In 2015, the World Health Organization registered 10.4 million people who developed tuberculosis worldwide and 480,000 new cases of multidrug-resistant tuberculosis were identified. The care of multi and extensively drug-resistant tuberculosis is based on a combination of pyrazinamide and second-line drugs. These regimens are lengthy, partially effective and poorly tolerated. The challenge is to re-evaluate the use of existing molecules and to develop new agents more effective against resistant strains with shorter treatment duration. This literature review gives an overview of the latest research addressing these therapeutic objectives. Some molecules are in late stage clinical development among which pretomanid is showing promising results. Bedaquiline and delamanid have been recently approved by the Food and Drug Administration. The efficacy of drug regimens combining these molecules is under evaluation.
Background
Cases of Toxoplasma reactivation or more severe primary infection have been reported in patients receiving immunosuppressive (IS) treatment for autoimmune diseases (AID). The purpose of this study was to describe features of toxoplasmosis occurring in patients with AID treated by IS therapy, excluded HIV-positive and transplant patients.
Methods
A multicenter descriptive study was conducted using data from the French National Reference Center for Toxoplasmosis (NRCT) that received DNA extracts or strains isolated from patients, associated with clinical data. Other cases were retrieved through a questionnaire sent to all French parasitology and internal medicine departments. Furthermore, a systematic literature review was conducted.
Results
61 cases were collected: 25 retrieved by the NRCT and by a call for observations and 36 from a literature review. Half of the cases were attributed to reactivation (50.9%), and most of cases (49.2%) were cerebral toxoplasmosis. The most common associated AID were rheumatoid arthritis (28%) and most frequent treatments were antimetabolites (44.3%). Corticosteroids were involved in 60.7% of cases. Patients had a favorable outcome (50.8%) but nine did not survive. For 12 cases, a successful Toxoplasma strain characterization suggested the possible role of this parasitic factor in ocular cases.
Conclusion
Although this remains a rare condition, clinicians should be aware for the management of patients and for the choice of IS treatment.
Étude de cas / Case report Hypotension sévère au cours d'une intoxication par deux plantes médicinales à l'île de la Réunion : Aphloia theiformis et Rubus alceifolius Severe low blood pressure during poisoning by two medicinal plants in Reunion Island: Aphloia theiformis and Rubus alceifolius (a case report)
Résumé -Si la majorité des envenimations marines observées sur les côtes européennes reste peu inquiétante, certaines peuvent nécessiter une prise en charge médicale, par exemple pour certaines piqûres de vives qui engendrent en saison estivale un nombre non négligeable de consultations auprès des centres antipoisons français. Les auteurs rapportent le cas d'un homme de 37 ans sans antécédent médical, qui a consulté aux urgences d'un hôpital varois pour une piqûre de vive au niveau du cuir chevelu après une chute la tête la première dans le sable. Cette observation a été caractérisée par une localisation inhabituelle des lésions et par un tableau clinique important avec persistance des symptômes malgré une prise en charge thérapeutique adaptée.
Mots clés : Envenimation, piqûre de vive, oedème facial persistantAbstract -In Europe, where marine envenomations are usually not severe, some rare stings may require medical management; for example, weever fish stings, inducing numerous marine envenomations on the European coasts (these accidents lead to frequent consultations during the summer season in the French poison centers). The authors report the case of a 37-year-old man, without a previous clinical history, who was treated in an emergency unit for a weever fish sting on the scalp after a headlong fall in the sand. This observation was characterized by the unusual localization of the venom injection, and by the clinical feature of persistence of symptoms despite therapeutic treatment.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.