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Calleri G.,Amedeo Of Savoia Hospital | Behrens R.H.,London School of Hygiene and Tropical Medicine | Schmid M.L.,Royal Infirmary | Gobbi F.,Center for Tropical Diseases | And 6 more authors.
Malaria Journal | Year: 2011

Background: Numbers of travellers visiting friends and relatives (VFRs) from Europe to malaria endemic countries are increasing and include long-term and second generation immigrants, who represent the major burden of malaria cases imported back into Europe. Most recommendations for malaria chemoprophylaxis lack a solid evidence base, and often fail to address the cultural, social and economic needs of VFRs. Methods. European travel medicine experts, who are members of TropNetEurop, completed a sequential series of questionnaires according to the Delphi method. This technique aims at evaluating and developing a consensus through repeated iterations of questionnaires. The questionnaires in this study included questions about professional experience with VFRs, controversial issues in malaria prophylaxis, and 16 scenarios exploring indications for prescribing and choice of chemoprophylaxis. Results: The experience of participants was rather diverse as was their selection of chemoprophylaxis regimen. A significant consensus was observed in only seven of 16 scenarios. The analysis revealed a wide variation in prescribing choices with preferences grouped by region of practice and increased prescribing seen in Northern Europe compared to Central Europe. Conclusions: Improving the evidence base on efficacy, adherence to chemoprophylaxis and risk of malaria and encouraging discussion among experts, using techniques such as the Delphi method, may reduce the variability in prescription in European travel clinics. © 2011 Calleri et al; licensee BioMed Central Ltd.


Bisoffi Z.,Center for Tropical Diseases | Gobbi F.,Center for Tropical Diseases | Buonfrate D.,Center for Tropical Diseases | Van den Ende J.,Institute of Tropical Medicine
Mediterranean Journal of Hematology and Infectious Diseases | Year: 2012

The revised W.H.O. guidelines for malaria management in endemic countries recommend that treatment should be reserved to laboratory confirmed cases, both for adults and children. Currently the most widely used tools are rapid diagnostic tests (RDTs), that are accurate and reliable in diagnosing malaria infection. However, an infection is not necessarily a clinical malaria, and RDTs may give positive results in febrile patients who have another cause of fever. Excessive reliance on RDTs may cause overlooking potentially severe non malarial febrile illnesses (NMFI) in these cases. In countries or areas where transmission intensity remains very high, fever management in children (especially in the rainy season) should probably remain presumptive, as a test-based management may not be safe, nor cost effective. In contrast, in countries with low transmission, including those targeted for malaria elimination, RDTs are a key resource to limit unnecessary antimalarial prescription and to identify pockets of infected individuals. Research should focus on very sensitive tools for infection on one side, and on improved tools for clinical management on the other, including biomarkers of clinical malaria and/or of alternative causes of fever.


Buonfrate D.,Center for Tropical Diseases | Angheben A.,Center for Tropical Diseases | Gobbi F.,Center for Tropical Diseases | Mistretta M.,Center for Tropical Diseases | And 2 more authors.
Infection | Year: 2016

Trichostrongylus spp. are parasites that are seldom recognized as a cause of eosinophilia and gastroenteric symptoms in industrialized countries. The index of suspicion raises when several members of a same household present eosinophilia. We report four clusters of Trichostrongylus infection diagnosed in a single center, in northern Italy. Patients came from four different provinces of three Italian Regions. Some patients presented symptoms (abdominal pain and diarrhea were the most frequent ones, reported by 67 and 42% of our patients, respectively), while other were asymptomatic. All of them presented eosinophilia, that was severe (>5000 eosinophils/mmc) in 58% cases. Obtaining an accurate history from patients, investigating possible ingestion of vegetables contaminated by organic manure or sheep dejections, is particularly important to achieve diagnosis, also in light of the low sensitivity of parasitological tests. © 2016 Springer-Verlag Berlin Heidelberg


PubMed | Center for Tropical Diseases
Type: | Journal: Infection | Year: 2016

Trichostrongylus spp. are parasites that are seldom recognized as a cause of eosinophilia and gastroenteric symptoms in industrialized countries. The index of suspicion raises when several members of a same household present eosinophilia. We report four clusters of Trichostrongylus infection diagnosed in a single center, in northern Italy. Patients came from four different provinces of three Italian Regions. Some patients presented symptoms (abdominal pain and diarrhea were the most frequent ones, reported by 67 and 42% of our patients, respectively), while other were asymptomatic. All of them presented eosinophilia, that was severe (>5000 eosinophils/mmc) in 58% cases. Obtaining an accurate history from patients, investigating possible ingestion of vegetables contaminated by organic manure or sheep dejections, is particularly important to achieve diagnosis, also in light of the low sensitivity of parasitological tests.


PubMed | Center for Tropical Diseases
Type: Journal Article | Journal: Mediterranean journal of hematology and infectious diseases | Year: 2012

The revised W.H.O. guidelines for malaria management in endemic countries recommend that treatment should be reserved to laboratory confirmed cases, both for adults and children. Currently the most widely used tools are rapid diagnostic tests (RDTs), that are accurate and reliable in diagnosing malaria infection. However, an infection is not necessarily a clinical malaria, and RDTs may give positive results in febrile patients who have another cause of fever. Excessive reliance on RDTs may cause overlooking potentially severe non malarial febrile illnesses (NMFI) in these cases. In countries or areas where transmission intensity remains very high, fever management in children (especially in the rainy season) should probably remain presumptive, as a test-based management may not be safe, nor cost effective. In contrast, in countries with low transmission, including those targeted for malaria elimination, RDTs are a key resource to limit unnecessary antimalarial prescription and to identify pockets of infected individuals. Research should focus on very sensitive tools for infection on one side, and on improved tools for clinical management on the other, including biomarkers of clinical malaria and/or of alternative causes of fever.

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