The American journal of tropical medicine and hygiene
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Am. J. Trop. Med. Hyg. · Oct 2019
Characteristics and Impact of Disseminated Gonococcal Infection in the "Top End" of Australia.
The "Top End" of Australia is presently experiencing a gonorrhea epidemic. Gonococcal infection is usually limited to mucosal tissues but can lead to disseminated gonococcal infection (DGI), joint destruction, and severe sepsis. This study aimed to explore the epidemiology, presentation, management, and health-care impact of DGI in the Top End of the Northern Territory. ⋯ DGI is an important cause of morbidity in the Top End, particularly in the young, remote Indigenous Australian population. Clinical presentation varies from classical teaching. Urgent action in the health and community sector is required, particularly for at-risk populations, to prevent further debilitating and costly complications of gonococcal infection.
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Am. J. Trop. Med. Hyg. · Jul 2019
Case ReportsCase Report: Spontaneous Resolution of Intracavitary Hepatic Artery Pseudoaneurysm Caused by Amebic Liver Abscess following Percutaneous Drainage.
Intrahepatic pseudoaneurysm (IHPA) is generally iatrogenic, and it warrants urgent management because of its reportedly significant risk of rupture leading to considerable mortality. Intrahepatic pseudoaneurysm caused by amebic liver abscess (ALA) is exceedingly rare with fewer than seven published reports. All reported symptomatic cases have been treated with hepatic artery embolization; therefore, little is known about its natural course and effect of abscess drainage on its outcome. We report the first case of symptomatic intracavitary IHPA caused by ALA in which ultrasound-guided percutaneous catheter drainage of the abscess resulted in the spontaneous resolution of the IHPA.
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Am. J. Trop. Med. Hyg. · Jul 2019
Yellow Fever: Factors Associated with Death in a Hospital of Reference in Infectious Diseases, São Paulo, Brazil, 2018.
Faced with the reemergence of yellow fever (YF) in the metropolitan region of São Paulo, Brazil, we developed a retrospective study to describe the cases of YF attended at the Institute of Infectology Emilio Ribas from January to March 2018 and analyze the factors associated with death, from the information obtained in the hospital epidemiological investigation. A total of 72 cases of sylvatic YF were confirmed, with 21 deaths (29.2% lethality rate). Cases were concentrated in males (80.6%) and in the age group of 30 to 59 years (56.9%). ⋯ The risk of death in the model with continuous variables was calculated from the increase of 1 year (age), 1 mg/dL (creatinine), and 100 U/L for AST and ALT. Another logistic regression analysis with dichotomous variables indicated AST > 1,841 IU/L (ORadj: 12.92; CI 95%: 1.50-111.37) and creatinine > 1.2 mg/dL (ORadj: 81.47; CI 95%: 11.33-585.71) as independent factors associated with death. These results may contribute to the appropriate clinical management of patients with YF in health-care services and improve the response to outbreaks and public health emergencies.
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Am. J. Trop. Med. Hyg. · Jun 2019
Evaluation of an Emergency Bulk Chlorination Project Targeting Drinking Water Vendors in Cholera-Affected Wards of Dar es Salaam and Morogoro, Tanzania.
In August 2015, an outbreak of cholera was reported in Tanzania. In cholera-affected areas of urban Dar es Salaam and Morogoro, many households obtained drinking water from vendors, who sold water from tanks ranging in volume from 1,000 to 20,000 L. Water supplied by vendors was not adequately chlorinated. ⋯ The results suggest high acceptability and use of the chlorine tablets by water vendors. However, given variation in the water source used and longer storage times, dosing could be increased in future programming. Bulk chlorination using chlorine tablets offers an efficient community-level approach to treating water closer to the point of use.