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1
Treatment options for second-stage gambiense human African trypanosomiasis
Eperon, G.; Balasegaram, M.; Potet, J.; Mowbray, C.; Valverde, O.; ois Chappui, F.
Informa Healthcare
(2014)
CC
Treatment of second-stage gambiense human African trypanosomiasis relied on toxicarsenic-based derivatives for over 50 years. The availability and subsequent use of eflornithine,initially in monotherapy and more recently in combination with nifurtimox (NECT), has drasticallyimproved the pro
...
gnosis of treated patients. However, NECT logistic and nursing requirementsremain obstacles to its deployment and use in peripheral health structures in rural sub-SaharanAfrica. Two oral compounds, fexinidazole and SCYX-7158, are currently in clinical development.The main scope of this article is to discuss the potential impact of new oral therapies to improvediagnosis-treatment algorithms and patients’access to treatment, and to contribute to reach theobjectives of the recently launched gambiense humanAfrican trypanosomiasis elimination program
more
Sleeping sickness is a neglected tropical disease affecting rural communities in sub-Saharan Africa. The reduction in the number of reported cases in recent years indicates that disease transmission is under control. However, many aspects of patient management still need to be improved. Undiagnosed
...
patients or inappropriate treatment due to an incorrect determination of the disease stage could in fact lead to its re-emergence. There is thus a strong need for new diagnostic and staging tools to keep the disease under control and to improve the clinical care of patients. This review describes the most promising biomarkers proposed so far for the diagnosis and stage determination of patients suffering from sleeping sickness, with a particular emphasis on their translation into diagnostic tools for field applications.
more
DOI: 10.5772/intechopen.102891Little progress has been made since the 1960s and 19. 70s to widen the therapeutic arsenal against Trypanosoma cruzi, the causative pathogen of Chagas disease, which remains a frustrating and perplexing infectious disease. This chapter focuses on the strategic and opera
...
tional challenges in the clinical drug development of a novel antitrypanosomal agent for Chagas disease. The various elements that contribute to a robust assessment of treatment effect including dose selection, choice of patient population, trial methodology, endpoint measures, and regulatory perspectives are discussed. The learnings herein should serve as resource to help researchers and other stakeholders optimize their clinical development plans and speed delivery of new medicines to patients with Chagas disease.
more
Leptospirosis is a zoonotic disease with epidemic potential, especially after a heavy rainfall,
caused by a bacterium called Leptospira. Leptospira interrogans is pathogenic to humans and
animals, with more than 200 serologic variants or serovars. Humans usually acquire
leptospirosis through dire
...
ct contact with the urine of infected animals or a urine-contaminated
environment. Human-to-human transmission occurs only very rarely. Leptospirosis may present
with a wide variety of clinical manifestations, from a mild illness that may progress to a serious
and sometimes fatal disease. Its symptoms may mimic many diseases, such as influenza,
dengue and other viral haemorrhagic diseases; making the correct diagnosis (clinical and
laboratory) at the onset of symptoms is important to prevent severe cases and save lives,
primarily in outbreak situations.
more
Lateral-flow rapid diagnostic tests (RDTs) continue to play a vital role in global health in the management and diagnosis of infectious diseases, including malaria, HIV and COVID-19. Visually interpreted RDTs, more than any other class of diagnostics, fulfil WHO’s ASSURED criteria,1 enabling their
...
use at the lowest levels of health care and in self-testing.2 Their utility is, however, compromised every time a test is incorrectly performed or interpreted or its result is not available in a timely manner for clinical decisionmaking and surveillance.
more
Chromoblastomycosis (CMB) is a chronic fungal infection of the skin and the subcutaneous tissue caused by a transcutaneous traumatic inoculation of a specific group of dematiaceous fungi occurring mainly in tropical and subtropical zones worldwide. If not diagnosed at early stages, patients with CBM
...
require long term therapy with systemic antifungals, sometimes associated with physical methods. Unlike other neglected endemic mycoses, comparative clinical trials have not been performed for this disease. Nowadays, therapy is based on a few open trials and on expert opinion. Itraconazole either as monotherapy or associated with other drugs, or with physical methods, is widely used. Recently, photodynamic therapy has been successfully employed in combination with antifungals in patients presenting with CBM. In the present revision the most used therapeutic options against CBM are reviewed as well as the several factors that may have impact on the patient's outcome.
more
The purpose of this guide is to provide practical advice for health staff undertaking infectious disease preparedness and response activities to ensure that access to safe abortion care (SAC) is maintained when an infectious disease outbreak occurs. It is an operational guide which can serve to supp
...
ort health actors to maintain SAC services during outbreaks and ensure that necessary SAC considerations are integrated within outbreak responses; it is not a clinical guide. The locational focus of this document is humanitarian and fragile settings; however, recommendations may apply to infectious disease outbreaks in all low-resource populations. This guide is intended to complement Sexual and Reproductive Health and Rights During Infectious Disease Outbreaks: Operational Guidance for Humanitarian and Fragile Settings.
more
The objectives of the meeting were:
1. To update the current status of the disease transmission, country capacities and plans for tackling the disease.
2. To understand the epidemiology including disease distribution and risk, the models
for estimating under-detection, the geographical variati
...
ons of in clinical presentation,
the roles of domestic and wild animal reservoirs and the subsequent different
transmission patterns and control approaches, including vector control.
3. To update current research and development efforts for improving diagnostic and
treatment tools.
4. To define the goals for achieving the control of r-HAT, the need for a multisectoral
approach and to discuss the strategy for controlling r-HAT and the coordination
mechanisms.
more
Snakebite envenoming is a serious public health problem in Central America, where approximately 5,500 cases occur every year. Panama has the highest incidence and El Salvador the lowest. The majority, and most severe, cases are inflicted by the pit viper Bothrops asper (family Viperidae), locally kn
...
own as ‘terciopelo’, ‘barba amarilla’ or ‘equis’. About 1% of the bites are caused by coral snakes of the genus Micrurus (family Elapidae). Despite significant and successful efforts in Central America regarding snakebite envenomings in the areas of research, antivenom manufacture and quality control, training of health professionals in the diagnosis and clinical management of bites, and prevention of snakebites, much remains to be done in order to further reduce the impact of this medical condition. This essay presents seven challenges for improving the confrontation of snakebite envenoming in Central America. Overcoming these challenges demands a coordinated partnership of highly diverse stakeholders though inter-sectorial and inter-programmatic interventions.
more
Cutaneous Leishmaniasis (CL) is a painful disease that exerts a serious toll on societies around the world that are afflicted by it. Although not life-threatening, the skin ulcers and scars it causes can lead to isolation and psychosocial pathologies due to social stigma, and its occurrence is often
...
associated with regional conflicts. The Cutaneous Leishmaniasis Research Meeting was held on December 7, 2020, with participation by basic researchers, clinical researchers, and drug discovery experts involved in research and development related to CL under the auspices of the Joint Usage/Research Center on Tropical Disease, Institute of Tropical Medicine. In addition, the CL Webinar was held on March 5, 2021, hosted by the Graduate School of Tropical Medicine and Global Health, co-hosted by the Institute of Tropical Medicine, and supported by Médecins Sans Frontières and DNDi.
more
Violence against women and girls is widespread in the Region of the Americas, resulting in enormous consequences for the health and wellbeing of women and girls, their families and communities. These costs are unacceptable and they can be prevented through evidence-based action, including the health
...
sector through its policies and protocols, as well as in collaboration with other sectors. This report remains the first of its kind and is a major milestone for the Region. It is specifically informed by the commitments of Member States in the regional Strategy and Plan of Action on Strengthening the Health System to Address Violence against Women. The report provides an analysis of efforts to advance the prevention of violence against women through health policies, clinical protocols, multisectoral plans and related approaches across the Americas. Attention to this topic is timely, as the COVID-19 pandemic has created new visibility for this area of work. This report offers critical information on efforts in the Region that can be learned from and used to build upon in the future to prevent and respond to violence against all women and girls everywhere.
more
Diabetes mellitus (DM) is a global epidemic with significant morbidity. Diabetic
retinopathy (DR) is the specific microvascular complication of DM and affects 1 in 3 persons with DM. DR remains a leading cause of vision loss in working adult populations. Patients with severe levels of DR are report
...
ed to have poorer quality of life and reduced levels of physical, emotional, and social well-being, and they utilize more health care resources.
Epidemiological studies and clinical trials have shown that optimal control of blood glucose, blood pressure, and blood lipids can reduce the risk of developing retinopathy and slow its progression. Timely treatment with laser photocoagulation, and increasingly, the appropriate use of intraocular administration of vascular endothelial growth factor (VEGF) inhibitors can prevent visual loss in vision- threatening retinopathy, particularly diabetic macular edema (DME). Since visual loss may not be present in the earlier stages of retinopathy, regular screening of persons with diabetes is essential to enable early intervention.
more
Lymphatic filariasis (LF) is an avoidable, debilitating, disfiguring disease caused by infection with the filarial parasites Wuchereria bancrofti, Brugia malayi and B. timori. Globally, 51.4 million people are
estimated to be infected. Lymphoedema and hydrocoele are the visible, chronic
...
clinical consequences of the lymphatic vessel impairment caused by infection with these parasites. Mosquitos in the genera Culex, Anopheles, Mansonia and Aedes transmit the parasites from person to person. 2020 marked the 20th year since WHO established the Global Programme to Eliminate Lymphatic Filariasis (GPELF) which aims to stop transmission of infection with mass drug administration (MDA) and to alleviate suffering among people affected by the disease through morbidity management and disability prevention (MMDP).
more
Through the USAID-funded Organized Network of Services for Everyone’s Health (ONSE) Activity, MSH is assisting Malawi’s National Malaria Control Program to provide high-quality malaria services at the facility and community levels in 10 districts, covering nearly a third of the country.
Our
...
team in Malawi share recent results on strengthening malaria services through Outreach Training and Supportive Supervision (OTSS).
Designed to provide ongoing support to clinicians, data, and laboratory staff, OTSS combines a standardized checklist with targeted mentorship and supportive supervision to identify areas for improvement and strengthen clinical and diagnostic services in health facilities.
This webinar shares lessons learned on how the application of OTSS, as part of broader quality assurance systems, impacts staff performance and improves the provision and quality of malaria services.
more
Worm infestation is a common issue that is seen mostly among children. However, this issue can be found among adults as well due to the change in lifestyle patterns. In most cases, worm infestation is not a life-threatening infection but it can lead to various
...
clinical problems.
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Chagas disease or American trypanosomiasis is, together with geohelminths, the neglected disease that causes more loss of years of healthy life due to disability in Latin America. Chagas disease, as determined by the factors and determinants, shows that different contexts require different actions,
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preventing new cases or reducing the burden of disease. Control strategies must combine two general courses of action including prevention of transmission to prevent the occurrence of new cases (these measures are cost effective), as well as opportune diagnosis and treatment of infected individuals in order to prevent the clinical evolution of the disease and to allow them to recuperate their health. All actions should be implemented as fully as possible and with an integrated way, to maximise the impact. Chagas disease cannot be eradicated due because of the demonstrated existence of infected wild triatomines
in permanent contact with domestic cycles and it contributes to the occurrence of at least few new cases. However, it is possible to interrupt the transmission of Trypanosoma cruzi in a large territory and to eliminate Chagas disease
as a public health problem with a dramatic reduction of burden of the disease.
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Emergency medical teams (EMT) are first response health care providers – doctors, nurses, paramedics, and others – during outbreaks and emergencies or disasters, working with governments, charities such as nongovernmental organizations (NGOs), armies, and international organizations such as the
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International Red Cross/Red Crescent movement. They comply with the classification and minimum standards set by the World Health Organization (WHO) and its partners and bring to an emergency their training and self-sufficiency so as not to burden the national health system. EMT initiatives strengthen national surge capacities and facilitate the deployment of internationally classified teams of health- care professionals to countries and territories during emergencies, particularly during disease outbreaks and natural disasters, providing immediate assistance when national health systems are overwhelmed . Considering that they aim to support the provision of quality clinical care services to populations affected by public health emergencies, the expectation is that financial resources and equipment will be available to enable the performance of the requested task.
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Leishmaniasis is a vector-borne tropical/subtropical disease caused by an intracellular parasite transmitted to humans by sand fly bite. It is endemic in Asia, Africa, the Americas, and the Mediterranean region. Worldwide reports include 1.5–2 million new cases each year, more than 300 million at
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risk of acquiring the disease, and 70,000 deaths per year. Clinical features depend on the Leishmania species and immune response of the host, varying from localized cutaneous disease to visceral form with potentially fatal outcome; however, the common presentation is either cutaneous, mucocutaneous, or visceral leishmaniasis. Many therapeutic agents are being used in Leishmania treatment, but the only effective treatment is achieved with current pentavalent antimonials. WHO considers Leishmaniasis as one of the “Neglected Tropical Diseases” that continues to be prevalent despite international, national, and local efforts towards its control and elimination over the last decade. This chapter reviews the global perspective of Leishmaniasis with increasing recognition of emerging “Atypical forms” and new surge of disease across the world mainly due to increasing conflicts in endemic areas leading to forced migration among other causes. All these challenges related to environment, disease, and vector pose major implications on WHO’s leishmaniasis control and elimination plan.
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Cystic echinococcosis (CE) is a well-known neglected parasitic disease. However, evidence supporting the four current treatment modalities is inadequate, and treatment options remain controversial. The aim of this work is to analyse the available data to answer
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clinical questions regarding medical treatment of CE.
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COVID-19 has altered health sector capacity in low-income and middle-income countries (LMICs). Cost data to inform evidence-based priority setting are urgently needed. Consequently, in this paper, we calculate the full economic health sector costs of COVID-19
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clinical management in 79 LMICs under different epidemiological scenarios.
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