Answer to Case 484

Answer:Trypanosoma bruceiThis is most likelyT. brucei rhodesiensebased on:The patient's recent travel to Eastern Africa (Kenya),His participation in a game tracking excursion (classic history given that wild ungulates are the reservoir for this subspecies),His rapid onset of symptoms, andThe very high (!) parasitemiaBe sure to check out the video which show the characteristic'auger'like motility of the trypomastigotes (i.e. rotating along its long axis).Thanks to everyone who wrote in with the excellent comments. A lot of good points were raised by all. Ali Mokbel mentioned that we can't exclusively rule outT. b. gambiense,given that the patient is a frequent traveler and may have been to West Africa. Idzi also reminded us that the trypomastigotes ofT. bruceiare indistinguishable from those ofT. rangeli,a non-pathogenic New World trypanosome which can occasionally infect humans. Fortunately, we can tentatively rule out these other species/subspecies based on the very high parasitemia and patient's symptoms. If there was any question about the identification (e.g. based on the patient's travel history), sub-species determination using PCR could be performed.  Finally, LS reminded us of the importance of determining whether the patient had central nervous system involvement since that would change the therapy. If suspected, a lumbar puncture could be performed to look for trypomastigotes.For our students of parasitology, the following contains some general inform...
Source: Creepy Dreadful Wonderful Parasites - Category: Parasitology Source Type: blogs

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Conclusions OCB are important biomarkers that can support MRI diagnostics and help to avoid false-positive MS diagnoses. Therefore, the revised McDonalds criteria have increased the importance of the OCB. New biomarkers such as AQP4 have now established themselves in clinical practice, and others such as Anti-MOG and NfL are about to enter clinical routine. An important focus in the search for new biomarkers is the monitoring of therapy efficacy and the prediction of severe side effects. Many other CSF molecules such as CHI3L1, IL-6, or CXCL13 show potential as markers for clinical practice, but further research is nee...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
In this report, we propose that the molecular mechanisms of beneficial actions of CR should be classified and discussed according to whether they operate under rich or insufficient energy resource conditions. Future studies of the molecular mechanisms of the beneficial actions of CR should also consider the extent to which the signals/factors involved contribute to the anti-oxidative, anti-inflammatory, anti-tumor and other CR actions in each tissue or organ, and thereby lead to anti-aging and prolongevity. RNA Interference of ATP Synthase Subunits Slows Aging in Nematodes https://www.fightaging.org/archives/...
Source: Fight Aging! - Category: Research Authors: Tags: Newsletters Source Type: blogs
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog aka Tropical Travel Trouble 009 The diagnosis of HIV is no longer fatal and the term AIDS is becoming less frequent. In many countries, people with HIV are living longer than those with diabetes. This post will hopefully teach the basics of a complex disease and demystify some of the potential diseases you need to consider in those who are severely immunosuppressed. While trying to be comprehensive this post can not be exhaustive (as you can imagine any patient with ...
Source: Life in the Fast Lane - Category: Emergency Medicine Authors: Tags: Clinical Cases Tropical Medicine AIDS art cryptococcoma cryptococcus HIV HIV1 HIV2 PEP PrEP TB toxoplasma tuberculoma Source Type: blogs
Rationale: Parasitic eosinophilic meningitis is rarely observed in infants. The diagnosis of this disease is complicated by its atypical and severe clinical manifestations. Patient concerns: An infant presented to our hospital with high fever and irritability, as well as refusal to walk. Cerebrospinal fluid collected through lumbar puncture showed increased eosinophil count and third-stage Angiostrongylus cantonensis larvae. Diagnoses: Eosinophilic meningitis was suspected. Interventions: We started empiric treatment with levamisole (14 mg bid, 2.5 mg/kg·day) and prednisone (17.5 mg qd, 1.5 mg/kg&...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog aka Tropical Travel Trouble 007 When you think tropical medicine, malaria has to be near the top. It can be fairly complex and fortunately treatment has become a lot simpler. This post is designed to walk you through the basic principals with links to more in depth teaching if your niche is travel medicine, laboratory diagnostics or management of severe or cerebral malaria. If you stubbled on this post while drinking a cup of tea or sitting on the throne and want a fe...
Source: Life in the Fast Lane - Category: Emergency Medicine Authors: Tags: Clinical Cases Tropical Medicine malaria Plasmodium plasmodium falciparum plasmodium knowles plasmodium malariae plasmodium ovale plasmodium vivax Source Type: blogs
We present a case of C. koseri meningitis in an immunocompetent adult secondary to intestinal micro-perforation caused by Strongyloides A 76-year-old man admitted for asthma exacerbation developed septic shock. A lumbar puncture revealed bacterial meningitis. Blood and CSF cultures grew Citrobacter koseri with identical susceptibilities, suggesting infection by one strain. Despite broad-spectrum antibiotics, the patient expired of multi-organ failure. Autopsy identified diffuse alveolar hemorrhage as the immedi ate cause of death with a heavy burden of Strongyloides stercoralis in his gastrointestinal system, lungs, and me...
Source: IDCases - Category: Infectious Diseases Source Type: research
This article is part HuffPost’s Project Zero campaign, a yearlong series on neglected tropical diseases and efforts to eliminate them. One morning a few years ago, a vial containing just a few drops of a long-forgotten drug candidate arrived at the office of bioengineer Els Torreele in Switzerland.  The compound, fexinidazole, had been studied at a drug company several decades earlier, but researchers had given up on it for no clear reason. Torreele had asked the company to unearth whatever it had left from its archive, hoping to get her hands on the final clue in a long process of painstaking detectiv...
Source: Healthy Living - The Huffington Post - Category: Consumer Health News Source Type: news
by Isabel M. Vincent, R ónán Daly, Bertrand Courtioux, Amy M. Cattanach, Sylvain Biéler, Joseph M. Ndung’u, Sylvie Bisser, Michael P. Barrett Treatment for human African trypanosomiasis is dependent on the species of trypanosome causing the disease and the stage of the disease (stage 1 defined by parasites being present in blood and lymphatics whilst for stage 2, parasites are found beyond the blood-brain barrier in the cerebrospinal fl uid (CSF)). Currently, staging relies upon detecting the very low number of parasites or elevated white blood cell numbers in CSF. Improved staging is desirable,...
Source: PLoS Neglected Tropical Diseases - Category: Tropical Medicine Authors: Source Type: research
Conclusion: In comatose children with suspected CM who were clinically stable, we found no evidence that LP increases mortality, even in children with objective signs of raised intracranial pressure.
Source: Neurology - Category: Neurology Authors: Tags: All Infections, Parasitic infections, All Pediatric, Patient safety ARTICLE Source Type: research
Apheresis has been used to lower the parasite burden of patients with Loa loa infection, but there are no reports regarding how to do this using modern, continuous flow equipment with a currently available program. A 23‐year‐old female refugee from Cameroon with known Loa loa infection presented to our Emergency Department with acute mental status changes and a picture of encephalitis. Lumbar puncture revealed Loa loa in her cerebrospinal fluid. Her midday blood microfilaria count was 15,000/mL. Because treatment with diethylcarbamazine was under consideration, we were asked to lower her parasite burden using apheresis...
Source: Journal of Clinical Apheresis - Category: Hematology Authors: Tags: Case Report Source Type: research
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