The ancient ectoparasitic diseases share many features in common with newly emerging infectious diseases, such as Lyme disease, including hyperendemic causative agents afforded selective advantages by changing ecological or socioeconomic conditions; origination as zoonoses; transmission by competent arthropod vectors; and introduction into new, susceptible host populations. Many ectoparasites are also developing increased resistance to medical therapies, including the safest insecticides. Over the past two decades, there have been several reports of outbreaks of ectoparasitic diseases, principally myiasis, scabies, and tungiasis, both in regional communities and in travelers returning from developing nations. Today ectoparasitic diseases infest not only executives and tourists returning from travel to developed and developing nations, but also individuals immunocompromised by advancing age and institutionalization, chronic infectious and malignant disease, malnutrition and homelessness. Ectoparasitic diseases are no longer infestations of children and socioeconomically disadvantaged populations in tropical countries; they have re-emerged as unusual, but not uncommon, infectious diseases worldwide.

View full abstract

Background: There are variations in the epidemiology, prevalent pathogens and antimicrobial susceptibility patterns of infections in the intensive care unit (ICU) from one health care facility to another, hospital to hospital, and country to country. This study was undertaken to determine and document the frequency of occurrence of microbial isolates and their antibiotic susceptibility pattern from clinical specimens received from the ICU of a tertiary regional hospital in Trinidad and Tobago.
Materials & methods: Microbial isolates from patients admitted to the ICU of the Eric Williams Medical Sciences Complex over a 4-year period were investigated. Automated systems and Standard microbiological methods including BACTEC 9240 (Becton-Dickinson Microbiology Systems), MicroScan Walk Away 96 SI (Dade Behring, USA), modified Kirby Bauer disc diffusion and Etest were used. Clinical specimens from 1,128 patients admitted to the ICU during the study period were processed, and 869 pathogens were recovered from 638 positive cultures.
Results: The most frequent pathogens were recovered from respiratory tract specimens, while the Enterobacteriaceae groups of organisms were the most prevalent isolates. Except for Acinetobacter species that exhibit a consistent multiple drug resistant patterns, all the pathogens showed variable susceptibility to the readily available antimicrobials in the country. A 4.2% incidence rate of ESBL producers was encountered among the K. pneumoniae and E. coli isolates from the unit. Methicillin-resistant S. aureus was noted to be on the decline in this unit, but we observed the emergence of genuine vancomycin resistant methicillin-resistant S. aureus.
Conclusions: Although Enterobacteriaceae and Pseudomonas aeruginosa were the most frequent isolates, there are still sufficient treatment options for patients infected with these organisms in the unit. Continuous surveillance and monitoring for multiple drug resistant pathogens in the unit should still be paramount especially with the ongoing establishment of the National Oncology Center and National Organ Transplant Units at the complex. There is an equal need for further studies on the determinants of drug resistance in this unit.

View full abstract

The present study was designed to determine anti-BCG titres, serum albumin, packed cell volume, white blood cell count and malaria parasite density in HIV infected subjects in a malaria endemic area with stable transmission. For this study 75 participants aged between 17 and 70 years (females=45; males=30) were enlisted and grouped into: (I) HIV⁄AIDS subjects (n=21) on anti-retroviral therapy (ART), 12 of these subjects had malaria co-infection; (ii) HIV seropositive subjects (n=29) not on ART, 13 of whom had malaria co-infection, and (iii) HIV seronegative control subjects (n=25), 15 of whom had malaria parasiteamia. Serum albumin, anti-BCG and PCV, WBC and malaria parasite density were determined in all participants. The results showed that all participants had detectable anti-BCG, but the titre was lowest in HIV⁄AIDS on ART followed by HIV seropositives and control subjects (f=16.878; p&It;0.001). The results also showed that serum albumin (g⁄l) was significantly different among the HIV seropositives, HIV⁄AIDS and control subjects (f=8.043; p&It;0.001). This pattern was also true for the PCV (f=17.505; p&It;0.001). When the above parameters were considered for subjects with malaria co-infection, a similar pattern of results was observed. There was no within-group difference in those with or without malaria for the respective groups except for WBC count, which was significantly reduced in HIV⁄AIDS subjects with malaria, compared with those without malaria. The positive association between WBC count and malaria parasite density was consistent in all groups. The present study thus indicates that, although there is evidence of prior exposure to bacterial infection, serum anti-BCG, serum albumin and PCV are mostly impaired by HIV infection even in cases of malaria co-morbidity in endemic areas.

View full abstract

The purpose of this study was to evaluate predictors of change in physical function in individuals diagnosed with chronic fatigue syndrome (CFS) following participation in nurse delivered, non-pharmacologic interventions. Participants diagnosed with CFS were randomly assigned to one of four, 6-month interventions including cognitive behavior therapy, cognitive therapy, anaerobic exercise, or a relaxation control group. Baseline measures including immune function, actigraphy, time logs, sleep status, and past psychiatric diagnosis significantly differentiated those participants who demonstrated positive change over time from those who did not. Understanding how patient subgroups differentially respond to non-pharmacologic interventions might provide insights into the pathophysiology of this illness.

View full abstract

This report compares rates of selected nationally notifiable diseases in the 100 most populated counties to overall U.S. rates. We analyzed data from the 2004 National Notifiable Diseases Surveillance System (NNDSS) maintained by CDC. Notifiable diseases reports, collected by the states and U.S. territories, are transmitted to CDC in an agreement with the Council of State and Territorial Epidemiologists. By using the Bureau of Census population estimates, we calculated and compared rates. Rates were higher in the most populated counties for six of the nine conditions examined in comparison with national rates: chlamydia (rate ratio:1.2), gonorrhea (rate ratio: 1.2), syphilis (rate ratio: 1.7), hepatitis A (rate ratio: 1.2), hepatitis B (rate ratio: 1.1), and shigellosis (rate ratio: 1.2). The incidence rate for Lyme disease was 40% lower among populated counties (rate ratio: 0.6). Incidence of infectious diseases is different in the most populated counties, and prevention programs should consider local occurrence.

View full abstract

Acute large bowel obstruction due to Ascaris lumbricoides is uncommon. Here we report a 4 year old girl presenting with acute left colon obstruction due to A. lumbricoides. She was managed conservatively with a hypertonic saline enema and anthelmintics and responded favourably. Early diagnosis and treatment are essential to minimize morbidity and mortality.

View full abstract

As malaria continues to be a public health problem in the Philippines, its control is now the responsibility of the Local Government Unit (LGU). In this set-up, social mobilization is believed to be the key strategy in effective and sustainable implementation of malaria prevention and control activities. Palawan has always been the most malarious province in the country. Despite untiring malaria control efforts and huge funds spent to curb this malady for which Palawan has become known, this province remains the largest contributor of malaria cases and deaths. Thus, Kilusan Ligtas Malaria (KLM: meaning Movement Against Malaria) has focused on social mobilization in the implementation of malaria prevention and control. Microscopic confirmation of malaria is done by trained village microscopists, while health education-promotion activities, advocacy and linkage building are carried out by trained village community organizers. The noticeable outcomes are the increase in malaria case finding as reflected in the total number of malaria smears done, the increase in microscopic confirmation of malaria, and the decline in clinical diagnoses. Other outcomes include policy development and implementation in the form of executive orders and community ordinances to support the village microscopists and community organizers. Now, the biggest challenge of KLM is maintaining the momentum and sustaining gains.

View full abstract