Polymorphisme parasitaire et accès graves en zone périurbaine - Conférence de la 5e édition du Cours international « Atelier Paludisme » - Ronan JAMBOU - Institut Pasteur de Dakar - rjambou@pasteur.sn
This lecture discusses principles of selecting antifungal agents in the intensive care unit in the treatment of suspected candidasis or confirmed fungemia.
This case report describes an immunocompetent 30-year-old male patient who presented with widespread painful skin lesions and uveitis of the right eye. Laboratory tests initially were negative for syphilis but later tested positive, confirming the diagnosis of early malignant syphilis. Malignant syphilis is an uncommon form of secondary syphilis typically seen in immunocompromised individuals. However, this report describes the second known case of an immunocompetent patient presenting with both skin and ocular involvement. The patient was treated with intravenous ceftriaxone for 14 days and experienced an excellent clinical response.
The document discusses invasive fungal infections in critically ill patients. It notes that these infections have increased due to factors like immunosuppression from medical therapies. Common fungal pathogens include Candida species and Aspergillus. Diagnosis can be challenging as cultures often have low sensitivity. Biomarkers like galactomannan and beta-D-glucan can help but have limitations. Early treatment with antifungals is important to reduce mortality, though choice of agent depends on individual patient and infecting organism factors. Fungal infections should be considered in critically ill patients with persistent fever despite antibiotics.
Fungal infections in hematology patients: advances in prophylaxis and treatmentspa718
This document summarizes advances in prophylaxis and treatment of fungal infections in hematology patients. It discusses risk stratification approaches and various randomized controlled trials comparing different antifungal agents for prophylaxis. Trials showed posaconazole, micafungin, and voriconazole reduced incidence of invasive fungal infections compared to fluconazole or itraconazole in high-risk patients. The document also reviews empirical antifungal therapy approaches and measures of success in clinical trials comparing liposomal amphotericin B, voriconazole, and caspofungin.
The document discusses principles for antibiotic use in critically ill patients, including:
1) Starting with broad-spectrum empiric therapy based on local microbiological data and guidelines.
2) Reassessing and de-escalating treatment based on culture results and the patient's clinical response.
3) Factors that increase the risk of resistant pathogens like hospital-acquired infections require broader initial coverage.
The document discusses HIV/AIDS and cryptococcal meningitis. It provides information on HIV/AIDS including that it is caused by the HIV virus and weakens the immune system. It then discusses cryptococcal meningitis as an opportunistic infection, describing its symptoms. The remainder of the document discusses a case of a 45-year-old male patient admitted with fever, vomiting and headache who is diagnosed with cryptococcal meningitis and treated with antifungal drugs like amphotericin B and fluconazole.
This document outlines objectives and content for a case presentation on cryptococcal meningitis. The objectives are to discuss global statistics on cryptococcal meningitis, the pathophysiology of the disease, signs and symptoms, and medical and nursing management. The document then provides definitions of cryptococcal meningitis and related terms. It also shares some facts about cryptococcal meningitis and its relationship to AIDS.
A 45-year-old woman's blood donation tested repeatedly reactive for HIV-1 on an enzyme immunoassay but had a negative Western blot. She has no risk factors for HIV and had a similar test result 1 year ago. The best advice is to inform her that HIV infection is unlikely given her negative Western blot and lack of risk factors.
This lecture discusses principles of selecting antifungal agents in the intensive care unit in the treatment of suspected candidasis or confirmed fungemia.
This case report describes an immunocompetent 30-year-old male patient who presented with widespread painful skin lesions and uveitis of the right eye. Laboratory tests initially were negative for syphilis but later tested positive, confirming the diagnosis of early malignant syphilis. Malignant syphilis is an uncommon form of secondary syphilis typically seen in immunocompromised individuals. However, this report describes the second known case of an immunocompetent patient presenting with both skin and ocular involvement. The patient was treated with intravenous ceftriaxone for 14 days and experienced an excellent clinical response.
The document discusses invasive fungal infections in critically ill patients. It notes that these infections have increased due to factors like immunosuppression from medical therapies. Common fungal pathogens include Candida species and Aspergillus. Diagnosis can be challenging as cultures often have low sensitivity. Biomarkers like galactomannan and beta-D-glucan can help but have limitations. Early treatment with antifungals is important to reduce mortality, though choice of agent depends on individual patient and infecting organism factors. Fungal infections should be considered in critically ill patients with persistent fever despite antibiotics.
Fungal infections in hematology patients: advances in prophylaxis and treatmentspa718
This document summarizes advances in prophylaxis and treatment of fungal infections in hematology patients. It discusses risk stratification approaches and various randomized controlled trials comparing different antifungal agents for prophylaxis. Trials showed posaconazole, micafungin, and voriconazole reduced incidence of invasive fungal infections compared to fluconazole or itraconazole in high-risk patients. The document also reviews empirical antifungal therapy approaches and measures of success in clinical trials comparing liposomal amphotericin B, voriconazole, and caspofungin.
The document discusses principles for antibiotic use in critically ill patients, including:
1) Starting with broad-spectrum empiric therapy based on local microbiological data and guidelines.
2) Reassessing and de-escalating treatment based on culture results and the patient's clinical response.
3) Factors that increase the risk of resistant pathogens like hospital-acquired infections require broader initial coverage.
The document discusses HIV/AIDS and cryptococcal meningitis. It provides information on HIV/AIDS including that it is caused by the HIV virus and weakens the immune system. It then discusses cryptococcal meningitis as an opportunistic infection, describing its symptoms. The remainder of the document discusses a case of a 45-year-old male patient admitted with fever, vomiting and headache who is diagnosed with cryptococcal meningitis and treated with antifungal drugs like amphotericin B and fluconazole.
This document outlines objectives and content for a case presentation on cryptococcal meningitis. The objectives are to discuss global statistics on cryptococcal meningitis, the pathophysiology of the disease, signs and symptoms, and medical and nursing management. The document then provides definitions of cryptococcal meningitis and related terms. It also shares some facts about cryptococcal meningitis and its relationship to AIDS.
A 45-year-old woman's blood donation tested repeatedly reactive for HIV-1 on an enzyme immunoassay but had a negative Western blot. She has no risk factors for HIV and had a similar test result 1 year ago. The best advice is to inform her that HIV infection is unlikely given her negative Western blot and lack of risk factors.
This document discusses several primary immunodeficiencies including agammaglobulinemia, common variable immunodeficiency, and selective IgA deficiency. It provides information on the epidemiology, pathophysiology, clinical manifestations, diagnosis, and treatment of each condition. Key points include that agammaglobulinemia is caused by mutations in the BTK gene that halt B cell development, common variable immunodeficiency has unknown causes in most cases, and selective IgA deficiency involves a block in differentiation of B cells into IgA secreting plasma cells. Clinical features often involve recurrent respiratory and gastrointestinal infections. Treatment focuses on antibody replacement therapy and infection prophylaxis.
Primary immune deficiency diseases( PID) comprise a heterogeneous group of genetic disorders that affects distinct components of the innate and adaptive immune system such as:
-neutrophils
-macrphages
-dendritic cells
-natural killer cells
-T and B lymphocytes
-complement components
More than 200 distinct PID disorders have been identified and 276 gene have been associated with these diseases.
Spectrum of these diseases can vary from mild presentation to lethal disorders. Lethality is due to increase susceptibility to infections and malignancies.
This document discusses the antifungal drug micafungin. It inhibits fungal cell wall synthesis and has activity against Candida and Aspergillus species. The document reviews micafungin's approved uses, dosing, safety profile, and a study evaluating its use at a hospital which found it was being used appropriately in most patients according to predetermined criteria for antifungal therapy. The study recommends continued restrictions on prescribing and improved documentation of infections and drug choice.
This document discusses diagnosis of AIDS and HIV infection. It covers several key points:
1. AIDS is a global pandemic that affects all regions of the world. Accurate diagnosis is important for treatment and prevention of further transmission.
2. Both screening and confirmatory tests are needed to properly diagnose HIV/AIDS. Common screening tests include ELISA, while Western Blot is the gold standard confirmatory test.
3. Molecular tests like PCR and viral load tests can detect HIV even earlier than antibody tests, but are more expensive. CD4 counts are also useful for assessing disease progression.
This document discusses masquerade syndromes in allergic diseases. It describes how primary immunodeficiencies (PIDs) can often present with symptoms that mimic common allergic conditions like eczema. Two examples of PIDs that frequently masquerade as allergies are discussed in detail - Omenn syndrome, a rare form of severe combined immunodeficiency that typically appears in infancy as erythroderma and diarrhea; and IPEX syndrome, an X-linked condition causing diarrhea, polyendocrinopathy, and fatal infections in male infants. The document emphasizes that a PID should be considered for patients with allergic-like symptoms that are treatment-resistant or associated with unusual clinical features.
An approach to the patient with suspected immune deficiencyFawzia Abo-Ali
1) The document discusses various cases of patients presenting with recurrent infections. It evaluates their clinical history, lab results, and diagnoses various primary immunodeficiencies including deficiencies in B-cell immunity, T-cell immunity, phagocytic defects, complement deficiencies, and leukocyte adhesion deficiency.
2) It also provides details on specific cases, such as a patient with low IgG, IgA presenting with sinusitis and pneumonia who is diagnosed with a B-cell deficiency. Another case involves a patient with recurrent hepatic abscesses and a family history of infections who has chronic granulomatous disease.
3) The document emphasizes that primary immunodeficiencies can present with recurrent, unusual or severe infections and
This document discusses antifungal drugs used to treat invasive fungal infections in the intensive care unit (ICU). It covers the epidemiology of fungal infections, the mechanisms and targets of different antifungal drug classes, resistance mechanisms, side effects and drug interactions. It reviews the evidence for different antifungal therapies and discusses expert opinions on the use of echinocandins to treat invasive candidiasis in ICU patients.
Clinical cases from infection diseases hospital, part 3drandreyst-p
Presentation shows some real cases from infection diseases hospital and allow you to challenge your knowledge in medicine. After presentation of each case you will see a slide with a question about diagnosis. Try to answer and if you would have problems go to next slide where you will find a hint. Goodluck! If you would interested in new cases please contact Dr Andrey Dyachkov cd4@inbox.ru
This document provides an overview of hyper IgE syndrome (HIES). It discusses the two main classifications of HIES - autosomal dominant (AD-HIES) and autosomal recessive (AR-HIES). AD-HIES is caused by mutations in the STAT3 gene and is characterized by eczema, respiratory infections, and elevated IgE levels, as well as skeletal and connective tissue abnormalities. AR-HIES can be caused by mutations in DOCK8, TYK2, PGM3, or other genes. It presents similarly to AD-HIES immunologically but without skeletal features. Laboratory findings include elevated IgE, eosinophilia, and lymphopenia. Management involves treatment
Wiskott-Aldrich Syndrome is a rare X-linked immunodeficiency disease characterized by immunodeficiency, thrombocytopenia, and eczema. It is caused by mutations in the WAS protein gene which regulates actin cytoskeleton organization. This leads to defects in T-cells and B-cells, recurrent infections, bleeding issues, and increased cancer risk. The only cure is hematopoietic stem cell transplant from a matched sibling donor, while treatment focuses on antibiotics, platelet transfusions, and IVIG for antibody replacement.
This document provides a summary of key information about primary care approaches to treating HIV patients, including:
1) It discusses the history and epidemiology of HIV, modes of transmission, clinical presentations to different specialists, treatment with HAART, and baseline evaluations prior to treatment initiation.
2) Primary care providers should offer ART to patients with CD4 counts <200 or symptoms, consider treatment for counts 200-350, and can defer for asymptomatic patients with counts >350 and low viral loads.
3) When initiating ART, providers should evaluate readiness, ensure adherence, perform baseline testing, and select preferred first-line regimens consisting of 2 NRTIs combined with an NNRTI or PI.
Clinical cases from infection diseases hospitaldrandreyst-p
Presentation shows some real cases from infection diseases hospital and allow you to challenge your knowledge in medicine. After presentation of each case you will see a slide with a question about diagnosis. Try to answer and if you would have problems go to next slide where you will find a hint. Goodluck! If you would interested in new cases please contact Dr Andrey Dyachkov cd4@inbox.ru
Laboratory investigation of dengue in Jeddahhosammadani
The document discusses laboratory diagnosis of dengue hemorrhagic fever. It describes dengue virus characteristics and various diagnostic techniques used including virus isolation, serological tests like ELISA and hemagglutination inhibition, and molecular detection of dengue virus RNA through reverse transcription PCR. It provides details of specific diagnostic tests and procedures used at the Jeddah Regional Laboratory.
Neutropenic fever : Challenges and Treatmentspa718
1) Gram-negative bacteria, especially Pseudomonas aeruginosa and Escherichia coli, are the major causes of neutropenic fever in Asia.
2) Antimicrobial resistance rates of bacteria causing neutropenic fever vary significantly by region and hospital. Regular monitoring of local resistance patterns is needed to guide empirical antibiotic selection.
3) Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae bloodstream infections are associated with worse outcomes in neutropenic patients compared to non-ESBL infections. Prior hospitalization and prolonged antibiotic use increase the risk of ESBL bacteremia.
1. Chronic HCV infection can lead to increased mortality from both hepatic and extrahepatic diseases such as liver cancer, cardiovascular disease, and kidney disease.
2. HCV infection is associated with a variety of autoimmune manifestations and lymphoproliferative disorders, most notably mixed cryoglobulinemia vasculitis.
3. Treatment of HCV infection with direct-acting antivirals or pegylated interferon/ribavirin can result in remission of extrahepatic manifestations by achieving sustained virological response.
This document summarizes cryptococcal meningitis, a fungal infection of the membranes surrounding the brain and spinal cord that is common in people with HIV/AIDS. It describes the causative organism, Cryptococcus neoformans, and outlines the clinical presentation, diagnosis, and treatment of cryptococcal meningitis. The treatment involves amphotericin B and flucytosine initially, followed by long-term fluconazole therapy and antiretroviral treatment once the patient's CD4 count recovers. Prevention strategies include screening high-risk HIV patients and treating asymptomatic cryptococcal infections before starting antiretroviral therapy.
This document summarizes guidelines for the evaluation and management of fever in neutropenic patients. It discusses the initial evaluation, appropriate antimicrobial therapy including both combination regimens and monotherapy options. It also addresses criteria for adding antifungal therapy if fever persists after initial treatment and antibiotics.
Chronic allograft nephropathy (CAN) is a poorly understood condition characterized by slow progressive loss of kidney function in transplant recipients. It is caused by multiple factors including chronic rejection mediated by both antibody and T cell responses, as well as non-immune causes like CNI toxicity, hypertension, and viral infections. Risk factors include acute rejection episodes, older donor age, deceased donation, DGF, and non-adherence to immunosuppression. The diagnosis relies on biopsy demonstrating interstitial fibrosis and tubular atrophy without another identifiable cause. Treatment focuses on optimization of immunosuppression and management of risk factors.
Protection conférée par l'hémoglobine C contre les formes neurologiques du paludisme en Afrique - Conférence de la 4e édition du Cours international « Atelier Paludisme » - Ogobara K. DOUMBO - Malaria Research and Training Center DEAP/FMPOS/University of Bamako - Mali - okd@mrtcbko.org
Tests in vitro de l'action inhibitrice de la croissance de P. falciparum par les antipaludiques - Séances pratiques de la 4e édition du Cours international « Atelier Paludisme » - Milijaona RANDRIANARIVELO JOSIA - Institut Pasteur de Madagascar - milijaon@pasteur.mg
Phase hépathique - Présentationde la 2e édition du Cours international « Atelier Paludisme » - ANDRIANANTOANDRO Vololomboahangy - MINISTERE de la SANTE et du PLANNING FAMILIAL de MADAGASCAR - Responsable Paludisme, DPS Tamatave - andriboahangy@yahoo.fr
This document discusses several primary immunodeficiencies including agammaglobulinemia, common variable immunodeficiency, and selective IgA deficiency. It provides information on the epidemiology, pathophysiology, clinical manifestations, diagnosis, and treatment of each condition. Key points include that agammaglobulinemia is caused by mutations in the BTK gene that halt B cell development, common variable immunodeficiency has unknown causes in most cases, and selective IgA deficiency involves a block in differentiation of B cells into IgA secreting plasma cells. Clinical features often involve recurrent respiratory and gastrointestinal infections. Treatment focuses on antibody replacement therapy and infection prophylaxis.
Primary immune deficiency diseases( PID) comprise a heterogeneous group of genetic disorders that affects distinct components of the innate and adaptive immune system such as:
-neutrophils
-macrphages
-dendritic cells
-natural killer cells
-T and B lymphocytes
-complement components
More than 200 distinct PID disorders have been identified and 276 gene have been associated with these diseases.
Spectrum of these diseases can vary from mild presentation to lethal disorders. Lethality is due to increase susceptibility to infections and malignancies.
This document discusses the antifungal drug micafungin. It inhibits fungal cell wall synthesis and has activity against Candida and Aspergillus species. The document reviews micafungin's approved uses, dosing, safety profile, and a study evaluating its use at a hospital which found it was being used appropriately in most patients according to predetermined criteria for antifungal therapy. The study recommends continued restrictions on prescribing and improved documentation of infections and drug choice.
This document discusses diagnosis of AIDS and HIV infection. It covers several key points:
1. AIDS is a global pandemic that affects all regions of the world. Accurate diagnosis is important for treatment and prevention of further transmission.
2. Both screening and confirmatory tests are needed to properly diagnose HIV/AIDS. Common screening tests include ELISA, while Western Blot is the gold standard confirmatory test.
3. Molecular tests like PCR and viral load tests can detect HIV even earlier than antibody tests, but are more expensive. CD4 counts are also useful for assessing disease progression.
This document discusses masquerade syndromes in allergic diseases. It describes how primary immunodeficiencies (PIDs) can often present with symptoms that mimic common allergic conditions like eczema. Two examples of PIDs that frequently masquerade as allergies are discussed in detail - Omenn syndrome, a rare form of severe combined immunodeficiency that typically appears in infancy as erythroderma and diarrhea; and IPEX syndrome, an X-linked condition causing diarrhea, polyendocrinopathy, and fatal infections in male infants. The document emphasizes that a PID should be considered for patients with allergic-like symptoms that are treatment-resistant or associated with unusual clinical features.
An approach to the patient with suspected immune deficiencyFawzia Abo-Ali
1) The document discusses various cases of patients presenting with recurrent infections. It evaluates their clinical history, lab results, and diagnoses various primary immunodeficiencies including deficiencies in B-cell immunity, T-cell immunity, phagocytic defects, complement deficiencies, and leukocyte adhesion deficiency.
2) It also provides details on specific cases, such as a patient with low IgG, IgA presenting with sinusitis and pneumonia who is diagnosed with a B-cell deficiency. Another case involves a patient with recurrent hepatic abscesses and a family history of infections who has chronic granulomatous disease.
3) The document emphasizes that primary immunodeficiencies can present with recurrent, unusual or severe infections and
This document discusses antifungal drugs used to treat invasive fungal infections in the intensive care unit (ICU). It covers the epidemiology of fungal infections, the mechanisms and targets of different antifungal drug classes, resistance mechanisms, side effects and drug interactions. It reviews the evidence for different antifungal therapies and discusses expert opinions on the use of echinocandins to treat invasive candidiasis in ICU patients.
Clinical cases from infection diseases hospital, part 3drandreyst-p
Presentation shows some real cases from infection diseases hospital and allow you to challenge your knowledge in medicine. After presentation of each case you will see a slide with a question about diagnosis. Try to answer and if you would have problems go to next slide where you will find a hint. Goodluck! If you would interested in new cases please contact Dr Andrey Dyachkov cd4@inbox.ru
This document provides an overview of hyper IgE syndrome (HIES). It discusses the two main classifications of HIES - autosomal dominant (AD-HIES) and autosomal recessive (AR-HIES). AD-HIES is caused by mutations in the STAT3 gene and is characterized by eczema, respiratory infections, and elevated IgE levels, as well as skeletal and connective tissue abnormalities. AR-HIES can be caused by mutations in DOCK8, TYK2, PGM3, or other genes. It presents similarly to AD-HIES immunologically but without skeletal features. Laboratory findings include elevated IgE, eosinophilia, and lymphopenia. Management involves treatment
Wiskott-Aldrich Syndrome is a rare X-linked immunodeficiency disease characterized by immunodeficiency, thrombocytopenia, and eczema. It is caused by mutations in the WAS protein gene which regulates actin cytoskeleton organization. This leads to defects in T-cells and B-cells, recurrent infections, bleeding issues, and increased cancer risk. The only cure is hematopoietic stem cell transplant from a matched sibling donor, while treatment focuses on antibiotics, platelet transfusions, and IVIG for antibody replacement.
This document provides a summary of key information about primary care approaches to treating HIV patients, including:
1) It discusses the history and epidemiology of HIV, modes of transmission, clinical presentations to different specialists, treatment with HAART, and baseline evaluations prior to treatment initiation.
2) Primary care providers should offer ART to patients with CD4 counts <200 or symptoms, consider treatment for counts 200-350, and can defer for asymptomatic patients with counts >350 and low viral loads.
3) When initiating ART, providers should evaluate readiness, ensure adherence, perform baseline testing, and select preferred first-line regimens consisting of 2 NRTIs combined with an NNRTI or PI.
Clinical cases from infection diseases hospitaldrandreyst-p
Presentation shows some real cases from infection diseases hospital and allow you to challenge your knowledge in medicine. After presentation of each case you will see a slide with a question about diagnosis. Try to answer and if you would have problems go to next slide where you will find a hint. Goodluck! If you would interested in new cases please contact Dr Andrey Dyachkov cd4@inbox.ru
Laboratory investigation of dengue in Jeddahhosammadani
The document discusses laboratory diagnosis of dengue hemorrhagic fever. It describes dengue virus characteristics and various diagnostic techniques used including virus isolation, serological tests like ELISA and hemagglutination inhibition, and molecular detection of dengue virus RNA through reverse transcription PCR. It provides details of specific diagnostic tests and procedures used at the Jeddah Regional Laboratory.
Neutropenic fever : Challenges and Treatmentspa718
1) Gram-negative bacteria, especially Pseudomonas aeruginosa and Escherichia coli, are the major causes of neutropenic fever in Asia.
2) Antimicrobial resistance rates of bacteria causing neutropenic fever vary significantly by region and hospital. Regular monitoring of local resistance patterns is needed to guide empirical antibiotic selection.
3) Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae bloodstream infections are associated with worse outcomes in neutropenic patients compared to non-ESBL infections. Prior hospitalization and prolonged antibiotic use increase the risk of ESBL bacteremia.
1. Chronic HCV infection can lead to increased mortality from both hepatic and extrahepatic diseases such as liver cancer, cardiovascular disease, and kidney disease.
2. HCV infection is associated with a variety of autoimmune manifestations and lymphoproliferative disorders, most notably mixed cryoglobulinemia vasculitis.
3. Treatment of HCV infection with direct-acting antivirals or pegylated interferon/ribavirin can result in remission of extrahepatic manifestations by achieving sustained virological response.
This document summarizes cryptococcal meningitis, a fungal infection of the membranes surrounding the brain and spinal cord that is common in people with HIV/AIDS. It describes the causative organism, Cryptococcus neoformans, and outlines the clinical presentation, diagnosis, and treatment of cryptococcal meningitis. The treatment involves amphotericin B and flucytosine initially, followed by long-term fluconazole therapy and antiretroviral treatment once the patient's CD4 count recovers. Prevention strategies include screening high-risk HIV patients and treating asymptomatic cryptococcal infections before starting antiretroviral therapy.
This document summarizes guidelines for the evaluation and management of fever in neutropenic patients. It discusses the initial evaluation, appropriate antimicrobial therapy including both combination regimens and monotherapy options. It also addresses criteria for adding antifungal therapy if fever persists after initial treatment and antibiotics.
Chronic allograft nephropathy (CAN) is a poorly understood condition characterized by slow progressive loss of kidney function in transplant recipients. It is caused by multiple factors including chronic rejection mediated by both antibody and T cell responses, as well as non-immune causes like CNI toxicity, hypertension, and viral infections. Risk factors include acute rejection episodes, older donor age, deceased donation, DGF, and non-adherence to immunosuppression. The diagnosis relies on biopsy demonstrating interstitial fibrosis and tubular atrophy without another identifiable cause. Treatment focuses on optimization of immunosuppression and management of risk factors.
Protection conférée par l'hémoglobine C contre les formes neurologiques du paludisme en Afrique - Conférence de la 4e édition du Cours international « Atelier Paludisme » - Ogobara K. DOUMBO - Malaria Research and Training Center DEAP/FMPOS/University of Bamako - Mali - okd@mrtcbko.org
Tests in vitro de l'action inhibitrice de la croissance de P. falciparum par les antipaludiques - Séances pratiques de la 4e édition du Cours international « Atelier Paludisme » - Milijaona RANDRIANARIVELO JOSIA - Institut Pasteur de Madagascar - milijaon@pasteur.mg
Phase hépathique - Présentationde la 2e édition du Cours international « Atelier Paludisme » - ANDRIANANTOANDRO Vololomboahangy - MINISTERE de la SANTE et du PLANNING FAMILIAL de MADAGASCAR - Responsable Paludisme, DPS Tamatave - andriboahangy@yahoo.fr
Génétique de la susceptibilité au paludisme: possibles approches épidemiologiques sur le terrain - Présentation de la 1ere édition du Cours international « Atelier Paludisme » - MODIANO David - Università "La Sapienza", Rome - david.modiano@uniroma1.it
Quel apport l'utilisation d'un vaccin peut-elle apporter dans la lutte contre le paludisme ? - Présentation de la 4e édition du Cours international « Atelier Paludisme » - Germaine RETOFA - Médecin - Ministère de la Santé et du Planning Familial - Service de Lutte Contre le Paludisme - Madagascar
This document summarizes key mutations in the PfCRT transmembrane protein that are associated with chloroquine resistance in Plasmodium falciparum. It identifies 10 mutation sites, including K76T, A220S, N326D, I356T, and R371I. These mutations are located in different transmembrane domains and confer different levels of chloroquine resistance when present individually or in combination. Studies have found that the K76T mutation is most strongly associated with clinical resistance while other mutations can modulate the level of resistance.
Quel est l'impact de l'interaction entre les espèces de Plasmodium sur la transmission? - Présentation de la 7e édition du Cours international « Atelier Paludisme » - Gaye Abdoulaye - Sénégal - ablayeg@yahoo.fr
Reemergence of chloroquine susceptible malaria in Malawi - Séances pratiques de la 4e édition du Cours international « Atelier Paludisme » - Christopher PLOWE - University of Maryland School of Medicine - Baltimore - MD 21201 USA - Cplowe@medicine.umaryland.edu
This document provides information on the clinical management of Dengue Syndrome. It discusses dengue facts, pathophysiology, immunopathogenesis, clinical presentations and classifications. It describes the case definitions for dengue fever, dengue hemorrhagic fever and dengue shock syndrome. It also outlines the differential diagnosis, appropriate laboratory investigations, approach to management, and guidelines for home care versus hospital admission.
The document provides an outline on HIV pathophysiology, epidemiology, clinical manifestations, and treatment. It discusses how HIV causes immunosuppression leading to opportunistic infections affecting the respiratory, cardiac, neurological, ophthalmological, gastrointestinal, and renal systems. Common opportunistic infections include Pneumocystis jirovecii pneumonia, tuberculosis, toxoplasmosis, cryptococcosis, and cytomegalovirus retinitis. Treatment involves antiretroviral therapy and prophylaxis depending on CD4 count. Health care providers need to consider acute HIV infection and opportunistic diseases in patients presenting with related symptoms.
This document discusses infections in immunocompromised patients. It begins by describing the various microbes that can cause infection, including bacteria, parasites, fungi and viruses. It then discusses the different types of underlying immune defects that determine infection risk, such as humoral versus cell-mediated defects. The document outlines various factors that influence the risk of infection, including the level of immunosuppression, transplant organ, graft-versus-host disease, exposures, and immune-modulating medications. It presents several case examples of infections in immunocompromised patients.
Plasmodium vivax, un parasite pas si banal - Séances Pratiques de la 5e édition du Cours international « Atelier Paludisme » - Stéphane PICOT - Hôpital E. Herriot, Lyon, France - picot@rockefeller.univ-lyon1.fr
Dengue fever is a prevalent mosquito-borne illness caused by dengue virus and transmitted by Aedes aegypti mosquitoes. It affects over 100 countries and causes 50-100 million infections annually. The disease presentation varies from a nonspecific viral syndrome to severe dengue hemorrhagic fever/dengue shock syndrome. There is no vaccine currently available and treatment involves supportive care, with careful fluid management needed for severe cases to prevent shock. Prevention relies on personal protection from mosquito bites and reducing mosquito breeding sites.
Key Slides on ART for HIV : Evolving Concepts and Innovative Strategies.2020hivlifeinfo
Expert-authored slides on evolving ART concepts, including simplification to 2-drug therapy, ART safety during pregnancy, weight gain, and long-acting injectable ART.
File Size: 580 KB
Released: October 20, 2020
Watch the video of the presentation on Youtube: https://www.youtube.com/watch?v=WRegqg5yvRs
El Dr Welte té nombroses publicacions en àrees diverses relacionades amb el malalt crític. Particularment interessants són els seus estudis en relació al trasplantament pulmonar, així com els seus estudis sobre pneumònia i sèpsia. Així mateix, participa activament en la xarxa alemanya Capnetz, emprada per a l'elaboració d'estudis multicèntrics relacionats amb la pneumònia adquirida a la comunitat.
This document provides information about community acquired bacterial meningitis in adults. It discusses the changing epidemiology, pathogens, pathogenesis, diagnosis, and treatment guidelines. The key points are:
1) Since the introduction of vaccines for H. influenzae and S. pneumoniae, there has been a 90% reduction in H. influenzae infections and the median age of meningitis cases has increased to 39 years old.
2) Common pathogens include S. pneumoniae, N. meningitidis, Listeria monocytogenes, and gram-negative bacilli. Mortality is highest in those over 65.
3) Treatment guidelines recommend dexamethasone be administered with the first dose of antibiotics to
This document discusses central nervous system (CNS) infections such as meningitis and encephalitis. It defines the conditions and outlines their typical causes, signs and symptoms, diagnostic testing including lumbar puncture, and treatment considerations. The most common types of bacterial meningitis are caused by Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. Diagnosis involves imaging, blood and cerebrospinal fluid testing and analysis.
The document provides an overview of HIV and AIDS, including epidemiology, transmission, pathophysiology, stages of disease, manifestations, treatment, and nursing care considerations. It covers topics such as how HIV attacks and replicates in the body, common opportunistic infections associated with AIDS, antiretroviral treatment options, and the nurse's role in managing infections, nutrition, and psychosocial support for patients living with HIV/AIDS.
PPT Bonora "Clinica e terapia dell'HIV"StopTb Italia
The document discusses the clinical management of HIV infection and lessons from anti-tuberculosis therapy. It notes that combination antiretroviral therapy is effective at suppressing HIV due to its ability to prevent the selection of drug-resistant strains, in contrast to less effective single-drug regimens. Over time, combination therapy has resulted in more HIV-infected individuals achieving sufficient immune recovery to approach the life expectancy of the general population. However, non-AIDS comorbidities have become more prevalent as the HIV-infected population ages.
Bacterial meningitis remains a serious disease in adults, with S. pneumoniae and N. meningitidis causing the majority of cases. The initial approach involves assessing for the classic triad of symptoms, but lumbar puncture may be deferred if neuroimaging is warranted due to concerns for mass lesions or decreased consciousness. Empiric antibiotic therapy should begin as soon as possible, often in combination with vancomycin and dexamethasone, which reduces mortality and morbidity when given early in treatment. Outcomes depend on severity of symptoms and causative organism, with pneumococcal meningitis carrying the highest fatality and long-term complication rates.
HIV - AIDS. Associated Infections and InvasionsEneutron
This document provides information on various infectious diseases associated with HIV/AIDS, including those that affect the central nervous system. It discusses toxoplasmosis, cytomegalovirus encephalitis, cryptococcal meningitis, primary CNS lymphoma, and progressive multifocal leukoencephalopathy. It also covers common skin and mucous membrane disorders like candidiasis, Kaposi's sarcoma, and aphthous ulcers. Treatment options are provided for several conditions. The document contains detailed but technical medical information on infectious diseases indicators and presentations in patients with low CD4 counts.
This document discusses the diagnosis and genetic testing of primary immunodeficiencies. It begins by defining primary immunodeficiency as congenital or hereditary defects of the immune system resulting in increased infections. It then classifies primary immunodeficiencies and lists the most common infectious agents seen. The document goes on to discuss specific genetic mutations that can cause various forms of severe combined immunodeficiency (SCID) or other primary immunodeficiencies. Case studies are presented to illustrate the genetic testing process and diagnosis of conditions like perforin deficiency.
The document discusses dengue and dengue hemorrhagic fever (DHF) in adults. It provides epidemiological data showing over 2.5 billion people in 100 countries are at risk of dengue infection. It reviews clinical manifestations and laboratory findings in adults with dengue fever (DF) and DHF. Key points include thrombocytopenia being common, with over 25% of DHF patients having platelet counts less than 20,000/mm3. Bleeding is a risk, especially for those with severe thrombocytopenia, liver dysfunction, or shock. Proper fluid management and monitoring are important for treating DHF to avoid complications.
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Polymorphisme parasitaire et accès graves en zone périurbaine
1. High polymorphism of parasites isolates is
associated with Cerebral Malaria in Dakar.
Bob NS, Diop BM, Marrama L, MT Ekala, Tall A, Ka B, Hovette
Ph, Seck SY, O Mercereau-Puijalon, Jambou R
1 Institut Pasteur de Dakar,
2 Clinique des maladies infectieuses CHN Fann,
3 Institut Pasteur Paris,
4 Hôpital Principal de Dakar
4. Van der heyde 2006
Activation des endothéliums = expression d’ICAM
Adhesion RBC
Adhesion leukocytes
Disruption tigh junction = leakage
hemorrhage
Apoptose EC
Adhesion platelets
Blockage capillaries
1
3
22
3
2
4
3
mechanic + immune
4
4
Inflammation
Local /
general
5. Do isolates differ
MILD / CEREBRAL malaria
Which mechanism
the most important ?
RATIONALE
low transmission
Low immunity
Drug resistance
Travel
Highly virulent strains ?
treatment retardation
Malaria in Urban area
7. Prevalence of malaria in consultations
0
0,05
0,1
0,15
0,2
0,25
0,3
septembre octobre novembre decembre
0-1 y
1- 4 y
5-14 y
15- 49 y
> 50 y
0
0,1
0,2
0,3
0,4
0,5
0,6
septembre octobre novembre decembre
0
0,05
0,1
0,15
0,2
0,25
0,3
0,35
0,4
septembre octobre novembre decembre
part of class of age in the malaria cases
prevalence of severe malaria.
0
200
400
600
800
1000
1200
1400
M F M F M F M F M F
0-1 an 1- 4ans 5-14 ans 15- 49 ans 50ans &+
consultations by age
8. MALARIA AT CHN FANN
Number of cases / 2004
0 100 200 300 400 500 600
CHOLERA
HIV
malaria
Tetanos
infections
Meningitides
Tuberculosis
Others
In emergency unit, malaria = only 10% of the patients
9. Number of severe malaria : 170
Geographic origin of the patients : Dakar 92%
(urban population in Africa : 2030 = 50%)
Seasonality of the cases
Severe Malaria at CHN Fann , 2004
MALARIA AT CHN FANN – 2004 -
Rainy season
0
5
10
15
20
25
30
35
40
Nombrede
J F M A M J J A S O N D
Mois
10. Age : 15-34 ans = 64% of patients
Sex-ratio = 1,46 (male +++)
Delay before hospitalization > 48 hours for 68% patients
Evolution
- Duration of hospitalization : mean 5 days [0 to 40 d]
- Total Mortality : 26,8%
MALARIA AT CHN FANN
11. HospitalsHospitals
(1) Clinical enrolment : cerebral disorder + fever(1) Clinical enrolment : cerebral disorder + fever
(2) Classification as(2) Classification as
-- cerebral malaria (cerebral malaria (ICT + thick smear (+) / meningitides (ICT + thick smear (+) / meningitides (--) / Glasgow) / Glasgow))
-- Mild malariaMild malaria
-- othersothers
DispensariesDispensaries
(1) mild malaria : ICT and thick smear (+) / fever / symptoms of(1) mild malaria : ICT and thick smear (+) / fever / symptoms of
malaria / no symptoms of CMmalaria / no symptoms of CM
(2) matched for age / gender / area in town, with CM(2) matched for age / gender / area in town, with CM
ENROLMENT
13. DHFR
1850 bp
Sequencing of Pfdhfr and exon 2 Pfcrt
dhfr ts
PfCRT
Exon 2
PCR amplification
Sequencing
250 bp
14. Hôpital Principal de DakarHôpital Principal de Dakar
59 patients : 20 CM / 3959 patients : 20 CM / 39 mildmild malariamalaria
2727 womenwomen / 32/ 32 menmen
age : 2 to 67age : 2 to 67 yearsyears
CHNCHN FannFann
15 patients : 12 CM / 315 patients : 12 CM / 3 mildmild
5 W et 10 M5 W et 10 M
age 16 to 42age 16 to 42 yearsyears
Centre de SantCentre de Santéé GuediawayeGuediawaye
104 patients : 2 CM / 102104 patients : 2 CM / 102 mildmild malariamalaria
66 W et 38 M66 W et 38 M
age 3 to 65age 3 to 65 yearsyears
PATIENTS
15. CLINICAL DATA
57,8%31,7%35,3%
patients consulting before 4 days
after beguining of the symptoms
18,4 %38,5 %27,5 %
patients treated before
consultation
1043612762656Parasitemia (paras. / µL)
10,612,29,7Hemoglobin (mean g/L)
14 %12,5%14,7%
Patients with temperature
> 40°C (%)
0.81.51Sex ratio
13.7 (11)15.5 (13)14.5 (10.3)Mean age (SD)
1024234N°patients
Mild Mal.
dispensary
Mild Mal
Hospital
Cerebral
malaria
16. MUTATIONS in DHFR and PfCRT
+++triple
+++++two
+-+one
NRImutant
SCNwild
1085951codon
MM n= 28
CM n= 16
MM n= 102
CM n= 37
DHFR CRT exon 2
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Wild 1 mutat. 2 mutat. 3 mutat.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
CVIET CVIET/CVMNK CVMNK
CM
MM
18. Multiple Infections (by microsatellite)
0
5
10
15
20
25
30
35
40
45
50
TA
A42
PFPK
2
m
2490
AR
A2
TA
A87
B
M
27
TA
A109
PFG
377
7A11
Cerebral Malaria
Mild Mal (hosp)
Mild Mal. (dispens)
TAA109, PFG377, 7A11, ARA2 = highly
polymorphic in hospitalized patients
19. Number of alleles to describe
50% of the patients
Average = 2 for CM / 1 for MM
Total number of alleles/µSat
Average = 8 for CM and MM
= same
0
2
4
6
8
10
12
14
16
18
TAA42
PFPK
2
m
2490
A
R
A2
TAA87
B
M
27
TAA109
PFG
377
7A11
Cerebral Malaria
Mild Mal (hosp)
Mild Mal. (dispens)
0
0,5
1
1,5
2
2,5
3
3,5
TAA42 PFPK2 m2490 ARA2 TAA87 BM27 TAA109PFG377 7A11
0
1
2
3
4
5
6
TAA42
PFPK
2
m
2490
A
R
A2
TAA87
B
M
27
TAA109
PFG
377
7A11
Number of alleles ot describe
75% of the patients
Average = 3 for CM / 2 for MM
All µSat = more polymorphic
in hospitalized patients
21. No impact ofNo impact of bednetsbednets on the diversity of the parasiteson the diversity of the parasites
No impact of treatment before consultationNo impact of treatment before consultation
No correlation between parasiteamia or age andNo correlation between parasiteamia or age and
polymorphismpolymorphism
Fever more than 40Fever more than 40°° associated with multiple infectionsassociated with multiple infections
Isolates with medium parasiteamiaIsolates with medium parasiteamia [100 et 1000[100 et 1000 tropho./tropho./µµll]]
associated with more polymorphic isolates and with CMassociated with more polymorphic isolates and with CM
Clinical features and polymorphism
No linkage between a specific allele of µSta and :
- location in the town,
- type of infection, anemia, high parasiteamia..etc
- DHFR and CRT genotypes
22. Cerebral malaria associated with
- multiple infections (higher inoculation rate ?)
- lower parasiteamia ( treatment ? sequestration ?)
- higher allelic diversity
No change in alleles repartition for the different types of
infection = no evidence of specific isolates associated
with a specific feature
CONCLUSION
So why such a polymorphism
In low transmission area
Higher diversity = more pathology ??
23. No malaria during winter
suburban area :
-good quality surface water =
An arabiensis
- high density of population
- low immunity
- daily transfer of workers
- Input of parasites from the rural
area at the beginning of the rainy
season = end of vacations
Transmission
Selection of strains
Treatment
Origin of the polymorphism
24. Many thanks for the medical staffs
Centre de Santé de Guediawaye,
Service de Maladie infectieuses CHN de Fann
Service de Maladie infectieuses Hopital principal de Dakar
Programs : RAI –FSP MAE , Paris
RESMAL-Chip, EU
Academie des Sciences, Prix Louis D
Genopole Institut Pasteur