RESUMO
BACKGROUND: Outbreaks of histoplasmosis have been increasingly reported in association with travel to endemic areas. Multiple outbreaks have been reported following travel to the Americas, but reports of pulmonary histoplasmosis in short-term immunocompetent travelers to Africa are rare. METHODS: A biology student was referred to our unit with suspected pulmonary histoplasmosis following her return from a field trip in the Ugandan rainforest. The patient informed us that several of her multinational student colleagues on the same expedition had developed a similar illness. Using an alert in ProMED-mail and a questionnaire forwarded to each of the symptomatic students, we accumulated data on the other cases involved in this apparent outbreak of pulmonary histoplasmosis. RESULTS: Thirteen of 24 students developed respiratory symptoms following the expedition. Chest X-ray appearances were often suggestive of miliary tuberculosis but in most cases a final diagnosis of histoplasmosis was made (confirmed with serology in five cases, clinically diagnosed in six, and retrospectively suspected in two). Detailed questioning indicated that the likely source was a large hollow bat-infested tree within the rainforest. CONCLUSIONS: This is an unusual outbreak of histoplasmosis following short-term travel to Africa. Pulmonary histoplasmosis should always be considered in the differential diagnosis of an acute febrile respiratory illness in travelers returning from endemic areas or reporting activities suggesting exposure.
Assuntos
Surtos de Doenças , Histoplasma/imunologia , Histoplasmose , Pneumopatias Fúngicas , Combinação Amoxicilina e Clavulanato de Potássio/administração & dosagem , Animais , Antibacterianos/administração & dosagem , Anticorpos Antifúngicos/sangue , Quirópteros , Claritromicina/administração & dosagem , Diagnóstico Diferencial , Vetores de Doenças , Feminino , Histoplasmose/diagnóstico , Histoplasmose/fisiopatologia , Histoplasmose/terapia , Histoplasmose/transmissão , Humanos , Pulmão/diagnóstico por imagem , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/etiologia , Pneumopatias Fúngicas/fisiopatologia , Pneumopatias Fúngicas/terapia , Pneumopatias Fúngicas/transmissão , Masculino , Radiografia , Viagem , Uganda/epidemiologia , Adulto JovemRESUMO
We describe a case of multiorgan dysfunction secondary to Trypanosoma brucei rhodesiense infection acquired on safari in Zambia. This case was one of several recently reported to ProMED-mail in persons who had traveled to this region. Trypanosomiasis remains rare in travelers but should be considered in febrile patients who have returned from trypanosomiasis-endemic areas of Africa.
Assuntos
Insuficiência de Múltiplos Órgãos/diagnóstico , Viagem , Trypanosoma brucei rhodesiense , Tripanossomíase Africana/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/tratamento farmacológico , Insuficiência de Múltiplos Órgãos/parasitologia , Suramina/uso terapêutico , Resultado do Tratamento , Tripanossomicidas/uso terapêutico , Tripanossomíase Africana/tratamento farmacológico , Tripanossomíase Africana/parasitologiaRESUMO
We assessed the risk of clinically significant drug interactions in patients receiving antiretrovirals, and their recognition by physicians. Clinically significant drug interactions were recorded in 27% of 159 patients, with 15% of interactions potentially lowering antiretroviral concentrations. Risk of clinically significant drug interactions was significantly related to receipt of protease inhibitors. Only 36% of clinically significant drug interactions were correctly identified by physicians.
