Placebo-controlled trial co-trimoxazole for cyclospora infections among travellers and foreign residents in Nepal.

Hoge, C. W.; Gaudio, Paul A.; Echeverria, Peter; Shlim, David R.; Rabold, J; Pandey, Prativa; Walch, Anne; Rajah, Ramachandra; Ghimire, Madhav Prasad

doi:10.1016/s0140-6736(95)90868-4

Cited by 175 publications

(48 citation statements)

References 14 publications

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“…The mean time with detectable Cyclospora oocysts was 4.8 Ϯ 1.2 days for the treated group, compared to 12.1 Ϯ 6.1 days for the placebo group (115). In Nepal, adult expatriates with Cyclospora infection participated in a randomized double-blinded study with TMP-SMX given at 160-800 mg twice a day (BID) for 7 days (88). At that time, 6% of the treated group was still excreting oocysts.…”

Section: Treatmentmentioning

confidence: 99%

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Update on Cyclospora cayetanensis , a Food-Borne and Waterborne Parasite

2010

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SUMMARY The coccidian parasite Cyclospora cayetanensis is recognized as an emerging pathogen that causes protracted diarrhea in humans. The first cases of Cyclospora infection were reported in the late 1970s and were observed among expatriates and travelers in regions where infections are endemic. Since then, Cyclospora has been considered a cause of traveler's diarrhea. Epidemiological investigations were reported and examined in areas of endemicity even before the true identity of Cyclospora was elucidated. Cyclospora was fully characterized in the early 1990s, but it was not until the 1995 Cyclospora outbreak in the United States and Canada that it caught the attention of the public and physicians. The biology, clinical presentation, epidemiology, diagnosis, treatment, and control of cyclosporiasis are reviewed, with a focus on diagnostic assays currently being used for clinical and environmental samples. Challenges and limitations in working with Cyclospora are also discussed.

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Section: Treatmentmentioning

confidence: 99%

“…In these patients, the infection resolved after extending treatment for an additional week. The eradication of Cyclospora in stools was directly correlated with clinical improvement (88). In Haiti, 43 patients with Cyclospora infection were treated with TMP-SMX (144).…”

Section: Treatmentmentioning

confidence: 99%

Update on Cyclospora cayetanensis , a Food-Borne and Waterborne Parasite

2010

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“…With progressive immune suppression (CD4 ϩ T cell counts of Ͻ200 cells/l in HIV-infected individuals) prolonged carriage occurs, resulting in frequent severe relapses which may last from 4 to 7 weeks (11,90,139). These recurrences in turn result in severe malnutrition and significant morbidity and mortality in HIV-coinfected patients (201).…”

Section: Cyclosporamentioning

confidence: 99%

Clinical Significance of Enteric Protozoa in the Immunosuppressed Human Population

et al. 2009

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SUMMARY Globally, the number of immunosuppressed people increases each year, with the human immunodeficiency virus (HIV) pandemic continuing to spread unabated in many parts of the world. Immunosuppression may also occur in malnourished persons, patients undergoing chemotherapy for malignancy, and those receiving immunosuppressive therapy. Components of the immune system can be functionally or genetically abnormal as a result of acquired (e.g., caused by HIV infection, lymphoma, or high-dose steroids or other immunosuppressive medications) or congenital illnesses, with more than 120 congenital immunodeficiencies described to date that either affect humoral immunity or compromise T-cell function. All individuals affected by immunosuppression are at risk of infection by opportunistic parasites (such as the microsporidia) as well as those more commonly associated with gastrointestinal disease (such as Giardia). The outcome of infection by enteric protozoan parasites is dependent on absolute CD4+ cell counts, with lower counts being associated with more severe disease, more atypical disease, and a greater risk of disseminated disease. This review summarizes our current state of knowledge on the significance of enteric parasitic protozoa as a cause of disease in immunosuppressed persons and also provides guidance on recent advances in diagnosis and therapy for the control of these important parasites.

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“…15 Formalin-preserved samples were also examined using modified trichrome stain for detection of microsporidia. 16 Permanent trichrome-stained preparations were made from the samples collected in PVA and examined for intestinal protozoa. To ensure quality control, positive and negative controls for microsporidia (Meridian Diagnostics) and commercially available permanent slides and samples with protozoan cysts and trophozoites were included with each batch of samples that was stained and analyzed.…”

Section: Subjectsmentioning

confidence: 99%

Intestinal parasitic infections in human immunodeficiency virus (HIV)-positive and HIV-negative individuals in San Pedro Sula, Honduras.

Lindo¹,

Dubon²,

Ager³

et al. 1998

The American Journal of Tropical Medicine and Hygiene

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Abstract. Honduras has at least five-times more human immunodeficiency virus (HIV)-infected individuals than any other country in Central America. The relationship between HIV status and the presence of intestinal parasites in this part of the world is unknown. This study presents the results from a prospective, comparative study for the presence of parasites in 52 HIV-positive and 48 HIV-negative persons in San Pedro Sula, Honduras. Infection with HIV was determined by microagglutination and confirmed by Western blot analysis. Parasites were detected in stools using formalin-ether concentration, and Kinyoun and trichrome staining. Age, sex, and clinical state of HIV infection were recorded for each study participant. Our results indicate that Cryptosporidium parvum and Strongyloides stercoralis, which are intracellular or live in the mucosa, were found exclusively in persons infected with HIV. In comparison, the prevalence of the extracellular parasites Giardia lamblia, Ascaris lumbricoides, and Trichuris trichiura was significantly higher (P Ͻ 0.05) in persons who were HIV-negative. Trichuris worms are in contact with the gut epithelium and less so with the mucosa, whereas Strongyloides lives within the gut mucosa. It is possible that changes in the gut epithelium due to HIV infection do not affect the mucosa and therefore would not affect Strongyloides. We conclude that infection with HIV may selectively deter the establishment of certain intestinal parasites. This may be due to the fact that HIV-induced enteropathy does not favor the establishment of extracellular parasites. Intracellular and mucosal dwelling organisms, however, may benefit from pathologic changes and reduced local immune responses induced by the virus, which, in turn, may lead to higher prevalence among HIV-infected individuals.

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Placebo-controlled trial co-trimoxazole for cyclospora infections among travellers and foreign residents in Nepal.

Cited by 175 publications

References 14 publications

Update on Cyclospora cayetanensis , a Food-Borne and Waterborne Parasite

Update on Cyclospora cayetanensis , a Food-Borne and Waterborne Parasite

Clinical Significance of Enteric Protozoa in the Immunosuppressed Human Population

Intestinal parasitic infections in human immunodeficiency virus (HIV)-positive and HIV-negative individuals in San Pedro Sula, Honduras.

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