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Prevention of Waterborne Illness

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181. Giardiasis (Treatment)

& Fordtran's Gastrointestinal and Liver Disease . 8th ed. Philadelphia, PA: Saunders; 2006. Vol 2: 2420-3. Robertson LJ, Forberg T, Gjerde BK. Giardia cysts in sewage influent in Bergen, Norway 15-23 months after an extensive waterborne outbreak of giardiasis. J Appl Microbiol . 2008 Apr. 104(4):1147-52. . Ryu H, Alum A, Mena KD, Abbaszadegan M. Assessment of the risk of infection by Cryptosporidium and Giardia in non-potable reclaimed water. Water Sci Technol . 2007. 55(1-2):283-90. . Farthing MJ (...) ):11-5. . Dizdar V, Gilja OH, Hausken T. Increased visceral sensitivity in Giardia-induced postinfectious irritable bowel syndrome and functional dyspepsia. Effect of the 5HT3-antagonist ondansetron. Neurogastroenterol Motil . 2007 Dec. 19(12):977-82. . Penrose AS, Wells EV, Aiello AE. Infectious causation of chronic disease: examining the relationship between Giardia lamblia infection and irritable bowel syndrome. World J Gastroenterol . 2007 Sep 14. 13(34):4574-8. . Hanevik K, Dizdar V, Langeland

2014 eMedicine Emergency Medicine

182. Leptospirosis in Humans (Follow-up)

Leptospira atop a 0.1-µm polycarbonate filter. (This image is in the public domain and thus free of any copyright restrictions. Courtesy of the Centers for Disease Control/Rob Weyant) Signs and symptoms Leptospirosis ranges in severity from a mild illness suggesting a viral infection to a multisystemic syndrome with unique features. It is characterized by sudden onset of the following: Fever (38-40°C) Rigors Headache, retro-orbital pain, photophobia Muscle pain localized to the calf and lumbar areas (...) disease. [ ] Women who become ill during the last trimester of pregnancy and have had high-risk exposure should present promptly for treatment to prevent in utero infection. Newborns of ill mothers can also be treated. Leptospires may be shed in breastmilk for an unknown duration. Travelers and participants in "adventure racing" or other freshwater sports who may be hiking and may otherwise be exposed to fresh water, soil, mud, and vegetation are at higher risk, especially those older than 60 years

2014 eMedicine Emergency Medicine

183. Campylobacter Infections (Diagnosis)

Updated: Aug 24, 2018 Author: Mahmud H Javid, MBBS; Chief Editor: Michael Stuart Bronze, MD Share Email Print Feedback Close Sections Sections Campylobacter Infections Overview Background Campylobacter infections are among the most common bacterial infections in humans. They produce both diarrheal and systemic illnesses. In industrialized regions, enteric Campylobacter infections produce an inflammatory, sometimes bloody, diarrhea or dysentery syndrome. Campylobacter jejuni (see image below (...) in intestinal secretions. The severity and persistence of C jejuni infections in individuals with AIDS and indicates that both cell-mediated and humoral immunity are important in preventing and terminating infection. The oral cavity contains numerous Campylobacter species, such as Campylobacter concisus, that have been associated with a subtype of inflammatory bowel disease. [ , ] Previous Next: Epidemiology Frequency United States An estimated 2 million cases of Campylobacter enteritis occur annually

2014 eMedicine.com

184. Giardiasis (Diagnosis)

of the epidemics documented over the last 2 decades have originated in day-care centers. Estimates of the prevalence of infection, defined by the presence of cyst passage, have been as high as 20-25% in children younger than 3 years. [ , ] According to 2003–2005 data from the Centers for Disease Control and Prevention, the greatest number of reported cases occurred among children aged 1-4 and 5-9 years and adults aged 35-44 years. [ ] Previous Next: Prognosis The prognosis for patients with giardiasis (...) visceral sensitivity in Giardia-induced postinfectious irritable bowel syndrome and functional dyspepsia. Effect of the 5HT3-antagonist ondansetron. Neurogastroenterol Motil . 2007 Dec. 19(12):977-82. . Penrose AS, Wells EV, Aiello AE. Infectious causation of chronic disease: examining the relationship between Giardia lamblia infection and irritable bowel syndrome. World J Gastroenterol . 2007 Sep 14. 13(34):4574-8. . Hanevik K, Dizdar V, Langeland N, Hausken T. Development of functional

2014 eMedicine.com

185. Cyclospora (Diagnosis)

, CDC Warns. Medscape Medical News. Available at . August 7, 2017; Accessed: August 8, 2017. Shlim DR, Cohen MT, Eaton M, Rajah R, Long EG, Ungar BL. An alga-like organism associated with an outbreak of prolonged diarrhea among foreigners in Nepal. Am J Trop Med Hyg . 1991 Sep. 45(3):383-9. . Ortega YR, Sterling CR, Gilman RH, Cama VA, Díaz F. Cyclospora species--a new protozoan pathogen of humans. N Engl J Med . 1993 May 6. 328(18):1308-12. . Centers for Disease Control and Prevention. Update (...) at wastewater treatment plants in Arizona. Sci Total Environ . 2014 Jun 15. 484:129-36. . Hall RL, Jones JL, Hurd S, Smith G, Mahon BE, Herwaldt BL. Population-based active surveillance for Cyclospora infection--United States, Foodborne Diseases Active Surveillance Network (FoodNet), 1997-2009. Clin Infect Dis . 2012 Jun. 54 Suppl 5:S411-7. . Baldursson S, Karanis P. Waterborne transmission of protozoan parasites: review of worldwide outbreaks - an update 2004-2010. Water Res . 2011 Dec 15. 45(20):6603-14

2014 eMedicine.com

186. Acanthamoeba (Diagnosis)

. Acanthamoeba was first established as a cause of human disease in the 1970s and might be considered an emerging infection. This genus causes 3 clinical syndromes: granulomatous amebic encephalitis (GAE), disseminated granulomatous amebic disease (eg, skin, sinus, and pulmonary infections), and, most commonly, amebic ocular . Individuals who develop GAE or disseminated disease are usually immunocompromised, whereas those with keratitis are usually immunocompetent. Disseminated disease and GAE carry a poor (...) have occurred among persons with a wide variety of immunocompromising conditions, including AIDS [ ] , posttransplantation, cancer being treated with chemotherapy, , steroid use, diabetes mellitus, malnutrition, or liver disease. [ ] Children who are malnourished, but otherwise healthy, are also at increased risk. Likewise, persons with disseminated disease without CNS involvement are usually immunocompromised; this condition is most common among patients with AIDS who have low CD4 counts (eg, 15

2014 eMedicine.com

187. Cryptosporidiosis (Diagnosis)

, Xiao L, Yoder JS, Centers for Disease Control and Prevention. Cryptosporidiosis surveillance -- United States, 2011-2012. MMWR Suppl . 2015 May 1. 64 (3):1-14. . Chalmers RM, Smith R, Elwin K, Clifton-Hadley FA, Giles M. Epidemiology of anthroponotic and zoonotic human cryptosporidiosis in England and Wales, 2004-2006. Epidemiol Infect . 2011 May. 139(5):700-12. . Scallan E, Hoekstra RM, Angulo FJ, Tauxe RV, Widdowson MA, Roy SL, et al. Foodborne illness acquired in the United States--major (...) -infected people after the waterborne outbreak of cryptosporidiosis in Milwaukee. N Engl J Med . 1996 Jan 4. 334(1):19-23. . Chalmers RM, Campbell BM, Crouch N, Charlett A, Davies AP. Comparison of diagnostic sensitivity and specificity of seven Cryptosporidium assays used in the UK. J Med Microbiol . 2011 Nov. 60:1598-604. . Committee on Infectious Diseases, American Academy of Pediatrics. Cryptosporidiosis. Kimberlin DW, Brady MT, Jackson MA, Long Ss, eds. Red Book . 30th ed. Elk Grove Village, Ill

2014 eMedicine.com

188. Pneumonia, Community-Acquired (Diagnosis)

infiltrates, and shock in the absence of conditions associated with hyposplenism should be evaluated for imitators of pneumonia, such as acute myocardial infarction or acute . Conditions that predispose to severe CAP should be considered in patients presenting with CAP and shock in the absence of one of the aforementioned cardiopulmonary diseases. The following disorders and therapies have been associated with severe CAP: Chronic alcoholism Amyloidosis Chronic active hepatitis Hyposplenism in elderly (...) in individuals with comorbid factors such as underlying cardiopulmonary disease, diminished splenic function, and/or heightened pathogenic virulence. Even in young and/or healthy hosts, severe CAP can develop if the causative pathogen is sufficiently virulent. For example, , ( ), ( ), and Legionnaires disease may present as severe CAP. [ , , , ] Patients with severe CAP should have the benefit of an infectious disease specialist to assist in the underlying cause of their condition. Complications associated

2014 eMedicine.com

189. Hematopoietic Stem Cell Transplantation (Diagnosis)

-Blackfan anemia Osteopetrosis Inborn errors of metabolism Autoimmune disorders *Uncommon in children; common reasons for transplantation in adults Previous Next: Prognosis Transplantation-related mortality and morbidity rates have considerably decreased because of improved conditioning regimens, human leukocyte antigen (HLA) typing, supportive care, and prevention and treatment of serious infections. Currently, overall and event-free survival rates are based on the individual's disease pathology (...) to treat the following conditions: Multiple myeloma Non-Hodgkin lymphoma Hodgkin lymphoma Acute myeloid leukemia Neuroblastoma Germ cell tumors Autoimmune disorders (systemic lupus erythematosus [SLE], systemic sclerosis) Amyloidosis Allogeneic HSCT is used to treat the following disorders: Acute myeloid leukemia Acute lymphoblastic leukemia Chronic myeloid leukemia Chronic lymphocytic leukemia Myeloproliferative disorders Myelodysplastic syndromes Multiple myeloma Non-Hodgkin lymphoma Hodgkin lymphoma

2014 eMedicine.com

190. Near Drowning (Overview)

in many cases. Australian, Scottish, and Canadian data showed that 30-50% of older adolescents and adults who drowned in boating incidents were inebriated, as determined by blood alcohol concentrations. All age groups Any of the following may lead to drowning episodes in people of any age: Seizure disorder Myocardial infarction (MI) or syncopal episode Poor neuromuscular control, such as that seen with significant arthritis, Parkinson disease, or other neurologic disorders Major depression/suicide (...) by the flooding of New Orleans after Hurricane Katrina: analysis of the relationship between flood characteristics and mortality. Risk Anal . 2009 May. 29(5):676-98. . Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Injury Prevention and Control: Data & Statistics. Web-based Injury System (WISQARS). Available at . May 4, 2016; Accessed: July 1, 2016. Centers for Disease Control and Prevention. CDC. Wide-ranging online data for Epidemiologic research (WONDER

2014 eMedicine Pediatrics

191. Naegleria (Overview)

phosphorylation in Naegleria fowleri amebae in response to normal human serum. J Eukaryot Microbiol . 2000 Jan-Feb. 47(1):40-7. . Naegleria fowleri — Primary Amebic Meningoencephalitis (PAM) — Amebic Encephalitis. Centers for Disease Control and Prevention. Available at . September 24, 2015; Accessed: September 12, 2016. Linam WM, Ahmed M, Cope JR, Chu C, Visvesvara GS, da Silva AJ, et al. Successful treatment of an adolescent with Naegleria fowleri primary amebic meningoencephalitis. Pediatrics . 2015 Mar (...) and the biology of Naegleria fowleri. Annu Rev Microbiol . 1982. 36:101-23. . Kidney DD, Kim SH. CNS infections with free-living amebas: neuroimaging findings. AJR Am J Roentgenol . 1998 Sep. 171(3):809-12. . Lawande RV, Macfarlane JT, Weir WR, Awunor-Renner C. A case of primary amebic meningoencephalitis in a Nigerian farmer. Am J Trop Med Hyg . 1980 Jan. 29(1):21-5. . Levy DA, Bens MS, Craun GF, et al. Surveillance for waterborne-disease outbreaks--United States, 1995-1996. Mor Mortal Wkly Rep CDC Surveill

2014 eMedicine Pediatrics

192. Leptospirosis (Follow-up)

polycarbonate filter. (This image is in the public domain and thus free of any copyright restrictions. Courtesy of the Centers for Disease Control/Rob Weyant) Signs and symptoms Leptospirosis ranges in severity from a mild illness suggesting a viral infection to a multisystemic syndrome with unique features. It is characterized by sudden onset of the following: Fever (38-40°C) Rigors Headache, retro-orbital pain, photophobia Muscle pain localized to the calf and lumbar areas Conjunctival suffusion Dry cough (...) and vector-borne diseases: a regional analysis. Bull World Health Organ . 2000. 78(9):1136-47. . . National Research Council. Advancing the Science of Climate Change . Washington, DC: The National Academies Press; 2010. CDC. From the Centers for Disease Control and Prevention. Update: outbreak of acute febrile illness among athletes participating in Eco-Challenge-Sabah 2000--Borneo, Malaysia, 2000. JAMA . 2001 Feb 14. 285(6):728-30. . CDC. Update: leptospirosis and unexplained acute febrile illness among

2014 eMedicine Pediatrics

193. Naegleria (Follow-up)

: Therapy for PAM requires hospitalization. Survivors may need seizure medications. Previous Next: Transfer See the list below: The rapidity of progression in PAM usually precludes transferring the patient long distances; however, treating patients in a medical facility with an intensive care unit and neurosurgical and infectious disease support is best whenever possible. Previous Next: Deterrence/Prevention See the list below: N fowleri is ubiquitous and is present in warm freshwater and soil (...) . The widespread presence of anti– N fowleri antibodies in the population indicates that exposure to this ameba is common and usually not associated with disease. Thus, general prevention of exposure to N fowleri is difficult if not impossible; however, most cases of clinical disease (ie, PAM) follow swimming or diving in warm freshwater. In swimming pools, proper chlorination is effective in significantly reducing risk; in open waterways, eradication of N fowleri is not a reasonable expectation. Previous Next

2014 eMedicine Pediatrics

194. Cyclosporiasis (Follow-up)

associated with imported raspberries. The Cyclospora Working Group. N Engl J Med . 1997 May 29. 336(22):1548-56. . Ho AY, Lopez AS, Eberhart MG, et al. Outbreak of cyclosporiasis associated with imported raspberries, Philadelphia, pennsylvania, 2000. Emerg Infect Dis . 2002 Aug. 8(8):783-8. . . CDC. From the Centers for Disease Control and Prevention. Outbreaks of cyclosporiasis--United States, 1997. JAMA . 1997 Jun 11. 277(22):1754. . CDC. From the Centers for Disease Control and Prevention. Update (...) : outbreaks of cyclosporiasis--1997. JAMA . 1997 Jul 9. 278(2):108. . CDC. From the Centers for Disease Control and Prevention. Update: outbreaks of cyclosporiasis--United States, 1997. JAMA . 1997 Jun 18. 277(23):1838. . CDC. From the Centers for Disease Control. Outbreak of cyclosporiasis-- Northern Virginia-Washington, DC-Baltimore, Maryland, metropolitan area, 1997. JAMA . 1997 Aug 20. 278(7):538-9. . Hoang LM, Fyfe M, Ong C, et al. Outbreak of cyclosporiasis in British Columbia associated

2014 eMedicine Pediatrics

195. Cryptosporidiosis (Follow-up)

with cryptosporidiosis should not use recreational waters for 2 weeks after symptoms resolve. Wearing gloves and handwashing after handling diapers can prevent person-to-person spread in daycare centers and hospitals. Endoscopes and similar instruments should be disinfected between uses. Prompt antiparasitic treatment of infected children decreases oocyst shedding. Individuals with AIDS or another immunosuppressive condition should avoid swimming in communal pools or recreational water. In hospitalized patients (...) diagnostics, therapeutics, and vaccine targets for cryptosporidium. Lancet Infect Dis . 2015 Jan. 15 (1):85-94. . Bouzid M, Hunter PR, Chalmers RM, Tyler KM. Cryptosporidium pathogenicity and virulence. Clin Microbiol Rev . 2013 Jan. 26(1):115-34. . . Yoder JS, Beach MJ. Cryptosporidium surveillance and risk factors in the United States. Exp Parasitol . 2010 Jan. 124(1):31-9. . Painter JE, Hlavsa MC, Collier SA, Xiao L, Yoder JS, Centers for Disease Control and Prevention. Cryptosporidiosis surveillance

2014 eMedicine Pediatrics

196. Naegleria (Treatment)

-encephalitis in an infant: case report. Ann Trop Paediatr . 2005 Sep. 25(3):223-6. . Chu DM, Ferguson TJ, Marciano-Cabral F. Protein kinase activation and protein phosphorylation in Naegleria fowleri amebae in response to normal human serum. J Eukaryot Microbiol . 2000 Jan-Feb. 47(1):40-7. . Naegleria fowleri — Primary Amebic Meningoencephalitis (PAM) — Amebic Encephalitis. Centers for Disease Control and Prevention. Available at . September 24, 2015; Accessed: September 12, 2016. Linam WM, Ahmed M, Cope (...) Med Hyg . 1980 Jan. 29(1):21-5. . Levy DA, Bens MS, Craun GF, et al. Surveillance for waterborne-disease outbreaks--United States, 1995-1996. Mor Mortal Wkly Rep CDC Surveill Summ . 1998 Dec 11. 47(5):1-34. . Loschiavo F, Ventura-Spagnolo T, Sessa E, Bramanti P. Acute primary meningoencephalitis from entamoeba Naegleria Fowleri. Report of a clinical case with a favourable outcome. Acta Neurol (Napoli) . 1993 Oct. 15(5):333-40. . Ma P, Visvesvara GS, Martinez AJ, et al. Naegleria and Acanthamoeba

2014 eMedicine Pediatrics

197. Leptospirosis (Treatment)

polycarbonate filter. (This image is in the public domain and thus free of any copyright restrictions. Courtesy of the Centers for Disease Control/Rob Weyant) Signs and symptoms Leptospirosis ranges in severity from a mild illness suggesting a viral infection to a multisystemic syndrome with unique features. It is characterized by sudden onset of the following: Fever (38-40°C) Rigors Headache, retro-orbital pain, photophobia Muscle pain localized to the calf and lumbar areas Conjunctival suffusion Dry cough (...) and vector-borne diseases: a regional analysis. Bull World Health Organ . 2000. 78(9):1136-47. . . National Research Council. Advancing the Science of Climate Change . Washington, DC: The National Academies Press; 2010. CDC. From the Centers for Disease Control and Prevention. Update: outbreak of acute febrile illness among athletes participating in Eco-Challenge-Sabah 2000--Borneo, Malaysia, 2000. JAMA . 2001 Feb 14. 285(6):728-30. . CDC. Update: leptospirosis and unexplained acute febrile illness among

2014 eMedicine Pediatrics

198. Hematopoietic Stem Cell Transplantation (Follow-up)

-Blackfan anemia Osteopetrosis Inborn errors of metabolism Autoimmune disorders *Uncommon in children; common reasons for transplantation in adults Previous Next: Prognosis Transplantation-related mortality and morbidity rates have considerably decreased because of improved conditioning regimens, human leukocyte antigen (HLA) typing, supportive care, and prevention and treatment of serious infections. Currently, overall and event-free survival rates are based on the individual's disease pathology (...) to treat the following conditions: Multiple myeloma Non-Hodgkin lymphoma Hodgkin lymphoma Acute myeloid leukemia Neuroblastoma Germ cell tumors Autoimmune disorders (systemic lupus erythematosus [SLE], systemic sclerosis) Amyloidosis Allogeneic HSCT is used to treat the following disorders: Acute myeloid leukemia Acute lymphoblastic leukemia Chronic myeloid leukemia Chronic lymphocytic leukemia Myeloproliferative disorders Myelodysplastic syndromes Multiple myeloma Non-Hodgkin lymphoma Hodgkin lymphoma

2014 eMedicine Pediatrics

199. Giardiasis (Follow-up)

& Fordtran's Gastrointestinal and Liver Disease . 8th ed. Philadelphia, PA: Saunders; 2006. Vol 2: 2420-3. Robertson LJ, Forberg T, Gjerde BK. Giardia cysts in sewage influent in Bergen, Norway 15-23 months after an extensive waterborne outbreak of giardiasis. J Appl Microbiol . 2008 Apr. 104(4):1147-52. . Ryu H, Alum A, Mena KD, Abbaszadegan M. Assessment of the risk of infection by Cryptosporidium and Giardia in non-potable reclaimed water. Water Sci Technol . 2007. 55(1-2):283-90. . Farthing MJ (...) ):11-5. . Dizdar V, Gilja OH, Hausken T. Increased visceral sensitivity in Giardia-induced postinfectious irritable bowel syndrome and functional dyspepsia. Effect of the 5HT3-antagonist ondansetron. Neurogastroenterol Motil . 2007 Dec. 19(12):977-82. . Penrose AS, Wells EV, Aiello AE. Infectious causation of chronic disease: examining the relationship between Giardia lamblia infection and irritable bowel syndrome. World J Gastroenterol . 2007 Sep 14. 13(34):4574-8. . Hanevik K, Dizdar V, Langeland

2014 eMedicine Pediatrics

200. Cholera (Treatment)

are inadequate. WHO recommends improvements in water supply and sanitation as the most sustainable approach for protecting against cholera and other waterborne epidemic diarrheal diseases. However, such an approach is unrealistic for the many impoverished populations most affected by cholera. Outbreaks can be mitigated and case-fatality rates can be reduced by means of several other measures, many of which are suitable for community participation. Human behaviors related to personal hygiene and food (...) . [ ] Previous References Centers for Disease Control and Prevention. Cholera. Available at . Accessed: July 7, 2011. CDC. 150th anniversary of John Snow and the pump handle. Centers for Disease Control and Prevention. Available at . Accessed: March 29, 2006. Kenneth Todar. Todar's Online Textbook of Bacteriology. Available at . Accessed: April 12, 2010. Sack D, Cadoz M. Cholera vaccines. Plotkin SA, Orenstein WA. Vaccines . Philadelphia: WB Saunders Company; 1999. 639-649. Steinberg EB, Greene KD, Bopp CA

2014 eMedicine Pediatrics

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