Pulmonary Loiasis and HIV Coinfection in Rural Cameroon 英文参考文献.docVIP

Symposium PulmonaryLoiasisandHIVCoinfectioninRural Cameroon AlexisCambanis1,2 * 1St.ElizabethHospital,Shisong,Cameroon,2TropicalMedicineProgram,PIH-UCIFamilyMedicineResidency,Whittier,California,UnitedStatesofAmerica PresentationofCase normalization of his vital signs and total resolution of the pleural effusions on repeatradiography(Figure1).Thepatient was encouraged to participate in the annual ivermectin campaigns common in theareaandtomonitorhisHIVinfection athislocalmedicalcenter. [1]. Definitive cure sometimes requires repeated courses of DEC as some adult wormssurvivethefirsttreatment,andside effectssuchasitching,rash,headache,and fever are common. The microfilaricidal effect of ivermectin lasts for over a year. Both treatments can cause an often fatal encephalopathy, especially in people with high (30–50,000mff/ml) microfilaremias, characterized by aphasia, extrapyramidal signs, incontinence, and retinal hemor- rhage.Inheavilyinfectedpatients,themff loadcanbereducedbya3-weekcourseof albendazole,threesessionsofapheresis,or ivermectinpriortoadministeringcurative DECmoresafely[1]. A38-year-oldmanpresentedtoarural hospital in Northwest Cameroon with a one-month history of dyspnea that wors- ened upon exertion. He reported occa- sional cough, which was nonproductive. Reviewofsystemsrevealedafallinweight from81kgto71kgoverthelastyear,but no other problems were noted. The patient initially sought care at a health centerinDouala(10hoursawaybypublic transport), where he was treated for typhoidwithnoimprovement. CaseDiscussion Loiasisinsub-SaharanAfrica Loaloaisafilarialnematodetransmitted by Chrysops tabanid flies and is limited to West and Central Africa. Most infected people remain asymptomatic, but after a latency period from 6 months to several years,clinicalsymptomsmaydevelop,most oftenintermittentedematouslesionsinthe extremities(Calabarswellings)orpassageof theadultwormundertheconjunctiva[1]. It is estimated that between 2 and 13 millionpeopleareinfect