Clinical manifestations of co-infection with malaria and leptospirosis

Though both malaria and leptospirosis are frequent in the tropics, co-infections are under-recognized due to overlapping of clinical features. Here, we reviewed clinical manifestations of published co-infection along with our three cases. Out of a total of 18 patients, nine patients (50%) required ICU admission. Almost all patients had prodromal symptoms in the form of fever, headache and myalgia. Seven patients (37%) had altered sensorium, three patients (17%) had hypotension at admission, and 11 patients (61%) had acute kidney injury (AKI). Pulmonary manifestations in the form of pulmonary bleeding were present in four cases (22%). Three (17%) patients had acute lung injury/ acute respiratory distress syndrome. Almost 55% patients had DIC in the form of altered prothrombin time, activated partial thromboplastin time and low fibrinogen level. Four patients (22%) had subconjuctival suffusion, two of them had haematuria, while one presented with nasal bleeding. All patients had altered liver function tests. Of all the 18 patients, 17 (94%) survived, while one died.     

Co-infection of malaria with HIV: an immunological perspective

Human immunodeficiency virus (HIV) and Plasmodium parasites are pathogens that induce significant perturbation and activation of the immune system. Due to their geographical overlap, there have been concerns that co-infection with the two pathogens may be a factor in the modification of their development, and in the severity and rate of disease progression that they induce. In this article, we have reviewed some of the studies that have addressed this topic and we have tried to provide immunological mechanisms to explain these potential interactions.     

Co-infection of helminths and malaria: modulation of the immune responses to malaria

Chronic helminth infections induce strong type 2 and regulatory immune responses and are known to influence immune activity to other antigens such as allergens and vaccines. Since malaria and helminth infections often coincide geographically in the same tropical regions, the question arises whether helminth infections modulate the immune responses towards the malaria parasite and affect its course of disease. Here, we will review studies on co-infections in both animal models and in human populations, and discuss the changes in the immune system seen. Furthermore, the implications of helminth infection for the efficacy of malaria vaccines will be discussed.     

Co-infection with HIV and TB: double trouble

Co-infection with HIV and Mycobacterium tuberculosis is common, particularly in the developing world. Tuberculosis (TB) is the commonest co-infection in HIV-positive individuals, who are at increased risk of both reactivation of latent infection and acquisition of new infection. As the degree of immunosuppression increases, the risks of developing TB disease also increase. The patho-physiology, clinical picture, differential diagnosis and diagnostic tests are discussed, together with the interactions between antiretroviral therapy and anti-tuberculous chemotherapy. Indications for chemoprophylaxis and vaccination against TB are reviewed.     

艾滋病患者几种易被忽视的肠道寄生虫感染

为提高临床医生对艾滋病合并肠道寄生虫感染的认识，本文从病原学、流行病学、诊断方法、治疗和预防措施等方面对艾滋病患者混合感染常见的肠道寄生虫，如隐孢子虫、微孢子虫、蓝氏贾第鞭毛虫和粪类圆线虫等进行综述。     

Co-infection with human immunodeficiency virus and tuberculosis in Asia

Asia has the highest numbers of tuberculosis cases (60% of the global total) and has experienced a marked rise in HIV seroprevalence (22% of the global total) in key subpopulations of these highly populous nations. Thus, co-infected patients are a challenge for practitioners and public health workers alike. The U.S.-Japan Cooperative Medical Science Program is spearheading interdisciplinary collaborations in Asia to address the many outstanding research priorities for HIV-tuberculosis co-infection. There is an urgency to this agenda for many reasons, including the frequency with which tuberculosis accounts for the death of HIV-infected persons in Asia, and the continued rise of multiple drug-resistant Mycobacterium tuberculosis. We review briefly the public health situation in Asia, highlighting research questions from US-Japan-Asian partner joint meetings, and cite salient studies to indicate trends and challenges.     

恙虫病并发钩端螺旋体病1例

本文报道了我院收治的1例恙虫病合并钩端螺旋体病患者,详细描述了其临床特点、实验室检查结果及诊治过程,并做出相应的讨论分析.     

蜱媒传染病相关病原体混合感染

目前,蜱媒传染病对公共健康产生了严重的威胁,不断有新的致病的蜱媒病原体被报道。由于大多数的蜱媒传染病临床症状缺乏特异性,无法迅速准确的对单一的蜱媒病原体感染与多种蜱媒病原体混合感染进行区分,甚至因为疏忽混合感染的可能性而耽误治疗,造成严重的后果。因此,本文希望通过综述蜱媒传染病相关病原体可能出现的混合感染种类,减少临床工作中的漏诊和误诊,为临床医生的诊断和治疗提供更多的思路。     

Thrombocytopenia and leptospirosis

The present study has intended to contribute to the elucidation of the pathogenic mechanisms, involved in the thrombocytopenia and in the bleeding diathesis seen in the course of Leptospirosis. The group of cases included in the present prospective study consisted of 30 patients with Leptospirosis, admitted to the Infectious and Parasitic Diseases Ward, Hospital das Clínicas, Faculty of Medicine, University of S?o Paulo. The following possible mechanisms of thrombocytopenia have been considered and therefore investigated: platelet consumption, due to disseminated intravascular coagulation; immune-mediated platelet destruction, due to platelet-associated antibodies and an inhibited platelet production in the bone marrow. Thrombocytopenia occurred in 86.6% of 30 patients and did not seem to be immune-mediated by platelet-associated antibodies. Furthermore it did not seem to be due to a disseminated intravascular coagulation consumption. Although there was a statistically-significant correlation between bone marrow platelet production and platelet counts we think that the static microscopic examination of a bone marrow aspirate cannot accurately depict the dynamic mechanisms of platelet production when these cells are being consumed in peripheral blood. Vasculitis should be considered as the most important factor for the pathogenesis of the bleeding disturbances in Leptospirosis. However, we believe that thrombocytopenia, uremia and coagulation disorders, individually or as a group, should be included among the contributing factors that lead to and worsen bleeding episodes, which represent the leading cause of death in this disease.     

Hepatitis C Management in Patients with Hepatitis C and HIV Co-infection

Co-infection with HIV and hepatitis C (HCV) is common due to similar risk factors. Twenty-five to thirty percent of HIV+ patients are co-infected with HCV. HCV infection in HIV+ patients is associated with higher rates of fibrosis, progression to cirrhosis and decompensated liver disease, and liver-related mortality. The ultimate HCV treatment goal is viral eradication, or sustained virologic response (SVR) which results in decreased liver-related morbidity and mortality. Prior therapies were suboptimal in co-infected patients. However, the new HCV direct-acting antiviral agents provide excellent treatment options in co-infected patients with response rates and adverse events similar to the HCV mono-infected population. Drug interactions between HIV treatments and HCV treatments can be challenging and must be taken into consideration. To optimize outcomes, co-infected patients should be managed by experienced providers or in the setting of a collaborative multidisciplinary approach. This article will review the current treatment rationale and recommendations for HIV-HCV-co-infected patients.     

Antibodies against malaria sporozoites in patients with acute uncomplicated malaria and patients with cerebral malaria

Serum samples from 95 patients with acute uncomplicated falciparum malaria (AM) and 95 patients with cerebral malaria (CM) were tested by the indirect immunofluorescent assay (IFA) for IgG and IgM antibodies against Plasmodium falciparum and P. vivax sporozoites. Forty-six (48%) CM patients were positive for antibodies against P. falciparum sporozoites whereas only 23 (24%) were positive for antibodies against P. vivax sporozoites (P less than 0.002). A similar result was obtained in AM patients. However, CM patients had significantly lower mean IgG anti-sporozoite titer for P. falciparum than did AM patients (P less than 0.05), especially when only anti-sporozoite antibody-positive CM and AM patients were compared (P less than 0.0005), suggesting that CM patients had relatively less exposure and were probably less immune to malaria than were AM patients. The persistence of anti-sporozoite antibodies also was investigated in paired sera taken 63 days apart from 108 patients with acute falciparum malaria. There were significant decreases in the mean antibody titers in the follow-up sera during the period of stay in the malaria-free area. It was proposed that determination of anti-sporozoite antibody be made as a substitute for, or in addition to, anti-blood stage antibody for seroepidemiological study of malaria, especially in the monitoring of the success of the malaria control program.