Archive for August 24, 2008

Clinical Features of Viral Meningitis in Adults: Significant Differences in Cerebrospinal Fluid Findings among Herpes Simplex Virus, Varicella Zoster Virus, and Enterovirus Infections

Clinical Infectious Diseases 15 September 2008  V.47  N.6  p.783–789 

Ugo K. Ihekwaba,1 Goura Kudesia,2 and Michael W. McKendrick1

Departments of 1Infection and Tropical Medicine and 2Virology, Sheffield Teaching Hospitals, National Health Service Foundation Trust, Sheffield, United Kingdom

Background.  In this retrospective study, our objective was to review the epidemiology of viral meningitis and to compare clinical features associated with enterovirus, herpes simplex virus (HSV), and varicella zoster virus (VZV) infections in immunocompetent adults.

Methods.  Data on cerebrospinal fluid (CSF) samples submitted to the Trust Virology Laboratory (Sheffield, UK) from April 2004 through April 2007 were reviewed. Notes on immunocompetent adults who were polymerase chain reaction (PCR) positive for enterovirus, HSV type 2, or VZV and who had presented to local clinical departments were scrutinized (4 patients were positive for HSV type 1 and did not meet the inclusion criteria).

Results.  A total of 2045 samples were analyzed for viral pathogens during the 3-year period. Of the 109 PCR-positive samples, 38 (35%) were from immunocompetent adults, of whom 22 were infected with enterovirus, 8 were infected with HSV type 2, and 8 were infected with VZV. The median ages were 32 years (range, 16–39 years), 39 years (range, 22–53 years), and 47.5 years (range, 26–80 years), respectively. Rash occurred after the meningitis symptoms in 5 patients infected with VZV (median time from meningitis symptoms to rash, 6 days). Protein levels were significantly higher in CSF samples from patients infected with HSV type 2 (median, 1205 mg/L) and in samples from those infected with VZV (median, 974 mg/L) than in samples from those infected with enterovirus (median, 640 mg/L; P=.001 and P=.01, respectively). White blood cell counts were significantly higher in CSF samples from patients infected with HSV type 2 (median, 240 x106 cells/L) than in samples from those infected with enterovirus (median,  51 x 106 cells/L; P=.01).

Conclusions.  Enterovirus infection was the most common cause of viral meningitis in immunocompetent adults in this study. White blood cell counts and protein levels were significantly higher in CSF samples from patients infected with HSV type 2 than in samples from patients with enterovirus infection. Zoster rash often occurs after meningitis. PCR testing provides a rapid and specific etiological diagnosis.

abstract
http://www.journals.uchicago.edu/doi/abs/10.1086/591129

PDF
http://www.journals.uchicago.edu/doi/pdf/10.1086/591129

August 24, 2008 at 1:47 pm Leave a comment

Emergency Department Visits for Antibiotic-Associated Adverse Events

Clinical Infectious Diseases 15 September 2008  V.47  N.6  p.735–743 

Nadine Shehab, Priti R. Patel, Arjun Srinivasan, and Daniel S. Budnitz

Division of Healthcare Quality Promotion, National Center for Detection, Preparedness, and Control of Infectious Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

Background.  Drug-related adverse events are an underappreciated consequence of antibiotic use, and the national magnitude and scope of these events have not been studied. Our objective was to estimate and compare the numbers and rates of emergency department (ED) visits for drug-related adverse events associated with systemic antibiotics in the United States by drug class, individual drug, and event type.

Methods.  We analyzed drug-related adverse events from the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project (2004–2006) and outpatient prescriptions from national sample surveys of ambulatory care practices, the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey (2004–2005).

Results.  On the basis of 6614 cases, an estimated 142,505 visits (95% confidence interval [CI], 116,506–168,504 visits) annually were made to US EDs for drug-related adverse events attributable to systemic antibiotics. Antibiotics were implicated in 19.3% of all ED visits for drug-related adverse events. Most ED visits for antibiotic-associated adverse events were for allergic reactions (78.7% of visits; 95% CI, 75.3%–82.1% of visits). One-half of the estimated ED visits were attributable to penicillins (36.9% of visits; 95% CI, 34.7%–39.2% of visits) and cephalosporins (12.2%; 95% CI, 10.9%–13.5%). Among commonly prescribed antibiotics, sulfonamides and clindamycin were associated with the highest rate of ED visits (18.9 ED visits per 10,000 outpatient prescription visits [95% CI, 13.1–24.7 ED visits per 10,000 outpatient prescription visits] and 18.5 ED visits per 10,000 outpatient prescription visits [95% CI, 12.1–25.0 ED visits per 10,000 outpatient prescription visits], respectively). Compared with all other antibiotic classes, sulfonamides were associated with a significantly higher rate of moderate-to-severe allergic reactions (4.3% [95% CI, 2.9%–5.8%] vs. 1.9 % [95% CI, 1.5%–2.3%]), and sulfonamides and fluoroquinolones were associated with a significantly higher rate of neurologic or psychiatric disturbances (1.4% [95% CI, 1.0%–1.7%] vs. 0.5% [95% CI, 0.4%–0.6%]).

Conclusions.  Antibiotic-associated adverse events lead to many ED visits, and allergic reactions are the most common events. Minimizing unnecessary antibiotic use by even a small percentage could significantly reduce the immediate and direct risks of drug-related adverse events in individual patients.
abstract
http://www.journals.uchicago.edu/doi/abs/10.1086/591126

PDF
http://www.journals.uchicago.edu/doi/pdf/10.1086/591126

EDITORIAL COMMENTARY

Antibiotics for Treatment of Acute Respiratory Tract Infections: Decreasing Benefit, Increasing Risk, and the Irrelevance of Antimicrobial Resistance

Jeffrey A. Linder

Division of General Medicine and Primary Care, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts

http://www.journals.uchicago.edu/doi/full/10.1086/591149

PDF
http://www.journals.uchicago.edu/doi/pdf/10.1086/591149

August 24, 2008 at 1:29 pm Leave a comment

Q Fever — California, Georgia, Pennsylvania, and Tennessee, 2000–2001

MMWR  Oct.18, 2002  V.51  N.41  p.924-927

Q Fever — California, Georgia, Pennsylvania, and Tennessee, 2000–2001

FULL TEXT
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5141a2.htm

August 24, 2008 at 1:26 pm Leave a comment


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