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PLoS Neglected Tropical Diseases Apr 2019Central nervous system (CNS) melioidosis is rare. However, delayed diagnosis and treatment could lead to fatality. To identify knowledge of CNS melioidosis, we...
BACKGROUND
Central nervous system (CNS) melioidosis is rare. However, delayed diagnosis and treatment could lead to fatality. To identify knowledge of CNS melioidosis, we systematically review case reports and case series.
METHODOLOGY/PRINCIPAL FINDINGS
We searched through PubMed, Web of Science and Thai-Journal Citation Index databases as well as Google Scholar with the last date on July 10, 2018. The diagnosis of CNS melioidosis had to be confirmed with culture, serology or polymerase chain reaction. We excluded the animal cases and the studies that the clinical data were not available. We identified 1170 relevant studies, while 70 studies with a total of 120 patients were analyzed. Ninety-three percent of patients were reported from the endemic area of melioidosis. Median age was 40 years (IQR 18-53), and 70% were men. A total of 60% had one or more risk factors for melioidosis. The median duration from clinical onset to diagnosis was ten days (IQR 5-25). Fever (82%), headache (54%), unilateral weakness (57%) and cranial nerve deficits (52%) are among the prominent presentation. Most patient (67%) had at least one extraneurological organ involvement. The CSF profile mostly showed mononuclear pleocytosis (64%), high protein (93%) and normal glucose (66%). The rim-enhancing pattern (78%) is the most frequent neuroimaging finding in encephalomyelitis and brain abscess patients. Both brainstem (34%) and frontal lobe (34%) are the most affected locations. Mortality rate was 20%.
CONCLUSIONS/SIGNIFICANCE
This study is the most extensive systematic review of case reports and case series of CNS melioidosis in all age groups. However, the results should be cautiously interpreted due to the missing data issue. The propensity of brainstem involvement which correlates with prominent cranial nerve deficits is the characteristic of CNS melioidosis especially encephalomyelitis type. The presenting features of fever and neurological deficits (especially cranial nerve palsies) along with the mononuclear CSF pleocytosis in a patient who lives in the endemic area and also has the risk factor for melioidosis should raise the CNS melioidosis as the differential diagnosis.
Topics: Brain; Burkholderia pseudomallei; Central Nervous System Bacterial Infections; Diagnosis, Differential; Humans; Melioidosis
PubMed: 31022232
DOI: 10.1371/journal.pntd.0007320 -
Scientific Reports Oct 2022Malaria and pneumonia are the leading causes of childhood mortality in children under 5 years of age. Nevertheless, the proportions and deaths of malaria co-infection... (Meta-Analysis)
Meta-Analysis
Malaria and pneumonia are the leading causes of childhood mortality in children under 5 years of age. Nevertheless, the proportions and deaths of malaria co-infection among patients with severe pneumonia, particularly in children under 5 years of age, and characteristics of co-infection remain poorly explored. Hence, the present study aimed to collate the evidence of malaria among patients with severe pneumonia, severe pneumonia among patients with malaria, and the proportion of deaths among patients with co-infections. Potentially relevant studies were searched in six databases including PubMed, Scopus, Web of Science, Embase, Ovid, and MEDLINE to identify studies on malaria and severe pneumonia co-infections that were published until 21 July 2022 with a restriction for the non-English language but no restriction for the publication year. The quality of the included studies was determined using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). The pooled estimates, including the pooled proportion of malaria among patients with severe pneumonia, and the proportion of deaths among patients with co-infections, were estimated by the random-effects model. Of the 4094 studies examined, 11 studies that met the eligibility criteria were included in the review. Meta-analysis results showed that the proportion of malaria (2162 cases) among patients with severe pneumonia (9738 cases) was 19% (95% CI 12-26%, I: 98.79%, 11 studies). The proportion of severe pneumonia (546 cases) among patients with malaria (10,325 cases) was 20% (95% CI 0-40%, I: 99.48%, 4 studies). The proportion of deaths among patients with co-infection was 13% (95% CI 2-23%, I: 85.1%, 3 studies). In conclusion, nearly one-fifth of patients with severe pneumonia have malaria, one-fifth of patients with malaria have severe pneumonia, and about 13% of co-infections lead to deaths. This information raised the clinical importance of diagnosis and management of concurrent infections. Patients with severe pneumonia should be investigated for malaria, and vice versa. Detection of co-infections might provide the information to inform the physician to manage and cure co-infected patients who live in areas where both diseases were endemic.
Topics: Child; Child, Preschool; Coinfection; Humans; Malaria; Pneumonia
PubMed: 36243777
DOI: 10.1038/s41598-022-22151-x -
Transactions of the Royal Society of... Feb 2019Four out of five people in the world with diabetes now live in low- and middle-income countries (LMIC), and the incidence of diabetes is accelerating in poorer...
Four out of five people in the world with diabetes now live in low- and middle-income countries (LMIC), and the incidence of diabetes is accelerating in poorer communities. Diabetes increases susceptibility to infection and worsens outcomes for some of the world's major infectious diseases such as tuberculosis, melioidosis and dengue, but the relationship between diabetes and many neglected tropical diseases is yet to be accurately characterised. There is some evidence that chronic viral infections such as hepatitis B and HIV may predispose to the development of type 2 diabetes by chronic inflammatory and immunometabolic mechanisms. Helminth infections such as schistosomiasis may be protective against the development of diabetes, and this finding opens up new territory for discovery of novel therapeutics for the prevention and treatment of diabetes. A greater understanding of the impact of diabetes on risks and outcomes for infections causing significant diseases in LMIC is essential in order to develop vaccines and therapies for the growing number of people with diabetes at risk of infection, and to prioritise research agendas, public health interventions and policy. This review seeks to give an overview of the current international diabetes burden, the evidence for interactions between diabetes and infection, immune mechanisms for the interaction, and potential interventions to tackle the dual burden of diabetes and infection.
Topics: Communicable Diseases; Comorbidity; Developing Countries; Diabetes Mellitus, Type 2; Humans; Incidence; Parasitic Diseases; Poverty; Risk Factors
PubMed: 30517697
DOI: 10.1093/trstmh/try124 -
Journal of Infection and Public Health Jul 2024Burkholderia pseudomallei, a Gram-negative pathogen, causes melioidosis. Although various clinical laboratory identification methods exist, culture-based techniques lack... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Burkholderia pseudomallei, a Gram-negative pathogen, causes melioidosis. Although various clinical laboratory identification methods exist, culture-based techniques lack comprehensive evaluation. Thus, this systematic review and meta-analysis aimed to assess the diagnostic accuracy of culture-based automation and non-automation methods.
METHODS
Data were collected via PubMed/MEDLINE, EMBASE, and Scopus using specific search strategies. Selected studies underwent bias assessment using QUADAS-2. Sensitivity and specificity were computed, generating pooled estimates. Heterogeneity was assessed using I statistics.
RESULTS
The review encompassed 20 studies with 2988 B. pseudomallei samples and 753 non-B. pseudomallei samples. Automation-based methods, particularly with updating databases, exhibited high pooled sensitivity (82.79%; 95% CI 64.44-95.85%) and specificity (99.94%; 95% CI 98.93-100.00%). Subgroup analysis highlighted superior sensitivity for updating-database automation (96.42%, 95% CI 90.01-99.87%) compared to non-updating (3.31%, 95% CI 0.00-10.28%), while specificity remained high at 99.94% (95% CI 98.93-100%). Non-automation methods displayed varying sensitivity and specificity. In-house latex agglutination demonstrated the highest sensitivity (100%; 95% CI 98.49-100%), followed by commercial latex agglutination (99.24%; 95% CI 96.64-100%). However, API 20E had the lowest sensitivity (19.42%; 95% CI 12.94-28.10%). Overall, non-automation tools showed sensitivity of 88.34% (95% CI 77.30-96.25%) and specificity of 90.76% (95% CI 78.45-98.57%).
CONCLUSION
The study underscores automation's crucial role in accurately identifying B. pseudomallei, supporting evidence-based melioidosis management decisions. Automation technologies, especially those with updating databases, provide reliable and efficient identification.
Topics: Burkholderia pseudomallei; Melioidosis; Humans; Sensitivity and Specificity; Automation, Laboratory; Bacteriological Techniques; Automation
PubMed: 38820898
DOI: 10.1016/j.jiph.2024.04.022 -
The Indian Journal of Medical Research Oct 2018Although febrile illnesses are a frequent cause of consultation and hospitalization in low- and middle-income countries (LMICs), research has mainly focused on acute...
BACKGROUND & OBJECTIVES
Although febrile illnesses are a frequent cause of consultation and hospitalization in low- and middle-income countries (LMICs), research has mainly focused on acute febrile illnesses (AFIs). In contrast, there are limited data on the causes of persistent febrile illnesses (PFIs) in LMIC. Lack of clarity on the differential diagnosis of PFIs in the rural tropics leads to the absence of diagnostic guidance tools.
METHODS
In this study, a review of the potential causes of persistent fever defined as fever of more than seven days was done in Nepal, with a focus on nine pathogen-specific conditions. The current knowledge on their burden, distribution and diagnosis was summarized.
RESULTS
Limited data were found on the incidence and public health burden of leptospirosis, murine typhus and brucellosis due to the absence of diagnostic tools outside reference laboratories and the overlap of signs and symptoms with other febrile conditions. The incidence of malaria and visceral leishmaniasis (VL) was found to be decreasing in Nepal, with some changes of the geographical areas at risk.
INTERPRETATION & CONCLUSIONS
This review indicates a need for more research on the causes of PFIs in Nepal and in the region and for the development of clinical guidance tailored to current local epidemiology. Guidance tools should include specific clinical features (e.g. eschar), results of rapid diagnostic tests (e.g. malaria, VL), appropriate indications for more sophisticated tests (e.g. abdominal ultrasound, polymerase chain reaction) and recommendations for adequate use of empirical treatment.
Topics: Brucellosis; Fever; Gram-Negative Bacterial Infections; Humans; Incidence; Leishmaniasis, Visceral; Leptospirosis; Liver Abscess, Amebic; Malaria; Melioidosis; Nepal; Tuberculosis; Typhoid Fever; Typhus, Endemic Flea-Borne
PubMed: 30666001
DOI: 10.4103/ijmr.IJMR_505_18