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低收入/中等收入国家中被忽视的和(再)新发的中枢神经系统感染

Neglected and (re-)emergent infections of the CNS i n low-/middle-income countries.

作者信息

Cárdenas Graciela, Salgado Perla, Laura-Foronda Enrique, Popoca-Rodriguez Ignacio, Delgado-Hernández Rosa Delia, Rojas Rafael, Palacios Enrique

机构信息

Neuro-infectious Diseases Department, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico.

Neuroimaging Department, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico.

出版信息

Infez Med. 2021 Dec 10;29(4):513-525. doi: 10.53854/liim-2904-3. eCollection 2021.

Abstract

Low- and middle-income countries (LMIC) have suffered from long-term health system deficiencies, worsened by poor living conditions, lack of sanitation, a restricted access to health facilities and running water, overcrowding, and overpopulation. These factors favor human displacement and deepen marginalization; consequently, their population endures a high burden of infectious diseases. In this context, the current epidemiological landscape and its impact on health and economic development are not promissory, despite the commitment by the international community to eradicate neglected tropical infections - especially tuberculosis and malaria, by 2030. Neglected and (re)-emerging infectious diseases affecting the central nervous system (CNS) are a major public health concern in these countries, as they cause a great morbidity and mortality; furthermore, survivors often suffer from severe neurological disabilities. Herein, we present a retrospective review focused on some neglected and (re)-emerging infectious diseases, including neurocysticercosis, malaria, rabies, West Nile virus encephalitis, tuberculosis, neuroborreliosis, and SARS-CoV-2 in LMIC. A retrospective review of studies on selected neglected and (re)-emerging infectious diseases in LMIC was performed, including reports by the World Health Organization (WHO) published within the last five years. Data on infection by SARS-CoV-2 were provided by the John Hopkins University Coronavirus Resource Center. CNS neglected and (re)-emerging infectious diseases remain as important causes of disease in LMIC. An alarming increase in the prevalence of malaria, tuberculosis, and cysticercosis is observed in the region, compounded by the recent COVID-19 pandemic. The WHO is currently supporting programs/efforts to cope with these diseases. Herein, we highlight the epidemiological burden of some CNS infections in LMIC, and their clinical and neuroimaging features, to facilitate an accurate diagnosis, considering that most of these diseases will not be eradicated in the short term; instead, their incidence will likely increase along with poverty, inequality, and related socioeconomic problems.

摘要

低收入和中等收入国家(LMIC)长期存在卫生系统缺陷,恶劣的生活条件、缺乏卫生设施、难以获得医疗设施和自来水、过度拥挤以及人口过多使这些问题更加恶化。这些因素助长了人口流离失所并加深了边缘化;因此,这些国家的人口承受着很高的传染病负担。在这种背景下,尽管国际社会承诺到2030年根除被忽视的热带感染——尤其是结核病和疟疾,但当前的流行病学形势及其对健康和经济发展的影响并不乐观。影响中枢神经系统(CNS)的被忽视和(再)出现的传染病是这些国家的一个主要公共卫生问题,因为它们会导致很高的发病率和死亡率;此外,幸存者往往患有严重的神经残疾。在此,我们对低收入和中等收入国家一些被忽视和(再)出现的传染病进行回顾性综述,包括神经囊尾蚴病、疟疾、狂犬病、西尼罗河病毒脑炎、结核病、神经莱姆病和严重急性呼吸综合征冠状病毒2(SARS-CoV-2)。对低收入和中等收入国家选定的被忽视和(再)出现的传染病的研究进行了回顾性综述,包括世界卫生组织(WHO)在过去五年内发布的报告。严重急性呼吸综合征冠状病毒2感染的数据由约翰·霍普金斯大学冠状病毒资源中心提供。中枢神经系统被忽视和(再)出现的传染病仍然是低收入和中等收入国家重要的疾病病因。该地区疟疾、结核病和囊尾蚴病的患病率惊人上升,最近的2019冠状病毒病大流行更是雪上加霜。世卫组织目前正在支持应对这些疾病的项目/努力。在此,我们强调低收入和中等收入国家一些中枢神经系统感染的流行病学负担及其临床和神经影像学特征,以便于准确诊断,因为这些疾病中的大多数在短期内不会被根除;相反,随着贫困、不平等及相关社会经济问题的加剧,其发病率可能会上升。

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