N Engl J of Medicine  Nov 12, 2009  V.361  N.20  p.1935-1944

Seema Jain, M.D., Laurie Kamimoto, M.D., M.P.H., Anna M. Bramley, M.P.H., Ann M. Schmitz, D.V.M., Stephen R. Benoit, M.D., M.P.H., Janice Louie, M.D., M.P.H., David E. Sugerman, M.D., M.P.H., Jean K. Druckenmiller, B.S., S.M.(N.R.M.), Kathleen A. Ritger, M.D., M.P.H., Rashmi Chugh, M.D., M.P.H., Supriya Jasuja, M.D., M.P.H., Meredith Deutscher, M.D., Sanny Chen, Ph.D., M.H.S., John D. Walker, M.D., Jeffrey S. Duchin, M.D., Susan Lett, M.D., M.P.H., Susan Soliva, M.P.H., Eden V. Wells, M.D., M.P.H., David Swerdlow, M.D., Timothy M. Uyeki, M.D., M.P.H., Anthony E. Fiore, M.D., M.P.H., Sonja J. Olsen, Ph.D., Alicia M. Fry, M.D., M.P.H., Carolyn B. Bridges, M.D., Lyn Finelli, Dr.P.H., for the 2009 Pandemic Influenza A (H1N1) Virus Hospitalizations Investigation Team

Background During the spring of 2009, a pandemic influenza A (H1N1) virus emerged and spread globally. We describe the clinical characteristics of patients who were hospitalized with 2009 H1N1 influenza in the United States from April 2009 to mid-June 2009.

Methods Using medical charts, we collected data on 272 patients who were hospitalized for at least 24 hours for influenza-like illness and who tested positive for the 2009 H1N1 virus with the use of a real-time reverse-transcriptase–polymerase-chain-reaction assay.

Results Of the 272 patients we studied, 25% were admitted to an intensive care unit and 7% died. Forty-five percent of the patients were children under the age of 18 years, and 5% were 65 years of age or older. Seventy-three percent of the patients had at least one underlying medical condition; these conditions included asthma; diabetes; heart, lung, and neurologic diseases; and pregnancy. Of the 249 patients who underwent chest radiography on admission, 100 (40%) had findings consistent with pneumonia. Of the 268 patients for whom data were available regarding the use of antiviral drugs, such therapy was initiated in 200 patients (75%) at a median of 3 days after the onset of illness. Data suggest that the use of antiviral drugs was beneficial in hospitalized patients, especially when such therapy was initiated early.

Conclusions During the evaluation period, 2009 H1N1 influenza caused severe illness requiring hospitalization, including pneumonia and death. Nearly three quarters of the patients had one or more underlying medical conditions. Few severe illnesses were reported among persons 65 years of age or older. Patients seemed to benefit from antiviral therapy.

abstract

http://content.nejm.org/cgi/content/full/361/20/1935?query=TOC

PDF

http://content.nejm.org/cgi/reprint/361/20/1935.pdf

N Engl J of Medicine  Nov 12, 2009  V.361  N.20  p.1925-1934

The ANZIC Influenza Investigators

Background Planning for the treatment of infection with the 2009 pandemic influenza A (H1N1) virus through health care systems in developed countries during winter in the Northern Hemisphere is hampered by a lack of information from similar health care systems.

Methods We conducted an inception-cohort study in all Australian and New Zealand intensive care units (ICUs) during the winter of 2009 in the Southern Hemisphere. We calculated, per million inhabitants, the numbers of ICU admissions, bed-days, and days of mechanical ventilation due to infection with the 2009 H1N1 virus. We collected data on demographic and clinical characteristics of the patients and on treatments and outcomes.

Results From June 1 through August 31, 2009, a total of 722 patients with confirmed infection with the 2009 H1N1 virus (28.7 cases per million inhabitants; 95% confidence interval [CI], 26.5 to 30.8) were admitted to an ICU in Australia or New Zealand. Of the 722 patients, 669 (92.7%) were under 65 years of age and 66 (9.1%) were pregnant women; of the 601 adults for whom data were available, 172 (28.6%) had a body-mass index (the weight in kilograms divided by the square of the height in meters) greater than 35. Patients infected with the 2009 H1N1 virus were in the ICU for a total of 8815 bed-days (350 per million inhabitants). The median duration of treatment in the ICU was 7.0 days (interquartile range, 2.7 to 13.4); 456 of 706 patients (64.6%) with available data underwent mechanical ventilation for a median of 8 days (interquartile range, 4 to 16). The maximum daily occupancy of the ICU was 7.4 beds (95% CI, 6.3 to 8.5) per million inhabitants. As of September 7, 2009, a total of 103 of the 722 patients (14.3%; 95% CI, 11.7 to 16.9) had died, and 114 (15.8%) remained in the hospital.

Conclusions The 2009 H1N1 virus had a substantial effect on ICUs during the winter in Australia and New Zealand. Our data can assist planning for the treatment of patients during the winter in the Northern Hemisphere

abstract

http://content.nejm.org/cgi/content/full/361/20/1925?query=TOC

PDF

http://content.nejm.org/cgi/reprint/361/20/1925.pdf

Enf Infecc y Microbiol Clin NOV. 2009  V.27  N.10  p.571-9

Por Antonio Plata-Ciézar d, Arístides de Alarcón-González g, Carmen Hidalgo-Tenorio b, Francisco Javier Martínez-Marcos a, Javier de la Torre-Lima c, José Manuel Lomas-Cabezas a, José María Reguera-Iglesias d, Josefa Ruiz-Morales e, Juan Gálvez-Acebal f, Manuel Márquez-Solero e

Introducción

Aunque los enterococos ocupan el tercer lugar entre los microorganismos que más frecuentemente provocan endocarditis infecciosa (EI), tras los estreptococos y Staphylococcus aureus, hay pocos estudios multicéntricos que proporcionen un análisis en profundidad de la EI enterocócica.

Métodos

Descripción de las características de los 76 casos de endocarditis infecciosa izquierda (EII) enterocócica (59 nativas y 17 protésicas) de la base de datos del Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas. Además, se hace hincapié en la comparación con la EII no enterocócica.

Resultados

El enterococo fue el causante de 76 de 696 episodios de EII (11%). Comparada con la EII no enterocócica, la EII enterocócica fue más frecuentemente observada en pacientes mayores de 65 años (el 47,4 frente al 27,6%; p<0,0005), con enfermedades crónicas (el 75 frente al 54,6%; p<0,001), válvulas calcificadas (el 18,6 frente al 10%; p<0,05), foco infeccioso previo urinario (el 30,3 frente al 2,1%; p<0,00001) o abdominal (el 10,5 frente al 3,1%; p<0,01) y produjo una mayor tasa de recidivas (el 6,6 frente al 2,3%; p<0,05). La EII enterocócica produjo menos manifestaciones cutáneas o vasculares periféricas (el 14,5 frente al 27,1%; p<0,05) y menos fenómenos inmunológicos (el 10,5 frente al 24%; p<0,01). Un 36,8% de los pacientes con EII enterocócica fueron sometidos a cirugía valvular durante el ingreso. La mortalidad durante el ingreso hospitalario de los pacientes con EII enterocócica fue del 32,9%, de los pacientes con EII por estreptococos del grupo viridans (EGV) fue del 9,3% y de los pacientes con S. aureus fue del 48,6% (enterococo frente a EGV: p<0,0001; enterococo frente a S. aureus: p=0,02). Los pacientes con EII enterocócica tratados con la combinación de una penicilina o vancomicina asociada a un aminoglucósido (n=60) y aquellos pacientes tratados con ampicilina más ceftriaxona (n=6) tuvieron una mortalidad similar durante el ingreso (el 26,7 frente al 33,3%; p=0,66). La resistencia de alto valor a gentamicina se detectó en 5 de 38 episodios de EII enterocócica (13,1%).

Conclusiones

La EII enterocócica aparece en pacientes con unas características clínicas bien definidas y produce pocas manifestaciones cutáneas o vasculares periféricas y pocos fenómenos inmunológicos. Su tasa de recidivas es más alta que la de la EII no enterocócica. Aunque la mortalidad de la EII enterocócica es inferior a la de la EII por S. aureus, esta mortalidad es muy superior a la de la EII por EGV. La mortalidad de los pacientes con EII enterocócica tratados con ampicilina más ceftriaxona fue similar a la de los pacientes tratados con la combinación de una penicilina o vancomicina más un aminoglucósido. La resistencia de alto nivel a gentamicina es aún poco frecuente en los enterococos que causan EII.

abstract

http://www.elsevier.es/revistas/ctl_servlet?_f=7012&articuloid=13145365&newsletter=esummary+&revistaid=28

PDF

http://www.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=13145365&pident_usuario=0&pcontactid=&pident_revista=28&ty=82&accion=L&origen=elsevier&web=www.elsevier.es&lan=es&fichero=28v27n10a13145365pdf001.pdf

“”"”"”"”"”"”"”"”"”"”"”"”"”"”"”"”"”"”"”"”"”"”"”"”"”"”"”"”"”"”"”"”"”"”

NOV. 2005 –  NOV. 2009

INFECTONEWS  CUMPLE  CUATRO  (4) AÑOS de VIDA

Gracias a colegas y amigos por el incentivo y el aliento.

Un abrazo desde Tres Arroyos – Pcia Bs Aires – Argentina

Con afecto…

Dr. Jorge Omar Calabrese

Joc156@yahoo.com.ar

MMWR  November 20, 2009  V.58  N.45  p.1263-1267

Three years after the introduction and spread of West Nile virus (WNV) in the United States, transmission through blood transfusion and solid organ transplantation was documented in 2002 (1–3). Within a year, these findings led to nationwide screening of blood donors for WNV. Although screening is extremely sensitive, current methods still do not detect all WNV-infected blood donations, and organ donors are not screened routinely. In October 2008, the Louisiana Department of Health (LDH) was notified of a heart transplant recipient with suspected West Nile neuroinvasive disease (WNND). LDH launched an investigation to confirm the diagnosis and determine whether the organ recipient’s infection was derived from the organ donor or blood products the donor received before organ donation. The investigation concluded that two cases of probable transfusion-transmitted WNV resulted from a common blood donor; one infection resulted in WNND via an organ donor, and the other resulted in asymptomatic WNV infection via blood transfusion directly. This investigation also found …

Full Text

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5845a3.htm?s_cid=mm5845a3_e

PDF

http://www.cdc.gov/mmwr/PDF/wk/mm5845.pdf

MMWR  November 20, 2009  V.58  N.45  p.1267-1270

Murine typhus is a fleaborne rickettsial disease caused by the organism Rickettsia typhi. Symptoms include fever, headache, chills, vomiting, nausea, myalgia, and rash. Although murine typhus is endemic in southern Texas, only two cases had been reported during the past 10 years from Austin, located in central Texas (Figure 1). On August 8, 2008, the Austin/Travis County Department of Health and Human Services (ATCDHHS) contacted the Texas Department of State Health Services (TDSHS) concerning a cluster of 14 illnesses with serologic findings indicative of murine typhus. On August 12, 2008, TDSHS initiated an investigation …

Full Text

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5845a4.htm?s_cid=mm5845a4_e

PDF

http://www.cdc.gov/mmwr/PDF/wk/mm5845.pdf

N Engl J of Medicine  Nov.19, 2209  V.361  N.21  p.2015-2017

Pespective

Alexandra M. Stewart, J.D.

Mandatory vaccination of health care workers raises important questions about the limits of a state’s power to compel individuals to engage in particular activities in order to protect the public. In justifying New York State’s regulations requiring health care workers who have direct contact with patients or who may expose patients to disease to be vaccinated against seasonal and H1N1 influenza, New York State Health Commissioner Richard Daines recently argued, “[O]ur overriding concern . . . as health care workers, should be the interests of our patients, not our own sensibilities about mandates. . . . [T]he welfare of patients is . . . best served by . . . very high rates of staff immunity that can only be achieved with mandatory influenza vaccination — not the 40-50% rates of staff immunization historically achieved with even the most vigorous of voluntary programs. Under voluntary standards, institutional outbreaks occur. . . . Medical literature convincingly demonstrates that high levels of staff immunity confer protection on those patients who cannot be or have not been effectively vaccinated . . . while also allowing the institution to remain more fully staffed…

abstract

http://content.nejm.org/cgi/content/full/361/21/2015?query=TOC

PDF

http://content.nejm.org/cgi/reprint/361/21/2015.pdf

Chest  Nov. 2009  V.136  N.5  Suppl  738-743

Diagnostic, Epidemiologic, Therapeutic and Prophylactic Considerations

Robert Austrian, M.D.

8From the John Herr Musser Department of Research Medicine, The University of Pennsylvania School of Medicine, Philadelphia. Reprint requests: Dr Austrian, Department ofResearch Medicine,

PDF

http://chestjournal.chestpubs.org/content/90/5/738.full.pdf+html

Chest  Nov. 2009  V.136  N.5  Suppl  8-9

HARRISON F. FLIPPIN – Philadelphia, Pennsylvania

PDF

http://chestjournal.chestpubs.org/content/5/5/8.full.pdf+html

Chest  Nov. 2009  V.136  N.5  Suppl  255-267

ITALO F. VOLINI, JAMES R. HUGHES, and J. R. PEFFER

The Hektoen Institute for Medical Research of the Cook County Hospital and the Department of Medicine of the Cook County Hospital and Loyola University School of Medicine.

Abstract

1) This statistical comparison readily demonstrates that penicillin is a much more superior drug than sulfadiazine in the treatment of pneumococcic pneumonia.

2) Sulfadiazine is an inferior therapeutic agent for the treatment of pneumonia as compared to the antibiotic, penicillin.

3) The evidence adduced in these series of investigations, demonstrate that in the group in which there was addition of sulfadiazine to the antibiotic therapy, there was a delayed clinical response, a greater incidence of complications, and a higher mortality.

4) The clinical use of sulfadiazine with penicillin indicates a possible antagonistic action in vivo rather than a synergistic effect.

5) There is little justification for the combined administration of the sulfonamides and penicillin in the treatment of pneumonia. Penicillin alone will accomplish the therapeutically desired goal if this is attainable.

6) There are very, very few pneumonia patients who cannot be treated with penicillin. They may require sulfonamide therapy.

abstract

http://chestjournal.chestpubs.org/content/15/3/255.abstract

PDF

http://chestjournal.chestpubs.org/content/15/3/255.full.pdf+html