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Biomedical subjects

David O Freedman

Publications and source records attributed to David O Freedman.

9 recordsLinked to original sources
PubMed2006

Spectrum of disease and relation to place of exposure among ill returned travelers.

BACKGROUND: Approximately 8 percent of travelers to the developing world require medical care during or after travel. Current understanding of morbidity profiles among ill returned travelers is based on limited data from the 1980s. METHODS: Thirty GeoSentinel sites, which are specialized travel or tropical-medicine clinics on six continents, contributed clinician-based sentinel surveillance data for 17,353 ill returned travelers. We compared the frequency of occurrence of each diagnosis among travelers returning from six developing regions of the world. RESULTS: Significant regional differences in proportionate morbidity were detected in 16 of 21 broad syndromic categories. Among travelers presenting to GeoSentinel sites, systemic febrile illness without localizing findings occurred disproportionately among those returning from sub-Saharan Africa or Southeast Asia, acute diarrhea among those returning from south central Asia, and dermatologic problems among those returning from the Caribbean or Central or South America. With respect to specific diagnoses, malaria was one of the three most frequent causes of systemic febrile illness among travelers from every region, although travelers from every region except sub-Saharan Africa and Central America had confirmed or probable dengue more frequently than malaria. Among travelers returning from sub-Saharan Africa, rickettsial infection, primarily tick-borne spotted fever, occurred more frequently than typhoid or dengue. Travelers from all regions except Southeast Asia presented with parasite-induced diarrhea more often than with bacterial diarrhea. CONCLUSIONS: When patients present to specialized clinics after travel to the developing world, travel destinations are associated with the probability of the diagnosis of certain diseases. Diagnostic approaches and empiric therapies can be guided by these destination-specific differences.

Adult↗
PubMed2005

Prevalence and predictors of intestinal helminth infections among human immunodeficiency virus type 1-infected adults in an urban African setting.

Sub-Saharan Africa is disproportionately burdened by intestinal helminth and human immunodeficiency virus (HIV)-1 infection. Recent evidence suggests detrimental immunologic effects from concomitant infection with the two pathogens. Few studies, however, have assessed the prevalence of and predictors for intestinal helminth infection among HIV-1-infected adults in urban African settings where HIV infection rates are highest. We collected and analyzed sociodemographic and parasitologic data from 297 HIV-1-infected adults (mean age = 31.1 years, 69% female) living in Lusaka, Zambia to assess the prevalence and associated predictors of helminth infection. We found at least one type of intestinal helminth in 24.9% of HIV-infected adults. Thirty-nine (52.7%) were infected with Ascaris lumbricoides, and 29 (39.2%) were infected with hookworm. More than 80% were light-intensity infections. A recent visit to a rural area, food shortage, and prior history of helminth infection were significant predictors of current helminth status. The high helminth prevalence and potential for adverse interactions between helminths and HIV suggests that helminth diagnosis and treatment should be part of routine HIV care.

AIDS-Related Opportunistic Infections↗
PubMed2002

Treatment failure in intestinal strongyloidiasis: an indicator of HTLV-I infection.

BACKGROUND: The association of severe strongyloides with HTLV-I is well known; however, the seroprevalence of HTLV-I in other groups with strongyloidiasis is still unknown. We conducted a prospective study in patients with intestinal strongyloidiasis without known immunodepression who failed to respond to standard therapy with ivermectin or thiabendazole (failure was defined as one positive stool examination at the post-therapy follow up). All these patients were tested for HTLV-I by ELISA and Western Blot. RESULTS: Forty seven patients were evaluated: 74.5% (35 out of 47) were HTLV-I positive, without significant difference between males (76%) and females (72.7%). CONCLUSIONS: We recommend that all patients with uncomplicated intestinal strongyloidiasis, who fail standard therapy, be studied for HTLV-I infection.

Adolescent↗
PubMed2002

Sexual behavior of international travelers visiting Peru.

BACKGROUND: Sexual behavior of travelers to Latin America and the sexual behavior of US travelers in general are poorly characterized. GOAL: The goal of the study was to evaluate sexual risk factors of travelers to Peru. STUDY DESIGN: Anonymous written questionnaires were administered to 442/507 (87%) of the individuals approached in the international departures area of the Lima airport. RESULTS: Of the 442 respondents, 54 (12.2%) had new sex partners during their stay. Sex with a local partner (35/52; 67.3%) was more frequent than sex with other travelers (18/52; 34.6%) or with sex workers (4/52; 7.7%). Risk factors for a new sex partner included male sex (relative risk, 1.94), single marital status (relative risk, 2.59), duration of stay longer than 30 days (relative risk, 5.05), traveling alone or with friends (relative risk, 2.88), and bisexual orientation (relative risk, 4.94). Frequency of sexual activity among US travelers was greater than that among travelers from other countries (15.2% [22/145] versus 10.6% [30/282]; NS). Condoms were consistently used by 12/50 (24%) and sometimes used by 10/50 (20%), including 8/20 United States travelers and 13/29 travelers from other countries. CONCLUSION: Behaviors and risk factors are similar to those described for travelers to Africa, Asia, and Eastern Europe. Behavior of US travelers did not differ from that of other travelers.

Adolescent↗
PubMed2002

Educational programs to enhance medical expertise in tropical diseases: the Gorgas Course experience 1996-2001.

In 1995, the American Society of Tropical Medicine and Hygiene (ASTMH) adopted defined criteria for accreditation of clinical training programs in tropical diseases. The first data on the development, enrollment, and outcomes of such a program are presented. A nine-week Diploma course, the Gorgas Course in Clinical Tropical Medicine, given on-site in the tropics (Lima, Cusco, and Iquitos, Peru) has trained 157 individuals from 38 countries from 1996 through 2001. The average age of participants was 38.3 with 11.3 years since graduation. Graduates were 44.5% primary care physicians, 22.2% infectious diseases specialists, 12.7% emergency medicine specialists, 13.5% other specialists, and 7.1% nurses. Residents and fellows accounted for 32.8% and full-time academic faculty for 11.0%. Approximately half of all eligible Gorgas graduates have taken the ASTMH certification examination. In response to the enrollees' profiles and needs, adult learning theory has been extensively used in course design. Stable professional relationships between multiple educational partners are required for an endeavor of this scope.

Adult↗