Tropical Medicine and Health
Online ISSN : 1349-4147
Print ISSN : 1348-8945
ISSN-L : 1348-8945
41 巻, 4 号
選択された号の論文の4件中1~4を表示しています
Original Articles
Short communication
  • Claire E. Kendig, Denise J. McCulloch, Nora E. Rosenberg, Jonathan C. ...
    原稿種別: Short communication
    2013 年 41 巻 4 号 p. 163-170
    発行日: 2013年
    公開日: 2013/12/18
    [早期公開] 公開日: 2013/11/30
    ジャーナル フリー HTML
    Introduction: The World Health Organization (WHO) recommends HIV Counseling and Testing (HCT) in a range of clinical settings. We describe the characteristics of patients diagnosed with HIV on the medical and surgical wards at a tertiary care hospital in Malawi. Methods: Under the universal opt-out HCT protocol we characterized the number of new HIV/AIDS infections and associated clinical features among hospitalized surgical and medical patients diagnosed during the course of admission. Results: All 2985 and 3959 medical and surgical patients, respectively, admitted between April 2012 and January 2013 were screened for HCT. 62% and 89% of medical and surgical patients, respectively, had an unknown status on admission and qualified for testing. Of the patients with an unknown status, a new HIV diagnosis was made in 20% and 7% of medical and surgical patients, respectively. Of the newly diagnosed patients with a CD4 count recorded, 91% and 67% of medical and surgical patients, respectively, had a count less than 350, qualifying for ART by Malawi ART guidelines. Newly HIV-diagnosed medical and surgical patients had an inpatient mortality of 20% and 2%, respectively. Discussion: While newly diagnosed HIV-positive medical patients had high inpatient mortality and higher rates of WHO stage 3 or 4 conditions, surgical patients presented with less advanced HIV, though still meeting ART initiation guidelines. The medical inpatient wards are an obvious choice for implementing voluntary counseling and testing (VCT), but surgical patients present with less advanced disease and starting treatment in this group could result in more years of life gained.
Case report
  • Nobuyuki Mishima, Koichiro Tabuchi, Tomoaki Kuroda, Issaku Nakatani, P ...
    原稿種別: Case report
    2013 年 41 巻 4 号 p. 171-176
    発行日: 2013年
    公開日: 2013/12/18
    [早期公開] 公開日: 2013/11/30
    ジャーナル フリー HTML
    Leptospirosis is a worldwide zoonosis and common in tropical and subtropical areas with high rainfall. It should be noted as an imported infectious disease although it is sporadic in Japan. Some imported cases already have been reported in Japan and these cases occurred mainly in Southeast Asia. The case discussed in this article is the first reported Japanese case infected in Vietnam. Four days after returning back to Japan after a two-week stay in the mountain area near Hue, in the middle part of Vietnam, the patient suddenly experienced chills, a high fever, sore throat, gastrocnemius pain, and headache. Conjunctival jaundice, renal function disorder, and proteinuria were observed on the third day of onset. Significant increase in antibody titers against serovar Australis and Autumnalis strains was observed in paired serum samples by microscopic agglutination test (MAT). Consequently we recognized this case as a diagnosis of severe leptospirosis (Weil’s disease). Finally, renal function disorder did not deteriorate further, and then the patient recovered after the tenth day of onset with the administration of antibiotics and supportive care without sequelae. We experienced the first imported Japanese case of severe human leptospirosis infection from Vietnam that was successfully treated with ceftriaxone and minocycline.
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