ISSN:0164-2340    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Malaria, a disease with staggering mortality worldwide, is increasingly encountered in US emergency departments. Given both the unfamiliarity of US physicians with the disease and its nonspecific manifestations, the potential for misdiagnosis increases the risk of morbidity and mortality associated with malaria diagnosed in US emergency departments. Maintaining a high index of suspicion and eliciting a travel or blood transfusion history in any patient who presents with fever and nonspecific symptoms is central to making the diagnosis. Spreading resistance to standard antimalarial therapy and the recognition of the mortality associated withPlasmodium falciparuminfection has led to the development of better guidelines for therapy, including intravenous quinidine gluconate therapy and exchange transfusion. This article outlines these and other issues crucial to the diagnosis and management of malaria in the emergency department.

ISSN:0164-2340    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Amebiasis is responsible for considerable morbidity worldwide and an important cause of diarrhea in the traveler or immunocompromised patient. With a prevalence of 2% across most of the United States, infection occurs via the fecal-oral route or via sexual transmission. After a 1–3 week incubation period, symptoms of intestinal amebiasis include frequent bowel movements, of en bloody and tenesmus. Extra-intestinal amebiasis may affect the liver, pericardium, peritoneal cavity, skin and even cerebrum. Therapy includes luminal amebicides and tissue amebicides, with surgical intervention reserved for those patients who develop abscesses or peritonitis.

ISSN:0164-2340    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Cysticercosis is a potentially fatal disease caused by the parasiteTaenia solium, and neurocysticercosis is the leading cause of seizures in endemic areas of the world such as Latin America (especially Mexico, Ecuador, and Peru), sub-Saharan Africa, and Asia. Emergency physicians should suspect cysticercosis in patients from endemic areas areas of the world who develop seizures or hydrocephalus. In the United States, it is most commonly seen among immigrants from Latin America, and less frequently in travelers to endemic areas and in cases of transmission within the United States. Until resources are allocated for its global eradication, the infection may become a larger public health issue in the United States, as immigration from and travel in endemic areas increase. Improved diagnostic tests, though still imperfect, have increased detection of the disease. Available diagnostic tests are described. Better population-screening tools and treatment strategies are needed. IntestinalT. soliuminfection (taeniasis) is easy to treat, but optimal treatment of the disseminated larval stage, cysticercosis, depends on location and is still subject to substantial debate. There is yet much to discover aboutT. solium, its life cycle, and host–parasite interactions. This article provides the clinician with an overview of the parasite causing cysticercosis, its physiology and life cycle, the diseases it causes, and current approaches and dilemmas in diagnosis and management.

ISSN:0164-2340    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Ascariasis, caused byAscariasis lumbricoides, is one of the most common roundworm infections worldwide. While not as prevalent in the United States as in some developing countries, immigration from endemic areas has made the disease one that emergency physicians should be aware of. Presentation patterns are myriad, ranging from pneumonitis to intestinal obstruction and depend largely on the stage of the infestation. Once the diagnosis is made however, chemotherapeutic therapy is effective in halting the progression of the disease. Below, we review the presentation of ascariasis, the methods available to diagnose the disease and the therapeutic options available.

ISSN:0164-2340    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Typhoid fever is an infectious disease caused by the bacteriumSalmonella typhi. It has an insidious onset characterized by fever, headache, constipation, malaise, chills and myalgias. An estimated 16 million cases and 600,000 deaths from typhoid fever occur worldwide. Transmission of the bacteria is most often related to fecal contamination of water supplies or food sold by street vendors. Chronic carrier states occur in 5% of infected persons. Risk is very low in the United States, but international travelers to endemic areas such as Asia and India are at risk. Increasing resistance to antibiotics may lead to an increase in the case-fatality rates.

ISSN:0164-2340    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Travelers' diarrhea (TD) affects millions of international travelers annually. The risk of TD approaches 50%. EnterotoxigenicEscherichia colimost commonly causes TD, with that caused by other bacteria, viruses, and parasites occurring less often. TD is a clinical syndrome that manifests itself abruptly with 3 or more unformed stools in 24 hours and at least 1 symptom of enteric disease. Since the majority of TD is self-limited, extensive etiologic work-ups are unwarranted. The most important medical intervention is hydration. TD can be managed with hydration, antimotility agents, and antibiotics. Prevention of TD includes education on food and beverage consumption as well as possible chemoprophylaxis.

ISSN:0164-2340    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

It is important for the emergency medicine practitioners to expedite the diagnosis, treatment, and disposition of leishmaniasis patients. The disease process can be severely disfiguring and sometimes fatal. Epidemiology, clinical presentation, diagnosis, treatment, and disposition for the various forms of cutaneous, mucocutaneous, and visceral disease including HIV co-infection and organ transplant patients are discussed.

ISSN:0164-2340    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Viral hemorrhagic fever (VHF) viruses are diverse and include arenaviruses, bunyaviruses, filoviruses, and flaviviruses. Lassa fever, South American hemorrhagic fever (HF), Rift Valley HF, Crimean-Congo HF, Ebola, Marburg, yellow fever, and dengue fever are well known examples of the hemorrhagic fever viruses. They are often difficult to diagnose and treat resulting in significant morbidity and mortality. Transmission varies from vector borne to person-to-person. The common clinical presentation includes fever, myalgia, microvascular damage, and hemorrahage as well as a history of travel to the tropics. If VHF is suspected, strict infection control procedures must be implemented to prevent the spread of these agents within the emergency department. Management of VHF is largely supportive, but ribavirin has been useful for certain viruses.

ISSN:0164-2340    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

This is a comprehensive review of travel vaccinations necessary for travel to various regions of the world. The article also summarizes vaccination characteristics and side effects. Additionally, childhood accelerated vaccinations schedules and immunocompromised travelers are discussed.

ISSN:0164-2340    

出版商:OVID    

年代:2003

数据来源: OVID