renal insufficiency, pulmonary failure (shock lung), coagulopathy, disruption of the blood-brain barrier, and/or the nest of pathogens into the central nervous system. The following tropical illnesses can be associated with neuropsychiatric symptoms: neurocysticercosis, malaria, trypanosomiasis, dengue, and schistosomiasis. Neurological and psychiatric impairments induced by tropical diseases both represent a major category of invalidating disorders, which cause profound changes in the nervous system functions, often associated with severe sequels or late-onset disturbances. It is therefore important to disseminate knowledge of the neuropsychiatric symptoms accompanying tropical diseases in order to increase the awareness of these problems and challenges.

Malaria Diagnosis Using Automated Analysers: A Boon for Hematopathologists in Endemic Areas.

Haematological abnormalities are common in acute febrile tropical illnesses. Malaria is a major health problem in tropics. In endemic areas especially in the post monsoon season, it is not practical to manually screen all peripheral blood films (PBF) for malarial parasite. Automated analysers offer rapid, sensitive and cost effective screening of all samples. The study was done to evaluate the usefulness of automated cell counters analysing their histograms, scatter-grams and the flaggings generated in malaria positive and negative cases. The comparison of other haematological parameters were also studied which could help to identify malaria parasite in peripheral blood smear. The blood samples were analysed using Beckman coulter LH-750. The abnormal scatter grams and additional peaks in WBC histograms were observed diligently & compared with normal controls. Haematological abnormalities were also evaluated. Statistical analysis was done by using software Epi-Info version 7.1.4 freely available from CDC website. Fisher exact test was applied to calculate the p-value and value < 0.05 was considered as significant. Final identification of malarial parasite species was done independently by peripheral blood smear examination by two pathologists. Of all the 200 cases evaluated abnormal scatter grams were observed in all the cases of malaria while abnormal WBC histogram peaks were noted in 96% cases demonstrating a peak at the threshold of the histogram. The difference between number of slides positive for abnormal WBC scatter gram and abnormal WBC histogram peaks were statistically highly significant (p=0.007). So abnormal WBC scatter gram can better give idea of malarial parasite presence. Of the haematological parameters thrombocytopenia (92% cases) emerged as the strongest predictor of malaria. It is recommended for haematopathologists to review the haematological data and the scatter plots on the analyser along with peripheral blood smear examination.

Natural Disasters and Victorian Empire: Famines, Fevers and the Literary Cultures of South Asia by Upamanyu Pablo Mukherjee (review)

Reviewed by: Natural Disasters and Victorian Empire: Famines, Fevers and the Literary Cultures of South Asia by Upamanyu Pablo Mukherjee Kellie Holzer (bio) Upamanyu Pablo Mukherjee, Natural Disasters and Victorian Empire: Famines, Fevers and the Literary Cultures of South Asia (New York: Palgrave Macmillan, 2013), pp. vi + 221, $90/£50 cloth. The premise of Upamanyu Pablo Mukherjee’s latest book, Natural Disasters and Victorian Empire: Famines, Fevers and the Literary Cultures of South Asia, is simple, far-reaching, and riveting: disasters were crucial to the maintenance of the British Empire’s tropical holdings. Many of these so-called natural disasters had historical causes and consequences (a claim made by contemporaneous Indian scholars, writers, and activists). Still, the management of “natural” disasters became another way for the Victorians to legitimize empire, a rationalization that Mukherjee names “palliative imperialism.” The permanence of these tropical disaster zones yielded formal experiments in the literary realm. In chapter 1, Mukherjee analyzes the appearance of disaster writing in three nonliterary realms: administrative, medical, and journalistic. Writing in all three fields produced the idea of tropical colonies as environments [End Page 650] of inevitable and perpetual disaster (and colonized subjects as victims who were also, inevitably, to blame). Mukherjee explores how debates about the origins of disasters, as well as conflicting ideas about aid and intervention, were common to both imperial and anti-imperial British discourse, a paradox characteristic of liberal imperialism. Thus, administrative or medical discourse prescribed imperial interventions in the form of medical relief, technological solutions, or infrastructural development to ameliorate famines or epidemics. Meanwhile, these recommendations for aid were challenged by the investigative journalism of William Digby and Vaughan Nash, who published sensational exposés of administrative indifference or mismanagement of famine relief efforts as well as scathing critiques of imperial economic policies that contributed to or caused such disasters. In chapters 2 through 5, Mukherjee takes a fresh approach to the usual lineup of Anglo-Indian authors. He argues that the writings of the Eden sisters, Fanny Parks, Philip Meadows Taylor, Rudyard Kipling, and Flora Annie Steel, unassimilable to metropolitan literary aesthetics, developed in the genre-bending ways they did due to the demands of living in environments of perpetual disaster. Among other things, Mukherjee’s readings show how Parks and the Edens revised the conventions of the picturesque to account for famines and epidemics in their travel diaries. Meadows Taylor developed a new novel form, the “bureaucratic romance,” as a stage for the heroic actions of palliative imperialism’s ideal civil servant. And Kipling’s “paranoid journalism” for the Civil and Military Gazette offered autobiographical accounts of tropical illness as well as nightmarish descriptions of unsanitary conditions and chronic disease (141). Throughout these readings, Mukherjee relies on reviews published in metropolitan periodicals to establish the skeptical reception of Anglo-Indian writing emerging from tropical disaster zones. The stakes of Mukherjee’s argument are made quite clear: today’s neo-imperial benevolence vis-à-vis disaster is inherited from Victorian palliative imperialism. Put another way, on a global scale, palliative care remains integral to cultural domination. A former journalist himself, Mukherjee commences his book with critical analysis of the disaster rhetoric in Hurricane Katrina reportage. By the end, Mukherjee persuades us that imperialism created environments of permanent disaster, resulting in the creation of literary mutations to account for the lives—and deaths—there. [End Page 651] Kellie Holzer Virginia Wesleyan College Kellie Holzer Kellie Holzer is Assistant Professor of English at Virginia Wesleyan College, where she teaches courses on South Asian literature and Victorian literature and culture. She has published essays in South Asian Review, Nineteenth-Century Gender Studies, and Nineteenth-Century Contexts. Copyright © 2014 The Research Society for Victorian Periodicals

Cutaneous manifestations of infection in returning travelers.

Dermatologic problems are common in returning travelers who seek medical care. Some common illnesses such as cellulitis or abscesses occur in travelers but are not unique to this patient group. Additionally, dermatologic illnesses not due to infection such as drug eruptions or phototoxicity are seen. Skin manifestations occur in many tropical illnesses such as dengue, schistosomiasis, and leishmaniasis. This article reviews the common causes of cutaneous illnesses associated with travel including non-infectious causes, infections that are not limited to travelers, and infections that are almost exclusively seen in travelers.

The Double-Edged Sword in Pathogenic Trypanosomatids: The Pivotal Role of Mitochondria in Oxidative Stress and Bioenergetics

The pathogenic trypanosomatids Trypanosoma brucei, Trypanosoma cruzi, and Leishmania spp. are the causative agents of African trypanosomiasis, Chagas disease, and leishmaniasis, respectively. These diseases are considered to be neglected tropical illnesses that persist under conditions of poverty and are concentrated in impoverished populations in the developing world. Novel efficient and nontoxic drugs are urgently needed as substitutes for the currently limited chemotherapy. Trypanosomatids display a single mitochondrion with several peculiar features, such as the presence of different energetic and antioxidant enzymes and a specific arrangement of mitochondrial DNA (kinetoplast DNA). Due to mitochondrial differences between mammals and trypanosomatids, this organelle is an excellent candidate for drug intervention. Additionally, during trypanosomatids' life cycle, the shape and functional plasticity of their single mitochondrion undergo profound alterations, reflecting adaptation to different environments. In an uncoupling situation, the organelle produces high amounts of reactive oxygen species. However, these species role in parasite biology is still controversial, involving parasite death, cell signalling, or even proliferation. Novel perspectives on trypanosomatid-targeting chemotherapy could be developed based on better comprehension of mitochondrial oxidative regulation processes.

Leptospirosis and dengue fever: a predictive model for early differentiation based on clinical and biochemical parameters

Leptospirosis and dengue fever are increasingly seen as causes of tropical febrile illness and often are clinically indistinguishable. This two-year prospective study from a tertiary care centre comprised 200 patients including 68 men (mean 34.8 years) with dengue and 73 (mean 46.19 years) with leptospirosis. Oliguria, icterus, muscle tenderness, anaemia, leukocytopenia, thrombocytopenia, elevated erythrocyte sedimentation rate (ESR), acute renal failure (ARF) and hypoalbuminaemia appeared more commonly in leptospirosis in comparison to dengue. Eighteen per cent mortality was observed in leptospirosis compared to one per cent in dengue. ARF, hyperbilirubinaemia, acute respiratory distress syndrome (ARDS), creatine kinase (CK) elevation and thrombocytopenia were predictors of death in leptospirosis and thrombocytopenia, ARDS and ARF predictors of death in dengue. On receiver operating characteristics (ROC) analysis, leucocytosis >11000/mm(3), ESR >40 mm, serum creatinine >2 mg/dL, total serum bilirubin >2 mg/dL, CK >500 U/L and serum albumin <3 mg/dL were more likely to be an indication of leptospirosis at presentation compared to dengue.

Medicinal plants used by women from Agnalazaha littoral forest (Southeastern Madagascar)

BackgroundThe country of Madagascar is renowned for its high level of biodiversity and endemism, as well as the overwhelming pressures and threats placed on the natural resources by a growing population and climate change. Traditional medicine plays an important role in the daily lives of the Malagasy for various reasons including limited access to healthcare, limited markets and traditional values. The objective of this study was to assess the modern utitilization of the Agnalazaha Forest by the local population in Mahabo-Mananivo, Madagascar, for medicinal plants used by women, and to establish a list of medicinal plants used by women sourced from Agnalazaha Forest.MethodsEthnobotanical studies were conducted over a period of five months in 2010 to determine the diversity of medicinal plants used by women in the commune of Mahabo-Mananivo. In all, 498 people were interviewed, both male and female ranging age from 15 to over 60 years old.Results152 medicinal plants used by local people were collected during the ethnobotanical studies. Among the recorded species, eight native species are widely used by women. These species are known for their therapeutic properties in treating placental apposition and complications during childbirth as well as tropical illnesses such as malaria, filariasis, and sexual diseases like gonorrhea and syphilis.ConclusionsLittoral forests are rare ecosystems that are highly threatened on the island nation of Madagascar. Our investigation into the use of medicinal plants sourced from and around the Agnalazaha Forest by the women of Mahabo-Mananivo reinforces the need for this natural resource as a first line of health care for rural families.

LH750 hematology analyzers to identify malaria and dengue and distinguish them from other febrile illnesses

Tropical febrile illnesses such as malaria and dengue are challenging to differentiate clinically. Automated cellular indices from hematology analyzers may afford a preliminary rapid distinction. Blood count and VCS parameters from 114 malaria patients, 105 dengue patients, and 105 febrile controls without dengue or malaria were analyzed. Statistical discriminant functions were generated, and their diagnostic performances were assessed by ROC curve analysis. Three statistical functions were generated: (i) malaria-vs.-controls factor incorporating platelet count and standard deviations of lymphocyte volume and conductivity that identified malaria with 90.4% sensitivity, 88.6% specificity; (ii) dengue-vs.-controls factor incorporating platelet count, lymphocyte percentage and standard deviation of lymphocyte conductivity that identified dengue with 81.0% sensitivity and 77.1% specificity; and (iii) febrile-controls-vs.-malaria/dengue factor incorporating mean corpuscular hemoglobin concentration, neutrophil percentage, mean lymphocyte and monocyte volumes, and standard deviation of monocyte volume that distinguished malaria and dengue from other febrile illnesses with 85.1% sensitivity and 91.4% specificity. Leukocyte abnormalities quantitated by automated analyzers successfully identified malaria and dengue and distinguished them from other fevers. These economic discriminant functions can be rapidly calculated by analyzer software programs to generate electronic flags to trigger-specific testing. They could potentially transform diagnostic approaches to tropical febrile illnesses in cost-constrained settings.

Incidence and Etiology of Acute Kidney Injury in Southern India: Author’s Reply

To the Editor: Tropical acute febrile illnesses have been described as important causes of acute kidney injury (AKI) in developing countries [1–4]. There is renewal of interest with emergence of such diseases in the developed countries and non-tropical regions as well, due to global warming and travel to tropics [5]. In a study on 367 consecutively enrolled adult inpatients of a tertiary hospital in southern India, with tropical acute febrile illness due to scrub typhus, malaria, enteric fever, dengue, leptospirosis and undifferentiated acute febrile illness, the incidence of AKI was 41.1 % [1]. Scrub typhus accounted for the majority (51.2 %) of tropical acute febrile illnesses in this study. The authors had opined that since a large number of patients with AKI in febrile illnesses in tropics have no access to medical attention or reside far away from large hospitals, they are likely to succumb to complications, making this a major public health concern. In our study [6], tropical febrile illnesses accounted for 15.6 % of all children with AKI. Severe dengue constituted the largest proportion of this group (38.4 %), while scrub typhus, enteric fever and cholera together accounted for 46.1 %. These figures are indeed considerably high, and call for attention from the general practitioner. Early detection of AKI in tropical febrile illnesses, which are very commonly prevalent in developing countries, is important for commencement of preventive strategies including judicious usage of fluids and adjustment of antibiotic doses, as well as identifying patients early to avoid renal replacement therapy. It therefore seems to be prudent to investigate renal functions in pediatric patients with tropical febrile illnesses. This practice needs to be included into clinical practice guidelines for management of tropical febrile illnesses.

Adaptation to menopause in Southwest Nigeria

Little attention has been given to the treatment of menopausal symptoms in Africa. Reasons for this include the hot tropical climate and febrile illnesses that mask hot flushes, large bone mass of black women offering inherent protection against osteoporosis-induced fractures, and an extended family system contributing to women’s psychological adjustment to menopause [1]. However, there is growing concern that these assumptions may not be true and that a significant proportion of menopausal women may be tolerating reproductive health burden in silence [2].

Anti-oxidative trypanocidal drugs, myth or reality

Sir, “Blueberries best be eaten because they taste good, not because their consumption will lead to less cancer.” Prof. Jim Watson [1]. Recently, Professor Jim Watson, father of DNA double-helix, has described in his paper that antioxidant supplements may have caused more cancers than they have prevented. Alongside this controversial, several papers give rise on looking for anti-cancers among antioxidants [2-4]. In reality, mechanism of anti-cancer action is very important, where induction of free radicals and augmentation of Reactive Oxygen Species (ROS) are the main pharmacological modes of anti-neoplastic activity [5]. In spite of the fact that beneficial role of antioxidants in chemoprevention of cancer has been well-known, effectiveness of them in treatment of cancer is still in challenge. Interestingly, there is a similar situation for another important disease, Chagas (American trypanosomiasis), a tropical parasitic illness caused by the flagellate protozoan Trypanosoma cruzi and affects eight to 10 million people residing in Latin American countries [6,7]. Nowadays natural compounds have been evaluated for discovery of new chemotherapeutics in treatment of Chagas disease. But, literature revealed that most of the researchers select the compounds without attention to their probable antioxidant activity, while therapeutic action of the remarkable trypanocidal compounds like elatol involves mitochondria as the primary target leading to increase of ROS generation through the electron transport chain, which consequently affects cell membrane and DNA integrity and finally death of parasite [8]. Although this is not the only mechanism of action for trypanocidal drugs, well-known natural phenolics such as gallic acid can act via pro-oxidant activity as well as enhancing DNA single-strand breaks to kill Trypanosoma[9]. Furthermore, anti-trypanosoma activity of komaroviquinone (a diterpenoid) was found to be attributed by generation of ROS catalyzed by T. cruzi old yellow enzyme [10]. It seems that potent natural antioxidants like hydroxycoumarins derivatives or flavonoids are not potentially strong trypanocidal agents [11]. The question arise from this concept is “why does a physician recommend consumption of antioxidant in treatment of trypanosomiasis?” The answer to this question may be hidden behind the differences in mechanism of actions for trypanocidal drugs and also the role of antioxidants in prevention of inflammation in this illness. To the best of our knowledge, consumption of antioxidant supplements is new perspective in therapy of Chagas disease because of the attenuation of oxidative stress associated to this disease [12]. Additionally, it has been reported that Trypanosoma infection decreases the levels of reduced glutathione (GSH) in the blood, liver, kidney, and also the plasma levels of vitamin C [13]. For this reason, they believe that supplementation of infected patient with vitamin C could prevent the depletion of endogenous antioxidants. Actually, another probable reason for this entrenched attitude is the ubiquitous application of antioxidant supplements. Therefore, we recommend the researchers to focus on possible mode of actions for trypanocidal candidates, especially when the nominated compounds are proved to possess antioxidant ability.

Acute and Potentially Life-Threatening Tropical Diseases in Western Travelers—A GeoSentinel Multicenter Study, 1996–2011

We performed a descriptive analysis of acute and potentially life-threatening tropical diseases among 82,825 ill western travelers reported to GeoSentinel from June of 1996 to August of 2011. We identified 3,655 patients (4.4%) with a total of 3,666 diagnoses representing 13 diseases, including falciparum malaria (76.9%), enteric fever (18.1%), and leptospirosis (2.4%). Ninety-one percent of the patients had fever; the median time from travel to presentation was 16 days. Thirteen (0.4%) patients died: 10 with falciparum malaria, 2 with melioidosis, and 1 with severe dengue. Falciparum malaria was mainly acquired in West Africa, and enteric fever was largely contracted on the Indian subcontinent; leptospirosis, scrub typhus, and murine typhus were principally acquired in Southeast Asia. Western physicians seeing febrile and recently returned travelers from the tropics need to consider a wide profile of potentially life-threatening tropical illnesses, with a specific focus on the most likely diseases described in our large case series.

Congenital Toxoplasmosis: Current Brazilian public health policy

Event Abstract Back to Event Congenital Toxoplasmosis: Current Brazilian public health policy Rogerio S. Vaz1* 1 Complexo Pequeno Principe, Brazil Toxoplasmosis is caused by the protozoan parasite, Toxoplasma gondii. In pregnant women, the prenatal diagnosis should be made as early as possible, so that therapy may be applied to reduce parasitemia and avoid transplacental infection. Despite the high prevalence of infected individuals around the world (20-90%) in Brazil, seroprevalence may vary between 40% and > 80%, reflecting a significant disparity between the public health policies and resources applied in the different regions of the country and the human development index (HDI) of each of them. The lack of consistent and periodical data on seroprevalence per region makes it difficult to understand the significance of this infection and to plan specific public health policies and strategies. Regarding basic and clinical research, toxoplasmosis is not a priority if compared to the allocation of government funds and incentives to other tropical illnesses, such as: Chagas disease, Leishmaniasis, Dengue fever. There are also few study groups in Brazil that focus in this basic area, for genomics and proteomics studies of T. gondii strains-for the design of new methods of diagnosis, antiparasitic drugs and a vaccine model for humans and animals. This study highlights, taxonomic and epidemiologic aspects, diagnosis methods, treatment and technical-scientific aspects of Toxoplasma gondii and toxoplasmosis in the Brazilian context. References Castilho-Pelloso, M.; Falavigna, D. L. M; Falavigna-Guilherme, A. L. (2007) Suspected acute toxoplasmosis in pregnant women. Rev Saúde Pública., 41(1):27-34. Lopez, A, Dietz VJ, Wilson M, Navin TR, Jones J. L. Preventing Congenital Toxoplasmosis. M M W R–Recommendations and Reports. v. 49, (RR02), p. 57-75, 2000. Martins-Duarte, E. S.; Lemgruber, L.; Souza, W.; Vommaro, R. C. (2010) Toxoplasma gondii: Fluconazole and itraconazole activity against toxoplasmosis in a murine model. Experimental Parasitology 124, P. 466-469. Martins-Duarte, E. S.; Lemgrubera, L.; Lorente, S. O.; Gros, L.; Magaraci, F.; Ian H. Gilbert, Wanderley de Souzaa, Rossiane C. Vommaroa. (2011) Evaluation of three novel azasterols against Toxoplasma gondii. Veterinary Parasitology 177 p.157-161. Neto, C.N.; Amorim, F.; Lago, E. G. (2010) Estimation of the regional distribution of congenital toxoplasmosis in Brazil from the results of neonatal screening. Sci. Med, v. 20, n.1, p. 64-70. Spalding, S. M.; Amendoeira, M. R. R.; Ribeiro, L. C.; Silveira, C.; Garcia, A. P. E Camillo-Coura, L. Estudo prospectivo de gestantes e seus bebês com risco de transmissão de congenital toxoplasmosis em município do Rio Grande do Sul. Rev da Soc Bras de Med Trop. v. 36, n. 4, p. 483-491, 2003. Vaz et al. Technical evaluation of serological screening tests for anti-Toxoplasma gondii Antibodies to prevent unnecessary transfusion risks. Rev Bras Hematol Hemoter. 2008; v. 30, 277-280 Vaz et al., 2010. Serological prevalence of Toxoplasma gondii antibodies in pregnant womenFrom Southern Brazil. Parasitol Res (2010) 106:661-665. Vaz, R. S. Diagnóstico sorológico, isolamento e caracterização molecular de Toxoplasma gondii (Nicole & Manceaux, 1909) em mulheres gestantes atendidas pelo serviço público na cidade de Curitiba. (SERODIAGNOSTIC, ISOLATION AND MOLECULAR CHARACTERIZATION OF Toxoplasma gondii IN PREGNANT WOMEN ATTENDED BY PUBLIC HEALTH SERVICES IN THE CITY OF CURITIBA. http://www.ppgbiotec. ufpr.br/tes_teses.php Tese: Doutorado–Universidade Federal do Paraná. Setor Tecnológico. Pósgraduação em Processos Biotecnológicos. 2006 Keywords: seroepidemiology, Toxoplasmosis, Public Health, Pregnancy, Risk factors Conference: 15th International Congress of Immunology (ICI), Milan, Italy, 22 Aug - 27 Aug, 2013. Presentation Type: Abstract Topic: Host-pathogen interactions Citation: Vaz RS (2013). Congenital Toxoplasmosis: Current Brazilian public health policy. Front. Immunol. Conference Abstract: 15th International Congress of Immunology (ICI). doi: 10.3389/conf.fimmu.2013.02.00428 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 31 Mar 2013; Published Online: 22 Aug 2013. * Correspondence: Dr. Rogerio S Vaz, Complexo Pequeno Principe, Curitiba, Paraná, 80230-020, Brazil, rogerio.vaz@fpp.edu.br Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Rogerio S Vaz Google Rogerio S Vaz Google Scholar Rogerio S Vaz PubMed Rogerio S Vaz Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Dealing with Acute Febrile Illness in the Resource Poor Tropics

Diagnosis of infectious disease, similar to any other illness is based on history taking, examination, basic investigations and confirmatory diagnostics. However differences in clinical presentation based on evolution of aetiological agents or host factors, risk of exposure for re-emerging or emerging agents due to expanding human activities and travel has posed a great challenge on timely diagnoses of these illnesses especially in the resource poor tropical setting. Significant overlap of symptoms, signs and basic laboratory parameters of most of the tropical illnesses add to the challenge. Although confirmatory diagnostics are mandatory in the definitive diagnosis of tropical fevers their applicability, non-availability or non-accessibility has lead to a clinical based approach for the presumptive diagnosis of febrile illness. Such an approach may lead to inadequate clinical evaluation, delay in the diagnosis, and use of inappropriate antibiotics, extended morbidity and possibly avoidable mortality by other tropical diseases especially during busy disease outbreaks.

Incidence and Etiology of Acute Kidney Injury in Southern India: Correspondence

To the Editor: The recent article on incidence and etiology of acute kidney injury (AKI) in Southern India is very interesting [1]. In this report, Krishnamurthy et al. studied incidence and etiology of AKI in Southern India and found that “Tropical febrile illnesses (dengue, scrub typhus, enteric fever, cholera, tuberculosis, malaria and leptospirosis) constituted 15.6 % of children with AKI.” This percentage is considerable high and it calls for the attention from the general practitioner. Indeed, it is no doubt that several illnesses can be the starting point for renal problem. It is questionable whether a recommendation for investigation on renal function of any pediatric patients with tropical febrile illnesses should be included into the clinical practice guideline or not.

Incidence and Etiology of Acute Kidney Injury in Southern India

To determine the incidence, etiology, short term outcome and predictors of mortality in hospitalized children aged 1 mo to 13 y with Acute Kidney Injury (AKI). This prospective observational study was conducted in the pediatric wards and the pediatric intensive care unit (PICU) of a tertiary hospital in southern India, to study the clinico-etiological profile of AKI (defined according to the Acute Kidney Injury Network criteria). From June 2010 through March 2011, 2376 children were included in the study. The incidence of AKI was 5.2 % in the pediatric wards and 25.1 % in the PICU. AKI occurred in association with infections (55.4 %), acute glomerulonephritis (16.9 %), cardiac disease (4.8 %), envenomations (4.2 %) and hemolytic uremic syndrome (3.6 %). Pneumonia constituted 26.1 % of the infections. Tropical febrile illnesses (dengue, scrub typhus, enteric fever, cholera, tuberculosis, malaria and leptospirosis) constituted 15.6 % of children with AKI. Dialysis was required in 14.5 % of patients; mortality was 17.5 %. A significant proportion of children (17.5 % of survivors) had partial renal recovery at discharge. On multivariate logistic regression, dysnatremia and meningoencephalitis were independent predictors of mortality in AKI. The incidence of AKI is high in the patient population, including the non-critically ill children. AKI continues to be associated with adverse outcomes. Presence of dysnatremia and meningoencephalitis are poor predictors of outcome in AKI.