Книги з теми "Leishmaniasis-Disease"

Leishmaniasis is a neglected infectious disease of great importance in the Region of the Americas because of its prevalence, wide geographical distribution, morbidity and mortality. Several species of Leishmania can cause disease, and the resulting presentations differ in their clinical manifestations, diagnostic signs, severity, and treatment responses. The three main forms of leishmaniasis disease are: cutaneous, mucosal or visceral, of which cutaneous leishmaniasis is the most common. Visceral leishmaniasis (caused by L. infantum) is the most severe form and can cause death in up to 90% of untreated people. In 2013, PAHO, with the support of the Spanish Agency for International Development Cooperation, developed recommendations for the treatment of leishmaniasis in the Americas using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Since that time, new evidence has accumulated necessitating a revision of these recommendations. This publication, the second edition of the treatment guidelines for the Americas, has been put together with the leadership of PAHO’s Regional Program for Leishmaniasis with the support of the World Health Organization. It presents updated therapeutic recommendations for all three major forms of leishmaniasis disease, detailing the schemes and criteria for indication of treatment in the regional context. There are several notable changes from the first edition. For cutaneous disease, ketoconazole has been removed from the list of treatment options. Evidence for thermotherapy and pentamidine isethionate has been upgraded to “conditional” from “weak” in the previous edition. The number of Leishmania species for which there is strong evidence of the effectiveness of miltefosine has increased from two to four. And the evidence for intralesional antimonials in this disease form is now strong, whereas previously it was considered weak. The evidence for treatments for mucosal leishmaniasis – which is now considered separately to cutaneous disease – has become stronger since the first analysis, with the recommendation for use of pentavalent antimonials with or without oral pentoxifylline now strong. For visceral disease, the evidence has moved in the other direction. Whereas in the first edition, the evidence was considered strong for pentavalent antimonials, amphotericina B deoxycholate, it is now conditional. For miltefosine, there is now strong evidence against its useage. Further changes include the division of recommendations by adult and pediatric populations and the addition of new specific recommendations for immunocompromised patients that were not available in the first edition, including a strong recommendation against the use of pentavalent antimonials.

Visceral leishmaniasis, also known as kala-azar, has an insidious onset with constitutional features. Subsequently the intense parasitism of the reticuloendothelial system causes hepatosplenomegaly, anaemia, leucopenia, and thrombocytopaenia as well as hypergammaglobulinaemia. Kidney involvement manifests with proteinuria up to 1 g/24 hours, micro/macrohaematuria, and leucocyturia. Kidney involvement is generally mild and reversible with the treatment of infection. Biopsy appearances of diffuse proliferative glomerulonephritis, mesangial proliferation, and occasionally focal necrotizing glomerulonephritis with crescents have been described. Defects of urinary concentration and acidification have also been observed. Acute kidney injury (AKI) may be seen in one-third of patients and is associated with increased mortality.Trypanosomiasis has two forms. It causes sleeping sickness in Africa (T. brucei, transmitted by tsetse flies) or Chagas disease in South America (T. cruzei, transmitted by reduvid bugs). There is no direct association of these conditions with nephropathy, although there is in experimental models. AKI may occur, typically as a manifestation of multi-organ failure in African trypanosomiasis. APOL1 genotypes that confer susceptibility to FSGS are protective against T. brucei infection.

In the Region of the Americas, the leishmaniases are a group of diseases caused by various species of Leishmania, which cause a set of clinical syndromes in infected humans that can involve the skin, mucosa, and visceral organs. The spectrum of clinical disease is varied and depends on the interaction of several factors related to the parasite, the vector, and the host. Cutaneous leishmaniasis is the form most frequently reported in the Region and nearly 90% of cases present single or multiple localized lesions. Other cutaneous clinical forms, such as disseminated and diffuse cutaneous leishmaniasis, are more difficult to treat and relapses are common. The mucosal form is serious because it can cause disfigurement and severe disability if not diagnosed and treated early on. Visceral leishmaniasis is the most severe form, as it can cause death in up to 90% of untreated people. In the Americas, clinical differences can be frequently found between endemic countries, mainly in the cutaneous form. Furthermore, many other diseases can be confused clinically with the different presentations of leishmaniasis and this is one of the greatest challenges for diagnosticians of the disease, who must also be aware of epidemiological reports and the patient’s clinical history. This Interactive Atlas of Leishmaniasis in the Americas: Clinical Aspects and Differential Diagnosis is a joint effort of the Pan American Health Organization, experts on this subject, and other collaborators, with support from the Federico Lleras Acosta University Hospital Dermatology Center of Colombia and the health ministries of the countries of the Region. This is an important and innovative publication that takes a practical approach to the subject, allowing professionals to interactively search for and study photographs and illustrations that reflect their daily work in the health services. The atlas discusses the main concepts and knowledge about leishmaniasis in the Americas, illustrating the clinical situation of these diseases in 10 endemic countries, through 1,029 photographs and illustrations that can be viewed on smartphones, tablets, and desktop or laptop computers. We believe the material will be valuable for all students and professionals at all levels of health care, including those in other continents, when treating patients infected in the Americas.

This chapter describes infectious diseases, including common types of microbes (bacteria, viruses, fungi, protozoa, helminths) and antimicrobial agents (antibacterial, antiviral, and antifungal agents), as well as some common systemic infectious diseases such as human immunodeficiency virus (HIV), tuberculosis (TB), infectious mononucleosis, malaria, syphilis, Lyme disease, and leishmaniasis.