The American journal of tropical medicine and hygiene
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Am. J. Trop. Med. Hyg. · May 2009
Management of chronic strongyloidiasis in immigrants and refugees: is serologic testing useful?
We assessed the usefulness of serologic testing in monitoring strongyloidiasis in immigrants after treatment with two doses of ivermectin. An observational study was conducted in a group of Cambodian immigrants residing in Melbourne who were treated for strongyloidiasis and followed-up in a general practice setting. Two doses of ivermectin (200 microg/kg) were administered orally. ⋯ Antibody titers for Strongyloides sp. decreased in 95% (38 of 40) of the patients, 47.5% (19 of 40) had a decrease in optical density to less than 0.5, and 65% (26 of 40) reached levels consistent with a cure during the follow-up period. Serologic testing for Strongyloides sp. is a useful tool for monitoring a decrease in antibody levels after effective treatment. This testing should be carried out 6-12 months after treatment to ensure a sustained downward trend suggestive of cure.
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Am. J. Trop. Med. Hyg. · Feb 2009
Evaluation of interferences between dengue vaccine serotypes in a monkey model.
Interferences between different antigens in the same vaccine formulation have been reported for some vaccines (e.g., polio vaccines, live attenuated dengue vaccine candidates). We examined interferences between the four serotypes of ChimeriVax dengue vaccines (CYDs) in a monkey model when present within a tetravalent formulation in equal concentrations (TV-5555). ⋯ Parameters that affected the interferences were identified, including 1) the simultaneous administration of two complementary bivalent vaccines at separate anatomical sites drained by different lymph nodes; 2) the sequential administration of two complementary bivalent vaccines; 3) the establishment of heterologous flavivirus pre-immunity before subsequent tetravalent immunization; 4) the adaptation of formulations by decreasing the dose of the immunodominant serotype; and 5) the administration of a 1-year booster. The applicability of these data to human responses is discussed.
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Am. J. Trop. Med. Hyg. · Dec 2008
Case ReportsCase report: failure of subcutaneous ivermectin in treating Strongyloides hyperinfection.
A man with Escherichia coli meningitis and bacteremia, while on dexamethasone, developed Strongyloides hyperinfection syndrome and died despite salvage therapy with subcutaneous ivermectin. We report the first documented total and free levels of subcutaneous ivermectin used for therapy.
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Am. J. Trop. Med. Hyg. · Oct 2008
Case ReportsA severe eosinophilic meningoencephalitis caused by infection of Angiostrongylus cantonensis.
This paper reports a severe case of eosinophilic meningoencephalitis after infection with Angiostrongylus cantonensis.
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Am. J. Trop. Med. Hyg. · Jun 2008
Influence of the dengue serotype, previous dengue infection, and plasma viral load on clinical presentation and outcome during a dengue-2 and dengue-4 co-epidemic.
Martinique experienced a dengue outbreak with co-circulation of DENV-2 and DENV-4. In an emergency department-based study, we analyzed whether the clinical presentation and outcome of adult patients were related to serotype, immune status, or plasma viral load. Of the 146 adult patients who had confirmed dengue infection, 91 (62.3%) were classified as having classic dengue fever, 11 (7.5%) fulfilled World Health Organization criteria for dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS), 21 other patients (14.4%) presented with at least one typical feature of DHF/DSS [i.e., internal hemorrhage, plasma leakage, marked thrombocytopenia (platelet count < or = 50,000 platelets/mm(3)) and/or shock], and 23 further patients (15.8%) had unusual manifestations. ⋯ Multivariate regression analysis showed that gastrointestinal symptoms and other unusual manifestations were independently associated with DENV-2 infection, whereas cough and DHF/DSS features were independently associated with secondary immune response. A high plasma viral load was associated with DENV-2 infection, increased serum liver enzymes, and with DHF/DSS features in patients presenting after the third day of illness. The most severe cases of dengue resulted from the combined effects of DENV-2 and secondary infection.