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Respiratory Diseases
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Aref T. Senno, Ryan K. Brannon
Chemoprophylaxis after exposure to influenza is recommended for individuals at high risk of complications from influenza, which would include pregnant and women up to 14 days postpartum [81]. For household exposures, a 7–10 day course of either oseltamivir 75 mg once daily, or zanamivir as two 5-mg inhalations once daily are recommended. If symptoms begin, chemoprophylaxis dosing should be increased to therapeutic dosing. There are no RCTs of post-exposure influenza prophylaxis among pregnant women. The efficacy of oseltamivir prophylaxis has been called into question after a reanalysis of data obtained directly from the manufacturer showing a 55% decrease in symptomatic influenza cases, but no significant reduction in transmission or asymptomatic cases [82].
Constraints to Progress in Leprosy Control
Published in Max J. Miller, E. J. Love, Parasitic Diseases: Treatment and Control, 2020
Segregation was practiced before effective chemotherapy became available. Segregation, when strictly enforced, contributed to the decline of leprosy in some countries such as Norway in the 19th century and, more recently, in Japan. Segregation of paucibacillary cases is needless, since their role in transmission is minimal, and segregation of multibacillary cases is unnecessary when effective treatment is provided. Chemoprophylaxis showed a moderate protective effect in a limited number of trials. For epidemiological and operational reasons, it is neither advisable nor applicable on a large scale.
Diagnosis of Latent TB Infection
Published in Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies, Clinical Tuberculosis, 2020
Ajit Lalvani, Clementine Fraser, Manish Pareek
Clinical benefits from chemoprophylaxis for LTBI can only occur if IGRA-positive contacts are truly at increased risk of subsequently progressing to active TB compared with IGRA-negative contacts. The gold standard marker of LTBI is the correlation with risk of progression to active TB disease. In immunocompetent individuals only a small proportion, approximately 5%–10%, will develop TB disease from a latent infection during their lifetime; nearly all within the 2 years post exposure.2 If prophylaxis was provided for all those with LTBI, it would result in an enormous waste of resources, increased risks and side effects associated with the medications themselves and increased likelihood of anti-TB drug resistance, especially when the majority of patients would have never developed active TB. An additional caveat is that chemoprophylaxis is not completely effective. Studies have shown that traditional 6–12 month isoniazid regimens as chemoprophylaxis for LTBI (which have the most abundant evidence for clinical efficacy) have a protective effect of 60% when taken correctly,80 however initiation and completion rates of chemoprophylaxis are frequently suboptimal and vary greatly across different populations.81
Echinococcosis in a non-endemic country – 20-years’ surgical experience from a Norwegian tertiary referral Centre
Published in Scandinavian Journal of Gastroenterology, 2022
Sheraz Yaqub, Mogens Jensenius, Ole Einar Heieren, Anders Drolsum, Frank O. Pettersen, Knut Jørgen Labori
In principle, all tissues can be affected in echinococcosis. The liver is the most commonly affected organ in 70% of cases, followed by the lungs in about 20% and remaining organs in about 10% (kidney, brain, bone, muscles and others) [5]. Treatment modalities in CE can be surgery (radical or conservative), medical (benzimiadazoles), percutaneous techniques (as Puncture, Aspiration Injection, and Re-aspiration (PAIR)) for hepatic cystic echinococcosis, or a watch-and-wait strategy [5,6]. Diagnostic or therapeutic percutaneous intervention or surgery should be performed together with periinterventional chemoprophylaxis. The choice of treatment strategy is based on the WHO-IWGE cyst classification where cysts are classified as active, transitional and inactive with subsequent classification into subgroups requiring different treatment strategies [7]. In AE, the therapeutic options are fewer, and surgical resection of the entire larval mass, usually by excision of the entire affected lobe of the liver, is desired in combination with long-lasting medical therapy. In some cases radical surgery is not possible and prolonged suppressive anti-parasitic therapy remains the only option.
Drought-related cholera outbreaks in Africa and the implications for climate change: a narrative review
Published in Pathogens and Global Health, 2022
Gina E. C. Charnley, Ilan Kelman, Kris A. Murray
When outbreaks do occur, responses need to be rapid, due to the short incubation period of cholera (2 hours – 5 days). For example, in Mali, most cases and deaths were reported in the first week of the outbreak [17]. In Mauritania, the cholera outbreak was reported almost immediately and closure of contaminated wells, intensive vaccination, chemoprophylaxis for contacts and education campaigns meant that the outbreak was terminated within 3 weeks [26]. Despite this, chemoprophylaxis should be targeted, as not everyone is at risk, and it can lead to accelerated resistance [17]. Global policy on these actions may help those involved in the response to move swiftly during drought and stop outbreaks in the early stages, alongside rapid assessment of a population during and after a natural hazard to prioritize areas for aid and food distribution [26].
Hydroxychloroquine in the COVID-19 pandemic era: in pursuit of a rational use for prophylaxis of SARS-CoV-2 infection
Published in Expert Review of Anti-infective Therapy, 2021
Marco Infante, Camillo Ricordi, Rodolfo Alejandro, Massimiliano Caprio, Andrea Fabbri
Since its first identification in Wuhan (China) in December 2019 [1], coronavirus disease 2019 (COVID-19) caused by the novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) has been posing a serious threat to public health. COVID-19 outbreak spread quickly across countries and was declared a global pandemic by the WHO on 11 March 2020, thus placing unprecedented strain on healthcare systems worldwide. Therefore, a robust research effort to develop an effective vaccine is currently underway and countries around the world keep on promoting face mask use, eye protection, hygiene measures and physical distancing as nonpharmacologic interventions to counteract the spread of COVID-19 outbreak. Although the risk of acquiring SARS-CoV-2 may decrease in the near future, a residual risk of unpredictable extent will likely persist [2]. For the foreseeable future, there is an urgent need to find safe and effective pre- and post-exposure prophylactic strategies (chemoprophylaxis) for high-risk individuals (such as healthcare workers and contacts of laboratory-confirmed cases), as well as safe pharmacological interventions able to effectively cure the established disease. In addition, the current pandemic scenario demands to prioritize the prophylaxis of selected individuals who are at high risk for greater disease severity and death from COVID-19, such as aged frail subjects, as well as individuals with obesity, cardiovascular disease and type 2 diabetes [3–5].