Scrub typhus:pathophysiology,clinical manifestations and prognosis

Scrub typhus is a zoonosis caused by the pathogen Orientia tsutsugamushi(O.tsvtsugamushi). The disease has significant prevalence in eastern and Southeast Asia.Usually presenting as an acute febrile illness,the diagnosis is often missed because of similarities with oilier tropical febrile infections.Many unusual manifestations are present,and these are described in this review,together with an outline of current knowledge of pathophysiology.Awareness of these unusual clinical manifestations will help the clinician to arrive at an early diagnosis,resulting in early administration of appropriate antibiotics.Prognostic indicators for severe disease have not yet been clearly established.

Chemoprophylaxis in malaria:drugs,evidence of efficacy and costs

This review concentrates on different aspects of malaria chemoprophylaxis,namely drug combinations,resistance,impact of malaria prevention in pregnancy and cost effectiveness. A MEDLINE search was performed for all articles with the key word ’Malaria’ in the title field and ’Prophylaxis’ in any field.The search was restricted to articles published in English within the last decade(1999-2009).Data sources included review articles published in core clinical journals,cohort studies,interventional studies,case control studies and cross sectional analyses. The mechanism of action,trial evidence of efficacy,side effects and geographical distribution of resistance is discussed for each prophylactic drug regimen.Impact of prophylaxis in pregnancy and the cost considerations are discussed under two separate sub topics.

The need for preventive and curative services for malaria when the military is deployed in endemic overseas territories: a case study and lessons learned

Background: Sri Lanka has been free from indigenous malaria since November 2012 and received the WHO certificate for malaria-free status in September 2016. Due to increased global travel, imported malaria cases continue to be reported in the country. Military personnel returning home from international peace-keeping missions in malaria endemic countries represent a key risk group in terms of imported malaria. The present study intended to characterize the potential causes of a malaria outbreak among the Sri Lankan security forces personnel deployed in the Central African Republic(CAR).Methods: Data were collected from a cross-sectional survey distributed among Sri Lankan Air Force personnel who had returned from United Nations peace-keeping missions in the CAR region. A pre-tested questionnaire was used for the data collection, and focus group discussions were also conducted.Results: One hundred twenty male Air Force personnel were interviewed(out of a group of 122 officers and airmen). All participants were deployed in the CAR for 14 months and were aware of the existence of chemoprophylaxis against malaria. The majority of the subjects(92.5%, 111/120) also knew that prophylaxis should be started prior to departure. However, the regular use of chemoprophylaxis was reported by only 61.7%(74/120) of the sample. Overall, 30.8% of the participants(37/120) had 44 symptomatic episodes of malaria during deployment, and one person succumbed to severe malaria. All cases were associated with noncompliance with chemoprophylaxis.Conclusion: Better coordination with overseas healthcare services and the establishment of directly observed chemoprophylaxis may help to avoid similar outbreaks in the future.