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Introduction to Flaviviruses

Introduction The flaviviruses are the largest group of the Flaviviridae family that infects humans. Hepatitis C virus is also a member of the Flaviviridae family, but is not a flavivirus. Some flaviviruses cause severe pathology in both immunocompromised and immunocompetent people, while infection with other flaviviruses is typically asymptomatic or leads to only a mild, febrile disease. This book presents current and historical information about neglected…

The Impact of Vaccination on the Epidemiology of Infectious Diseases

Abstract Looking back at the past 100 years of medical advances in the prevention and treatment of disease, vaccination is the miracle of modern medicine. In the past 50 years, evidence suggests it has saved more lives worldwide than any other med… 1 You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in…

Evidence Synopsis

Title: Benefits and Harms of Melatonin and Hypnotics in Preventing Jet Lag in Long-Haul Air Travelers Date completed: May 7, 2015 Authors: Steven Lascher, DVM, PhD, MPH and David R. Goldmann, MD Clinical question: Are melatonin and/or hypnotics effective preventive interventions for jet lag in long-haul travelers? Author recommendations: For long-distance air travelers who may benefit from jet lag mitigation, clinicians may prescribe melatonin or a…

Evidence Synopsis

Title: Benefits and Harms of Drugs for Prevention of Chloroquine-Resistant Malaria in Travelers Date completed: April 20, 2015 Authors: Steven Lascher, DVM, PhD, MPH and David R. Goldmann, MD Clinical question: What are the benefits and harms of drugs for prevention of chloroquine-resistant malaria in travelers? Author recommendations: For travelers to areas with known or potential chloroquine-resistent malaria with a predominance of Plasmodium falciparum or Plasmodium…

Quick Evidence Synopsis

Title: Efficacy and Safety of Vaccines for Dengue Date completed: April 22, 2015 Authors: Tatyana A. Shamliyan, MD, MS and David R. Goldmann, MD Clinical question: What are the efficacy and safety of dengue vaccine in children and adults? What does the evidence conclude? Intervention Quality of Evidence a Balance between Benefits and Harms b Three injections of recombinant live attenuated tetravalent dengue vaccine (CYD-TDV) Moderate…

Evidence Synopsis

Title: Benefits and Harms of Immunization Against Typhoid Fever in Travelers Who Have Not Been Previously Exposed Date completed: April 23, 2015 Authors: Steven Lascher, DVM, PhD, MPH and David R. Goldmann, MD Clinical question: What are the benefits and harms of immunization against typhoid fever in travelers who have not been previously exposed? Author recommendations: For adult travelers who have never been exposed to typhoid…

Evidence Synopsis

Title: Benefits of Measures to Prevent Venous Thromboembolism in People Undertaking Long-Haul Air Travel Date completed: May 14, 2015 Authors: Steven Lascher, DVM, PhD, MPH and David R. Goldmann, MD Clinical question: What are the benefits and harms of measures to prevent venous thromboembolism (VTE) in people undertaking long-haul air travel? Author recommendations: For healthy travelers who are planning a long-haul flight of more than 4…

Evidence Synopsis

Title: Use of Supplementary Oxygen in Patients with Chronic Respiratory or Cardiac Disease During Air Travel Date completed: March 19, 2015 Authors: Steven Lascher, DVM, PhD, MPH and David R. Goldmann, MD Clinical question: What are the benefits and harms of supplementary oxygen in patients with chronic respirator or cardiac disease during air travel? Author recommendations: For patients with diagnosed chronic cardiac (e.g., New York Heart…

Evidence Synopsis

Title: Automated External Defibrillators for Cardiac Arrest During Air Travel Date completed: March 31, 2015 Authors: Steven Lascher, DVM, PhD, MPH and David R. Goldmann, MD Clinical question: What are the benefits and harms of automated external defibrillators (AEDs) for cardiac arrest during air travel? Author recommendations: For travelers who suffer sudden cardiac arrest (SCA) at the airline terminal or in flight, a combination of cardiopulmonary…

Evidence Synopsis

Title: Benefits and Harms of Sunscreens to Decrease Ultraviolet Exposure from Sunlight Date completed: May 28, 2015 Authors: Steven Lascher, DVM, PhD, MPH and David R. Goldmann, MD Clinical question: What are the benefits and harms of sunscreens to decrease ultraviolet (UV) exposure from sunlight? You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are…

The Eosinophilic Patient with Suspected Parasitic Infection

Elevations of the peripheral blood absolute eosinophil count (>450 eosinophils/mm 3 ) can occur in a wide variety of clinical situations, including parasitic infections, allergic states, collagen vascular diseases, hypereosinophilic syndromes, and other miscellaneous disorders ( Table 49.1 ). The immunobiology of eosinophils is thoroughly described in Weller (1997). The absolute eosinophil count is a more reliable indicator of the presence of eosinophilia than is the…

Trematodes

The flukes, or trematodes, are long-lived parasites that can cause human disease by mechanical obstruction and by inciting local inflammatory responses in affected organs ( Table 48.1 ). Blood flukes ( Schistosoma spp.), hepatobiliary flukes ( Clonorchis sinensis , Opisthorchis spp., and Fasciola hepatica ), and lung flukes ( Paragonimus spp.) can be associated with major systemic pathology, whereas intestinal flukes ( Metagonimus yokogawai , Heterophyes…

Filarial Infections

Filarial worms are nematodes or roundworms that dwell in the subcutaneous tissues and the lymphatics. Although eight filarial species commonly infect humans, four are responsible for most of the pathology associated with these infections. These are (1) Brugia malayi , (2) Wuchereria bancrofti , (3) Onchocerca volvulus , and (4) Loa loa. The distribution and vectors of all the filarial parasites of humans are given in…

Cestodes: Intestinal and Extraintestinal Tapeworm Infections, Including Echinococcosis and Cysticercosis

Infections by cestodes (tapeworms, or flat, segmented worms) in the United States, Canada, and other affluent countries are rare but do occur in specific at-risk populations related to geographic, behavioral, or migration risk characteristics. Clinical suspicion is needed to detect quiescent infections or asymptomatic disease. Some of the tapeworms affecting humans are endemic in the United States, Canada, and other developed nations. Practically, these can be…

Common Intestinal Roundworms

General Considerations Medically important worms belonging to the phylum Nematoda (roundworms) parasitize the gastrointestinal tract of humans. It is estimated that 60% of the world population is infected with at least one intestinal helminth. The worms are commonly acquired through ingestion of contaminated food (especially raw or undercooked vegetables), through skin contact with contaminated soil, or, in some instances, from direct contact with infected persons or…

Genital Ulcer Disease

A genital ulcer is defined as a discrete mucosal or cutaneous discontinuity involving the genitals, perineum, or surrounding tissues. Genital ulcer disease (GUD) is an important risk factor for sexual acquisition and transmission of human immunodeficiency virus (HIV), and serious long-term sequelae can result from all causes of GUD. The etiologies of GUD vary geographically and are strongly associated with behavioral, demographic, and socioeconomic factors, in…

Syphilis

Syphilis results from infection with the spirochete Treponema pallidum . Transmission of syphilis occurs most often through sexual contact. Mother-to-infant transmission also occurs, and infection via blood transfusion is possible. Although T. pallidum induces strong humoral and cell-mediated immune responses, untreated infections can persist for decades. Epidemiology Syphilis is transmitted only through human-to-human contact; there is no animal or environmental reservoir. The World Health Organization (WHO)…

Gonococcal and Chlamydial Genital Infections and Pelvic Inflammatory Disease

Infections caused by Neisseria gonorrhoeae and Chlamydia trachomatis are the most common of the bacterial sexually transmitted infections (STIs). Since 1995, genital chlamydial infections have been the most frequently reported bacterial infection in the United States; for gonorrhea, continued emergence of antimicrobial resistance remains a major threat. This chapter reviews the global epidemiology of these two pathogens, their associated clinical syndromes, and current guidelines for their…

Sexually Transmitted Infections and Foreign Travel

Because sexually transmitted infections (STIs) are defined by their transmission from one person to another during sex, travel—with its attendant opportunities for new contacts—can facilitate the transmission of STIs in several ways. The number of international travelers has increased steadily in recent years, with a trend toward areas of the world endemic for STIs not frequently seen in the United States. This allows for the exposure…