RESUMO
Paragonimiasis is an infection caused by lung flukes of the genus Paragonimus. In Asia, P. westermani infections are relatively common because of dietary practices. However, in North America, cases of paragonimiasis, which are caused by P. kellicotti flukes, are rare. Only 7 autochthonous cases of paragonimiasis were reported during 1968-2008. In 2009, we reported 3 new case-patients with paragonimiasis who had been seen at our medical center over an 18-month period. Six additional case-patients were identified in St. Louis, Missouri, USA, and treated at Washington University-affiliated health centers in 2009-2010. We report detailed descriptions of these case-patients, which includes unusual clinical manifestations. We also describe public health interventions that were undertaken to inform the general public and physicians about the disease and its mode of transmission.
Assuntos
Doenças Transmissíveis Emergentes/epidemiologia , Pneumopatias Parasitárias/epidemiologia , Paragonimíase/epidemiologia , Paragonimus , Adulto , Animais , Anti-Helmínticos/uso terapêutico , Astacoidea/parasitologia , Criança , Doenças Transmissíveis Emergentes/diagnóstico , Doenças Transmissíveis Emergentes/tratamento farmacológico , Doenças Transmissíveis Emergentes/parasitologia , Feminino , Contaminação de Alimentos , Humanos , Pneumopatias Parasitárias/diagnóstico , Pneumopatias Parasitárias/tratamento farmacológico , Pneumopatias Parasitárias/parasitologia , Masculino , Missouri/epidemiologia , Paragonimíase/diagnóstico , Paragonimíase/tratamento farmacológico , Paragonimíase/parasitologia , Paragonimus/classificação , Paragonimus/isolamento & purificação , Praziquantel/uso terapêutico , Frutos do Mar/parasitologia , Adulto JovemRESUMO
Sepsis and its attendant complications are commonly encountered in the intensive care unit. Early recognition of sepsis is critical because it allows for rapid deployment of a multifaceted resuscitation package. The cornerstones of sepsis management are antibiotic therapy, source control, and hemodynamic resuscitation. In select patients, ancillary therapies are indicated, such as activated protein C, corticosteroids, and glycemic control. Given the complexity of sepsis management, optimal care can be delivered as a bundle-a protocol encompassing the above interventions. The evidence behind the various components of sepsis management are reviewed here.
RESUMO
WU polyomavirus is a recently described polyomavirus found in patients with respiratory infections. Of 2,637 respiratory samples tested in St. Louis, Missouri, 2.7% were positive for WU polyomavirus by PCR, and 71% were coinfected with other respiratory viruses. Persistent human infection with WU polyomavirus is described.
