Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota, 420 Delaware Street SE, Mayo Building D407, MMC 250, Minneapolis, MN, 55455, USA,
Curr Infect Dis Rep. 2013 Jun;15(3):222-31. doi: 10.1007/s11908-013-0331-7.
More than 50,000 refugees are resettled to the United States annually, many from areas highly endemic for parasites. Some of these infections present little clinical consequence after migration, but others are responsible for morbidity and mortality. The Centers for Disease Control and Prevention has issued predeparture presumptive treatment and postarrival medical guidelines for the management of parasites. Although these guidelines are evidence based, there remain significant challenges to presumptive treatment programs in refugees. Gaps in the evidence continue; resettling populations are continually changing, thus altering the epidemiology; and there are logistical and cost barriers to fully implementing recommendations. This article will review the evolution and status of current guidelines, as well as identify gaps and challenges to full implementation. It is imperative for clinicians serving this population to be familiar with interventions received by refugees, since previous treatment will impact screening, diagnostic evaluation, and treatment decisions.
每年有超过 50000 名难民被重新安置到美国，其中许多人来自寄生虫高度流行的地区。这些感染中的一些在迁移后几乎没有临床后果，但另一些则会导致发病和死亡。疾病控制和预防中心已经发布了出发前的推定治疗和到达后的寄生虫管理医疗指南。尽管这些指南是基于证据的，但在难民的推定治疗方案中仍然存在重大挑战。证据仍然存在差距；重新安置的人群不断变化，从而改变了流行病学；并且全面实施建议存在后勤和成本障碍。本文将回顾当前指南的演变和现状，并确定全面实施的差距和挑战。为了服务于这一人群，临床医生必须熟悉难民接受的干预措施，因为先前的治疗将影响筛查、诊断评估和治疗决策。
