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Prevention of Waterborne Illness

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81. Intestinal Protozoal Diseases (Treatment)

therapy results in full recovery. Some patients with severe giardiasis may experience disaccharidase deficiency and may require lactose-free diets, but this is a temporary condition that usually does not last more than 2 weeks. Patients with AIDS and severe spore-forming protozoal infections (chronic diarrhea with wasting syndrome) require hypercaloric diets. This is indicated for the protozoal illness in addition to the wasting syndrome associated with the underlying disease. For amebic liver abscess (...) . . Carranza PG, Lujan HD. New insights regarding the biology of Giardia lamblia. Microbes Infect . 2009 Sep 20. . Muller N, von Allmen N. Recent insights into the mucosal reactions associated with Giardia lamblia infections. Int J Parasitol . Nov 2005. 35:1339-47. . Karanis P, Kourenti C, Smith H. Waterborne transmission of protozoan parasites: a worldwide review of outbreaks and lessons learnt. J Water Health . Mar 2007. 5:1-38. . Hunter PR, Thompson RC. The zoonotic transmission of Giardia

2014 eMedicine Pediatrics

82. Amebic Meningoencephalitis (Treatment)

Amebic Meningoencephalitis (Treatment) Amebic Meningoencephalitis Treatment & Management: Approach Considerations, Prevention, Consultations Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvOTk2MjI3LXRyZWF0bWVudA (...) like an overwhelming acute bacterial meningitis unresponsive to routine antibacterial agents. Next: Prevention Measures to prevent PAM and GAE include the following: The clinician should routinely discuss with individuals the risks of exposure to free-living amoebae in warm, typically stagnant, freshwater Some have advocated the avoidance of diving and jumping into these waters Advise individuals to consider the use of nose plugs for unavoidable exposures Advise individuals to verify adequate

2014 eMedicine Pediatrics

83. Intestinal Protozoal Diseases (Overview)

. Among all intestinal protozoa, those listed in Table 1 have been confirmed to cause GI disease. Others, such as Trichomonas hominis (in infants) and Entamoeba polecki (associated with pigs), have rarely been associated with diarrheal disease and are not discussed in this article. Table 1. Protozoa Associated with Intestinal Illness in Humans Name Mode of Transmission Symptoms Flagellates G lamblia Contaminated water, fecal-oral Nausea, bloating, gas, diarrhea, anorexia Dientamoeba fragilis Fecal (...) intestine and has no evident life cycle in humans. Cysticlike stages are rare and have been found in patients with acquired immunodeficiency syndrome (AIDS) and in vitro. The mechanisms of how this parasite causes illness have not been elucidated yet. Previous Next: Epidemiology Frequency United States At least 325 water-associated outbreaks of parasitic protozoan disease have been reported. [ ] North America and Europe accounted for 93% of all reports, and nearly two thirds occurred in the United

2014 eMedicine Pediatrics

84. Hematopoietic Stem Cell Transplantation (Overview)

undergoing bone marrow transplantation. Among the most important have been in selecting hematopoietic stem cell donors and the tissue source, optimizing transplantation conditioning, reducing the morbidity and mortality from transplantation conditioning, and preventing and treating graft versus host disease. [ ] Patient education For patient education information, see the . Previous Next: Indications for HSCT Interpretation of the results of trials is always complicated by the problem of patient (...) -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

2014 eMedicine Pediatrics

85. Giardiasis (Overview)

in children than in adults. [ , ] G intestinalis can cause asymptomatic colonization or acute or chronic diarrheal illness. The organism has been found in as many as 80% of raw water supplies from lakes, streams, and ponds and in as many as 15% of filtered water samples. [ , ] It is a common cause of chronic diarrhea and growth retardation in children in developing countries. Giardiasis usually represents a zoonosis with cross-infectivity between animals and humans. Giardia intestinalis has been isolated (...) of genes implicated in the apoptotic cascade and the formation of reactive oxygen species. Panaro et al demonstrated that Giardia trophozoites induce cell apoptosis by activation of both intrinsic and extrinsic apoptotic pathways, down-regulation of the antiapoptotic protein Bcl-2, and up-regulation of the proapoptotic Bax. These findings suggest a possible role for caspase-dependent apoptosis in the pathogenesis of giardiasis. [ ] Giardia can also prevent the formation of nitric oxide, a compound

2014 eMedicine Pediatrics

86. Fascioliasis (Overview)

Singh Arora, MD; Chief Editor: Russell W Steele, MD Share Email Print Feedback Close Sections Sections Fascioliasis Overview Background Fascioliasis is a waterborne and foodborne zoonotic disease caused by two parasites of class Trematoda, genus Fasciola ; namely F. hepatica and F . [ ] giganticaHumans are incidental hosts and become infected by ingesting contaminated watercress or water. The illness occurs worldwide, particularly in regions with intensive sheep or cattle production. Incidence (...) in preserved human stool samples. Am J Trop Med Hyg . 2009 Jul. 81(1):156-62. . Fascioliasis. DPDx: Centers for Disease Control and Prevention. Available at . Accessed: March 10, 2015. Ai L, Dong SJ, Zhang WY, et al. Specific PCR-based assays for the identification of Fasciola species: their development, evaluation and potential usefulness in prevalence surveys. Ann Trop Med Parasitol . 2010 Jan. 104(1):65-72. . Le TH, Nguyen KT, Nguyen NT, Doan HT, Le XT, Hoang CT, et al. Development and evaluation

2014 eMedicine Pediatrics

87. Amebic Meningoencephalitis (Overview)

amoebae as agents of human infection. J Infect Dis . 2009 Apr 15. 199(8):1104-6. . Centers for Disease Control and Prevention (CDC). Investigational drug available directly from CDC for the treatment of infections with free-living amebae. MMWR Morb Mortal Wkly Rep . 2013 Aug 23. 62 (33):666. . 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. 135 (3):e744-8 (...) water. Clin Infect Dis . 2012 Nov. 55(9):e79-85. . Naegleria fowleri — Primary Amebic Meningoencephalitis (PAM) — Amebic Encephalitis. Centers for Disease Control and Prevention. Available at . September 24, 2015; Accessed: September 6, 2016. Kemble SK, Lynfield R, Devries AS, Drehner DM, Pomputius WF 3rd, Beach MJ. Fatal Naegleria fowleri Infection Acquired in Minnesota: Possible Expanded Range of a Deadly Thermophilic Organism. Clin Infect Dis . 2012 Mar. 54(6):805-9. . Schuster FL, Yagi S, Gavali

2014 eMedicine Pediatrics

88. Cyclosporiasis (Overview)

Author: Shipra Gupta, MD; Chief Editor: Russell W Steele, MD Share Email Print Feedback Close Sections Sections Cyclosporiasis Overview Practice Essentials In August 2017, the Centers for Disease Control and Prevention issued a Health Alert Network advisory following an increase in reported cases of cyclosporiasis. The advisory guides providers to consider a diagnosis of cyclosporiasis in patients who experience prolonged or remitting-relapsing diarrhea. Between May 1, 2017 and August 2, 2017, 206 (...) as of August, 2014, CDC had been notified of 304 ill persons with confirmed Cyclospora infection in 2014. 64% of cases were reported from Texas and 64% were reported in July 2014. Preliminary investigation linked cases in Texas with Cilantro from Mexico; however, none of the cases outside Texas were linked to cilantro. International Worldwide, most fecal isolates have been obtained from residents of developing countries or from travelers returning from these regions. [ , ] Cyclosporiasis is endemic

2014 eMedicine Pediatrics

89. Cryptosporidiosis (Overview)

in about 4% of stools sent for parasitologic examination. Seroprevalence studies using antibody assays suggest that 25-35% of the population in industrialized countries (including the United States) have had cryptosporidiosis at some time in their life. Cryptosporidium species also cause waterborne outbreaks of diarrhea. In 1993, more than 400,000 cases of diarrheal illness due to Cryptosporidium infection were reported in Milwaukee, Wisconsin. [ ] Waterborne outbreaks continue to be common worldwide (...) , 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

2014 eMedicine Pediatrics

90. Hematopoietic Stem Cell Transplantation (Treatment)

undergoing bone marrow transplantation. Among the most important have been in selecting hematopoietic stem cell donors and the tissue source, optimizing transplantation conditioning, reducing the morbidity and mortality from transplantation conditioning, and preventing and treating graft versus host disease. [ ] Patient education For patient education information, see the . Previous Next: Indications for HSCT Interpretation of the results of trials is always complicated by the problem of patient (...) -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

2014 eMedicine Pediatrics

91. Cryptosporidiosis (Treatment)

, suppresses diarrhea in chronic cryptosporidiosis. Previous Next: Fluid and electrolyte loss Replacement of fluids and electrolytes is the critically important first step in the management of cryptosporidiosis, particularly in patients with large diarrheal losses. Fluids should include sodium, potassium, bicarbonate, and glucose. Oral rehydration is the preferred mode, but severely ill patients may require parenteral fluids. Biliary involvement Biliary involvement in cryptosporidiosis requires specific (...) interventions. Acalculous cholecystitis should be treated with cholecystectomy. Patients with sclerosing cholangitis can usually be treated with endoscopic retrograde cholangiopancreatography (ERCP), although sphincterotomy may result in temporary relief. In selected cases, recurrence may be prevented by placing a stent. Previous Next: Prevention of Cryptosporidiosis Water purification is the most important public health measure in the prevention of cryptosporidiosis. [ , ] Because chlorination has little

2014 eMedicine Pediatrics

92. Cyclosporiasis (Treatment)

. Protozoal infections in patients with AIDS. Cryptosporidiosis, isosporiasis, cyclosporiasis, and microsporidiosis. Infect Dis Clin North Am . 1994 Jun. 8(2):483-98. . Murray P, Rosenthal K, Pfaller M. Intestinal and Urogenital protozoa. Medical Microbiology . 7th edition. 2013. 745-758. Huang P, Weber JT, Sosin DM, Griffin PM, Long EG, Murphy JJ, et al. The first reported outbreak of diarrheal illness associated with Cyclospora in the United States. Ann Intern Med . 1995 Sep 15. 123(6):409-14. . Carter (...) 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

2014 eMedicine Pediatrics

93. Leptospirosis (Follow-up)

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 or those who are immunosuppressed (...) 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

94. Intestinal Protozoal Diseases (Follow-up)

2005. 35:1339-47. . Karanis P, Kourenti C, Smith H. Waterborne transmission of protozoan parasites: a worldwide review of outbreaks and lessons learnt. J Water Health . Mar 2007. 5:1-38. . Hunter PR, Thompson RC. The zoonotic transmission of Giardia and Cryptosporidium. Int j Parasitol . Oct 2005. 35:1181-90. . Fleming CA, Caron D, Gunn JE, Barry MA. A foodborne outbreak of Cyclospora cayetanensis at a wedding: clinical features and risk factors for illness. Arch Intern Med . 1998 May 25. 158(10 (...) and in unusual cases in immunocompetent hosts, hospitalization is required, and intravenous solutions are indicated to correct electrolyte imbalance. Outpatient medications: Oral antiprotozoal therapy is usually administered at home. Previous Next: Deterrence/Prevention Standard hospital precautions are used for all hospitalized patients. Additional control precautions are implemented for children with gastroenteritis, especially for patients using diapers or who have incontinence. This includes use of gowns

2014 eMedicine Pediatrics

95. Naegleria (Follow-up)

in 95% or more of patients. In patients who do survive, careful attention to the prevention of seizures and control of intracranial pressure is critical. Other measures include prevention of secondary bacterial infections (especially intravenous catheter–related infections and urinary tract infections in patients with Foley catheters), prevention of decubitus ulcers, and prevention of aspiration in patients with coma or seizures. Previous Next: Inpatient & Outpatient Medications See the list below (...) : 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

2014 eMedicine Pediatrics

96. Hematopoietic Stem Cell Transplantation (Follow-up)

undergoing bone marrow transplantation. Among the most important have been in selecting hematopoietic stem cell donors and the tissue source, optimizing transplantation conditioning, reducing the morbidity and mortality from transplantation conditioning, and preventing and treating graft versus host disease. [ ] Patient education For patient education information, see the . Previous Next: Indications for HSCT Interpretation of the results of trials is always complicated by the problem of patient (...) -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

2014 eMedicine Pediatrics

97. Hematopoietic Stem Cell Transplantation (Diagnosis)

undergoing bone marrow transplantation. Among the most important have been in selecting hematopoietic stem cell donors and the tissue source, optimizing transplantation conditioning, reducing the morbidity and mortality from transplantation conditioning, and preventing and treating graft versus host disease. [ ] Patient education For patient education information, see the . Previous Next: Indications for HSCT Interpretation of the results of trials is always complicated by the problem of patient (...) -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

2014 eMedicine.com

98. Giardiasis (Diagnosis)

common in children than in adults. [ , ] G intestinalis can cause asymptomatic colonization or acute or chronic diarrheal illness. The organism has been found in as many as 80% of raw water supplies from lakes, streams, and ponds and in as many as 15% of filtered water samples. [ , ] It is a common cause of chronic diarrhea and growth retardation in children in developing countries. Giardiasis usually represents a zoonosis with cross-infectivity between animals and humans. Giardia intestinalis has (...) of genes implicated in the apoptotic cascade and the formation of reactive oxygen species. Panaro et al demonstrated that Giardia trophozoites induce cell apoptosis by activation of both intrinsic and extrinsic apoptotic pathways, down-regulation of the antiapoptotic protein Bcl-2, and up-regulation of the proapoptotic Bax. These findings suggest a possible role for caspase-dependent apoptosis in the pathogenesis of giardiasis. [ ] Giardia can also prevent the formation of nitric oxide, a compound

2014 eMedicine.com

99. Cyclospora (Diagnosis)

, Mexico Canada/United States: raspberries, blackberries, mesclun, basil‡; Germany: lettuce imported from Southern France/Southern Italy; Mexico: watercress Waterborne outbreaks United States (Chicago), Nepal 14 cases of cyclosporiasis; tap water in medical dormitory, suspected source was contaminated water storage tank; 12 of 14 developed cyclosporiasis * Community-based studies † Highest in spring and early summer ‡ Fresh produce. Raspberries from Guatemala; blackberries from Guatemala (...) in several countries. [ ] It has also been isolated from wastewater in Tunisia and in Arizona. [ , ] In endemic countries, soil contact is an important risk factor for children younger than 2 years. Oocysts can survive in water for 2 months at 39.2°F (4°C) and for 7 days at 98.6°F (37°C). Heating them at 140°F (60°C) for 60 minutes prevents sporulation. Freezing them at -0.4°F (-18°C) prevents sporulation. Desiccation for 15 minutes ruptures the oocyst wall. They are resistant to chlorine disinfection

2014 eMedicine.com

100. Cryptosporidiosis (Diagnosis)

in about 4% of stools sent for parasitologic examination. Seroprevalence studies using antibody assays suggest that 25-35% of the population in industrialized countries (including the United States) have had cryptosporidiosis at some time in their life. Cryptosporidium species also cause waterborne outbreaks of diarrhea. In 1993, more than 400,000 cases of diarrheal illness due to Cryptosporidium infection were reported in Milwaukee, Wisconsin. [ ] Waterborne outbreaks continue to be common worldwide (...) , 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

2014 eMedicine.com

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