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1.
Imported malaria is a preventable disease, yet it is responsible for several thousand cases and a substantial number of deaths every year. There has been a pronounced rise in the incidence of imported malaria in most developed countries over the past three decades and, more concerning, Plasmodium falciparum, which is responsible for almost all cases of severe malaria, is now the most prevalent species. Children account for around 15-20% of all imported malaria cases and must be considered separately from adults because they have different risk factors for developing malaria and a higher risk of developing severe disease since they are more likely to be non-immune to malaria. We did a thorough review of the literature since 1980 to identify and critically assess clinical case series on children with imported malaria with respect to travel destination, reason for travel, the use of antimalarial prophylaxis, clinical presentation, delay in diagnosis, laboratory features, complications, management, and outcome. Children living in non-endemic countries and travelling during school holidays to visit family and relatives in their parents' country of origin currently account for the largest proportion of cases in many European countries. This group of travellers deserves special attention because they often do not take antimalarial prophylaxis or other preventive measures. There is a need for standardised recommendations on management and prevention of imported malaria in children, which should be supported by large multicentre clinical trials. A prospective national surveillance study on imported malaria in children was launched in the UK and Ireland through the British Paediatric Surveillance Unit in 2006, which may provide answers to some of the questions raised in this Review. 相似文献
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Vicas AE Albrecht H Lennox JL del Rio C 《The American journal of the medical sciences》2005,329(1):6-12
BACKGROUND: More than 1000 cases of malaria are reported to the Centers for Disease Control and Prevention each year among travelers or immigrants. METHODS: Retrospective study of patients with malaria seen at Grady Memorial Hospital in Atlanta, Georgia, between October 1988 and September 2000. RESULTS: One hundred twenty-six cases of malaria were diagnosed at Grady Memorial Hospital during the study period. Fourteen patients had seen a physician prior to coming to Grady Memorial Hospital, and in 71% the diagnosis was missed. Half had recently immigrated and half recently traveled to an endemic area, yet only 22% of travelers took prophylaxis. Plasmodium falciparum was the most commonly identified species (52.4%), followed by Plasmodium vivax (23.9%). Seventy-two patients (57.1%) required hospitalization. Presenting symptoms included fever (94%), chills (56%), nausea/vomiting (38%), headache (26%), and abdominal pain (26%). Most patients were diagnosed correctly on the day of admission (79%). Twelve patients (16.7%) had severe malaria, and their complications included severe anemia (9.7%), acute renal failure (4.2%), bleeding and/or disseminated intravascular coagulation (4.2%), shock (2.8%), seizures (2.8%), and hypoglycemia (2.8%). One patient died, and two pregnant women had premature deliveries. Median hospital stay was 3.9 days. One third of the hospitalized patients with P vivax failed to receive primaquine, and in 15% of patients with P falciparum, the treatment was considered to be inappropriate. CONCLUSIONS: Although some patients with malaria have a benign course and a good outcome, many patients require hospitalization, and some have severe complications. Increased efforts are needed to educate travelers about the need for prophylaxis. 相似文献
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BACKGROUND AND OBJECTIVES: The aim of this study is to better understand the epidemiological and clinical features of patients with sarcoidosis in Singapore and to ascertain if ethnic differences exist. METHODS: A review of hospital medical records from June 1998 to May 2004 to identify patients with sarcoidosis. RESULTS: There were 59 patients with sarcoidosis identified (19 Chinese, 29 Asian Indian and 11 Malay). The estimated annual incidence of sarcoidosis in Singapore was 0.56 per 100,000. There was a significant difference between the observed and expected disease frequency in Chinese (32.2% vs 78.7%) and Indians (49.2% vs 6.0%, P < 0.005). A bimodal distribution of age at diagnosis was seen with peaks in the 30-39 years and 50-59 years age groups; 38.9% of cases were over the age of 50. Chinese patients were more likely to be asymptomatic (57.9%, P = 0.015) and less likely to have impaired spirometry (P = 0.013). Pulmonary sarcoid presented largely as stage 0 or stage 1 disease (74.4%). Overall mean spirometry was unimpaired and prognosis was good with 79.2% showing no radiological deterioration. There were no significant differences in organ involvement or treatment between ethnic groups. CONCLUSION: Sarcoidosis in Singapore is rare and the incidence differs between ethnic groups. Chinese appear to have a lower incidence and a less symptomatic presentation; Indians have a higher incidence and poorer clinical course. 相似文献
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Pereira RM Bucaretchi F Barison Ede M Hessel G Tresoldi AT 《Revista do Instituto de Medicina Tropical de S?o Paulo》2004,46(3):127-131
From February, 1981 to May, 2001, 63 children under 15 y old (ages 2 - 15 y, median = 8 y, mean +/- 1 SD = 8 +/- 3 y) presenting 70 episodes of Paracoccidioidomycosis were admitted. The main clinical manifestations and laboratory features observed upon admission were: lymph node enlargement (87.1%), fever (75.7%), weakness (48.6%), pallor (41.4%), hepatomegaly (40%), splenomegaly (35.7%), anemia (90%), hypergammaglobulinemia (88.5%), eosinophilia (75.5%) and hypoalbuminemia (72.5%). Moderate to severe malnutrition was detected in 35.7% of the episodes (Gomez's criterion). Radiographic and technetium studies showed bone lesions in 20 of the episodes, most of them being multiple lytic lesions, involving both long (70%) and plain bones (30%). First line treatment consisted of an association of sulfametoxazole-trimethoprin, which was used, exclusively, in 50 episodes. Follow-up of hemoglobin levels, number of eosinophils in the peripheral blood, albumin and gammaglobulin serum levels revealed significant sequential improvement one and six months after hospital admission, being quite useful to evaluate treatment effectiveness. Six patients died (9.3%) and four developed sequelae (6.3%). In conclusion, the juvenile and disseminated forms can be observed in about 70% of the episodes of PCM occurring in children younger than 15 y old, most of them presenting with a febrile lymphoproliferative syndrome associated to anemia, eosinophilia and hypergammaglobulinemia. 相似文献
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Cerebral malaria. Factors affecting outcome of treatment in a suboptimal clinical setting 总被引:1,自引:0,他引:1
Over a period of 6 months, 109 patients were admitted to the medical wards of the Gondar College Hospital with malaria. Out of these, 26 patients (24.8%) had cerebral malaria as defined by the WHO Malaria Action Programme 1986. Fifteen of the 26 patients (57.7%) died. Longer duration of unconsciousness before coming to the hospital, hyperparasitaemia, oliguria, recurrent hypoglycaemia and convulsions were found to be significantly associated with mortality. 相似文献
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We reviewed the diagnostic features and clinical outcome of 7 consecutive neonates who were diagnosed to have cerebral arteriovenous malformations. All presented with cardiac failure, and a cranial bruit was heard in 6/7 patients. There was electrocardiographic evidence of myocardial ischemia in 6 patients. The diagnosis was established at cardiac catheterization, or by cardiac and cranial ultrasound. Three patients died of heart failure before definitive treatment. Despite early intervention, three of the remaining four patients died either during or immediately after embolization or ligation of the fistula. A cerebral arteriovenous malformation is a rare cause of neonatal heart failure. Despite prompt recognition and aggressive treatment, the outlook for symptomatic neonates is poor. 相似文献
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Z Shimoni S Pitlik L Leibovici Z Samra H Konigsberger M Drucker V Agmon S Ashkenazi M Weinberger 《Clinical infectious diseases》1999,28(4):822-827
In a retrospective study, 80 episodes of nontyphoid salmonella (NTS) bacteremia in children were compared with 55 episodes in adults over a 10-year period. The study disclosed major differences in the predisposition, clinical presentation, and outcome as well as the microbiology of NTS bacteremia in relation to age. Adults were more likely than children to have predisposing diseases (95% vs. 15%, respectively; P < .0001) and to receive prior medications (95% vs. 23%, respectively; P < .0001), particularly immunosuppressive agents (58% vs. 5%, respectively; P < .0001). In most adults (67%), NTS infection presented as a primary bacteremia and was associated with a high incidence of extraintestinal organ involvement (34%) and a high mortality rate (33%). In children, NTS bacteremia was usually secondary to gastroenteritis (75%) and caused no fatalities. Although group D Salmonella (78%) and the serovar Salmonella enteritidis were the predominant isolates from adults, the emergence of infections due to group C Salmonella (46%) and the serovar Salmonella virchow in children was noted. 相似文献
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目的 对合肥市1例输入性卵形疟病例进行流行病学调查和实验室诊断分析,为今后预防控制输入性疟疾提供参考依据。方法 对该例输入性卵形疟患者的流行病学史、诊疗经过等资料进行收集、整理和分析。结果 患者从非洲莫桑比克务工返乡,回国数月后因反复发热就医。快速诊断试纸条法(RDT)提示为非恶性疟原虫感染;镜检见被感染红细胞正常大小或略胀大、锯齿状不明显,大滋养体胞浆增多、形态不规则、基本无空泡。荧光定量PCR确诊该病例为卵形疟原虫感染。结论 临床医务人员应加强对有境外流行区生活及工作史人员的疟疾诊断意识,及时早期合理用药,防止疟疾疫情扩散。 相似文献
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Apitzsch L Rasch G Kiehl W 《Euro surveillance : bulletin européen sur les maladies transmissibles = European communicable disease bulletin》1998,3(4):35-36
Malaria is not endemic in Germany, but it is one of the most commonly imported infectious diseases. The numbers of imported cases increased from 1994 to 1996; in 1997 according to preliminary data there were a total of 994 cases. In 1996, 1021 cases of ma 相似文献
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Introduction Nonalcoholic fatty liver disease (NAFLD) affects one-fifth of the adult population and is currently the commonest liver problem
in the western world. The prevalence of NAFLD is likely to rise over the coming decades in parallel to the obesity and diabetes
epidemics. A retrospective study was undertaken in a UK. district general hospital (DGH) to determine the clinical and laboratory
features of patients with NAFLD.
Methods and findings A total of 48 patients with NAFLD were identified. Most (54%) were asymptomatic on presentation and 90% had an echogenic liver
on ultrasonography (USS). Liver tests were elevated in the majority, but did not distinguish between simple steatosis and
steatohepatitis. Having features of the metabolic syndrome and a low platelet count (P = 0.028) may help identify patients with advanced hepatic fibrosis.
Conclusions NAFLD is common in the DGH and should be considered in all patients with metabolic risk factors. A liver biopsy should be
considered in those with low platelets, type II diabetes mellitus, and the metabolic syndrome. 相似文献
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Forty-three cases of imported vivax malaria were notified in the Republic of Kabardino-Balkaria in 1981-1997. These included 40 military men serving in Afghanistan, a citizen from this country, a student of the Kabardino-Balkaria State University, a student of a Nal'chik technological college, and a newcomer from Armenia. Among the patients, urban and rural residents were 27.9 and 72.1%, respectively. 37.2% were detected in the season of effective mosquito infection; new cases of malaria were identified in 41.9%, relapses were found in 58.1% of patients. Analyzing the reasons of late diagnosis of imported malaria suggests that the patients visited health facilities too late due to their poor awareness of a risk for malaria. Out of 43 patients, 62.8% referred to in the first 3 days after the onset, 18.6, 9.3, 9.3, and 2.3% did on days 4-6, 7-15, 16, and after a month, respectively. Their physicians made diagnostic errors in 53% of cases. Acute respiratory disease, influenza, pneumonia, and hepatitis were most commonly diagnosed. They were found in 27.9, 11.6, 4.7, and 4.7%, respectively. 相似文献
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Y. J. Trakadis A. Alfares O. A. Bodamer M. Buyukavci J. Christodoulou P. Connor E. Glamuzina F. Gonzalez-Fernandez H. Bibi B. Echenne I. Manoli J. Mitchell M. Nordwall C. Prasad F. Scaglia M. Schiff B. Schrewe G. Touati M. C. Tchan B. Varet C. P. Venditti D. Zafeiriou C. A. Rupar D. S. Rosenblatt D. Watkins N. Braverman 《Journal of inherited metabolic disease》2014,37(3):461-473
Transcobalamin (TC) transports cobalamin from blood into cells. TC deficiency is a rare autosomal recessive disorder usually presenting in early infancy with failure to thrive, weakness, diarrhoea, pallor, anemia, and pancytopenia or agammaglobulinemia. It can sometimes resemble neonatal leukemia or severe combined immunodeficiency disease. Diagnosis of TC deficiency is suspected based on megaloblastic anemia, elevation of total plasma homocysteine, and blood or urine methylmalonic acid. It is confirmed by studying the synthesis of TC in cultured fibroblasts, or by molecular analysis of the TCN2 gene. TC deficiency is treatable with supplemental cobalamin, but the optimal type, route and frequency of cobalamin administration and long term patient outcomes are unknown. Here we present a series of 30 patients with TC deficiency, including an update on multiple previously published patients, in order to evaluate the different treatment strategies and provide information about long term outcome. Based on the data presented, current practice appears to favour treatment of individuals with TC deficiency by intramuscular injections of hydroxy- or cyanocobalamin. In most cases presented, at least weekly injections (1 mg IM) were necessary to ensure optimal treatment. Most centres adjusted the treatment regimen based on monitoring CBC, total plasma homocysteine, plasma and urine methylmalonic acid, as well as, clinical status. Finally, continuing IM treatment into adulthood appears to be beneficial. 相似文献
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López-Cano Gómez M Laguna Del Estal P García Montero P Gil Navarro M Castañeda Pastor A 《Gastroenterologia y hepatologia》2012,35(4):229-235