Transactions of the Royal Society of Tropical Medicine and Hygiene
-
Trans. R. Soc. Trop. Med. Hyg. · Nov 2008
Randomized Controlled TrialThe efficacy and tolerability of three different regimens of tafenoquine versus primaquine for post-exposure prophylaxis of Plasmodium vivax malaria in the Southwest Pacific.
Tafenoquine is being developed for radical cure and post-exposure prophylaxis of Plasmodium vivax malaria. In an open-label study, 1512 Australian Defence Force personnel received one of three tafenoquine 3 d regimens [400 mg once daily (od), 200 mg twice daily (bid), 200 mg od] or daily primaquine (22.5 mg) plus doxycycline (100 mg) over 14 d in Bougainville and in Timor-Leste for post-exposure prophylaxis. The relapse rate of subjects treated in Bougainville with tafenoquine (n=173) was 1.2% (200 mg bid x 3 d) and 2.3% (400 mg od x 3 d), while primaquine plus doxycycline (n=175) was 3.4%. ⋯ The most frequent adverse events reported across all groups were nausea, abdominal distress and diarrhoea. There was a dose-dependent reduction in adverse events with a reduced dose of tafenoquine, with the lowest dose (total 600 mg over 3 d) producing rates of adverse events equivalent to that of primaquine plus doxycycline. The much shorter dosing regimen of tafenoquine should increase compliance, which is often suboptimal with primaquine after leaving an endemic area. [Australian New Zealand Clinical Trials Registry Number 12607000588493].
-
Trans. R. Soc. Trop. Med. Hyg. · Oct 2008
Febrile illness at the emergency department of Cayenne Hospital, French Guiana.
Febrile illness is a common cause of attendance at emergency departments. The purpose of this study was to describe infectious aetiologies of fever in a tropical setting. We prospectively included 1443 febrile patients, all French Guiana residents, who presented at Cayenne Hospital emergency department. ⋯ Almost 30% of fevers remained unexplained. Further prospective multicentre studies are warranted to improve the diagnosis of overlooked pathogens in French Guiana. Such studies would lead to conclusions of specific interest in the travel medicine field.
-
Trans. R. Soc. Trop. Med. Hyg. · Sep 2008
Case ReportsMaggot infestation (myiasis) of external fixation pin sites in diabetic patients.
Diabetic patients, and especially elderly patients in a low-nutritional or immunocompromised state, are prone to a variety of opportunistic infections. 'Myiasis' is a term that refers to non-iatrogenic infestation of tissues by larvae, commonly known as maggots, of dipterous flies. Myiasis as a complication of fracture treatment by means of external fixation of long bones has not been reported. We present three diabetic patients, who suffered maggot infestation of their external fixation pin holes, and their outcome. Diabetes, immobilization, poor hygiene and low immune status are predisposing factors for developing myiasis, an extremely rare complication for external fixation of fractures.
-
Trans. R. Soc. Trop. Med. Hyg. · Mar 2008
ReviewAdvances and remaining uncertainties in the epidemiology of Burkholderia pseudomallei and melioidosis.
Major advances have been made in molecular studies of Burkholderia pseudomallei and the immunology of melioidosis. However, there remain large gaps in understanding of the epidemiology of this enigmatic disease. ⋯ Despite the potential for rapidly progressive septicaemia, the critical virulence factors in B. pseudomallei remain to be clarified. Inhalation following aerosolization of B. pseudomallei may account for the high mortality when melioidosis occurs after severe weather events.
-
Trans. R. Soc. Trop. Med. Hyg. · Feb 2008
ReviewNeurological complications of Schistosoma infection.
Schistosomiasis is a parasitic disease caused by blood flukes of the genus Schistosoma. Currently more than 200 million people worldwide are affected. Neuroschistosomiasis constitutes a severe presentation of the disease. ⋯ Severe schistosomal myelopathy can provoke a complete flaccid paraplegia with areflexia, sphincter dysfunction and sensory disturbances. Schistosomicidal drugs, steroids and surgery are the currently available treatments for neuroschistosomiasis. Rehabilitation and multidisciplinary team care are needed in severely disabled patients.