Archive for October, 2008

Neumonía varicelosa en adultos: 30 casos

Anales de Medicina Interna (Madrid) Dic 2003  V.20  N.12 


Servicio de Medicina Intensiva. Hospital Universitario Marqués de Valdecilla. Santander

Objetivos: Estudio retrospectivo de los pacientes >15 años que ingresaron en nuestro hospital por neumonía varicelosa en los últimos 10 años.

Métodos: Se incluyeron 30 pacientes, 16 varones y 14 mujeres. La edad media era de 32,73 ± 7,67 años (Rango: 15-58). El 90% eran fumadores y 3 estaban embarazadas. La estancia media en el hospital fue de 14,96 ± 12,02 días (Rango: 4-57).

Resultados: Ingresaron en UCI 7 pacientes y 2 necesitaron ventilación mecánica. El infiltrado intersticial (70%) y el alveolo-intersticial (23%) fueron los patrones radiológicos más frecuentes. La auscultación pulmonar fue normal en 2/3. Los hallazgos clínicos más frecuentes fueron: fiebre (100%), tos seca (86,6%), disnea (66,6%) y dolor pleurítico (50%). El índice pO2/FiO2 fue ≤300 en 15 casos. El 50% presentaron hiponatremia y el 40% trombopenia. Falleció un paciente, otro evolucionó a una fibrosis pulmonar y tres desarrollaron, posteriormente, asma.

Conclusiones: La neumonía varicelosa en adultos suele presentarse en individuos fumadores. Se debe realizar Rx tórax a todos los pacientes adultos con varicela e ingresar las neumonías. El tratamiento de elección es el Aciclovir endovenoso y en enfermos graves puede considerarse la asociación de corticoides.

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October 31, 2008 at 11:10 am Leave a comment

When to Perform a Lumbar Puncture in HIV-Infected Patients With Syphilis

Sexually Transmitted Diseases, March 2007, Vol. 34, No. 3, p.145–146


De´ ja` Vu All Over Again:



October 31, 2008 at 1:18 am Leave a comment

The rash of secondary syphilis

CMAJ • January 2, 2007; 176 (1)

Teaching Case Report

Joseph Dylewski*{dagger} and Minh Duong*

Departments of *Medicine and {dagger}Laboratories, St. Mary’s Hospital, Montréal, Quebec



October 31, 2008 at 1:16 am Leave a comment

Clostridium difficile — More Difficult Than Ever

N Engl J of Medicine  October 30, 2008  V.359  N.18  p.1932-1940

Review Article

Ciarán P. Kelly, M.D., and J. Thomas LaMont, M.D.



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October 30, 2008 at 12:00 am Leave a comment

Current Features of Infective Endocarditis in Elderly Patients

Archives of Internal Medicine  October 27, 2008  V.168  N.19  p.2095-2103 

Results of the International Collaboration on Endocarditis Prospective Cohort Study

Emanuele Durante-Mangoni, MD, PhD; Suzanne Bradley, MD; Christine Selton-Suty, MD; Marie-Françoise Tripodi, MD; Bruno Barsic, MD, PhD; Emilio Bouza, MD, PhD; Christopher H. Cabell, MD, MHS; Auristela Isabel de Oliveira Ramos, MD; Vance Fowler Jr, MD, MHS; Bruno Hoen, MD, PhD; Pam Koneçny, MD; Asuncion Moreno, MD; David Murdoch, MD, DTM&H, FRACP, FRCPA, FACTM; Paul Pappas, MS; Daniel J. Sexton, MD; Denis Spelman, MD; Pierre Tattevin, MD; José M. Miró, MD, PhD; Jan T. M. van der Meer, MD, PhD; Riccardo Utili, MD; for the International Collaboration on Endocarditis Prospective Cohort Study Group

Department of Cardiothoracic and Respiratory Sciences, Università di Napoli II, Naples, Italy (Drs Durante-Mangoni, Tripodi, and Utili); Divisions of Geriatric Medicine and Infectious Diseases, University of Michigan Medical School, Ann Arbor (Dr Bradley); Department of Cardiology, Centre Hôpitalier Universitaire (CHU) Nancy-Brabois, Nancy, France (Dr Selton-Suty); Intensive Care Unit, University Hospital for Infectious Diseases, Zagreb, Croatia (Dr Barsic); Department of Medical Microbiology, Hospital General Universitario Gregorio Marañon, Ciberes, Madrid, Spain (Dr Bouza); Quintiles Transnational, Durham, North Carolina (Dr Cabell); Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil (Dr Ramos); Departments of Medicine, Duke University Medical Center, Durham (Drs Fowler and Sexton), St George Hospital, Sydney, Australia (Dr Koneçny), Hospital Clinic–IDIBAPS (Institut d’Investigacions Biomèdiques August Pi I Sunyer), University of Barcelona, Barcelona, Spain (Drs Moreno and Miró), and University of Otago, Christchurch, New Zealand (Dr Murdoch); Department of Cardiology, Departments of Infectious Diseases, University Medical Center of Besançon, Besançon, France (Dr Hoen), CHU de Rennes, Rennes, France (Dr Tattevin), and University of Amsterdam, Amsterdam, the Netherlands (Dr van der Meer); INC Research, Raleigh, North Carolina (Mr Pappas); and Department of Infectious Disease, Alfred Hospital, Melbourne, Australia (Dr Spelman).

Background  Elderly patients are emerging as a population at high risk for infective endocarditis (IE). However, adequately sized prospective studies on the features of IE in elderly patients are lacking.

Methods  In this multinational, prospective, observational cohort study within the International Collaboration on Endocarditis, 2759 consecutive patients were enrolled from June 15, 2000, to December 1, 2005; 1056 patients with IE 65 years or older were compared with 1703 patients younger than 65 years. Risk factors, predisposing conditions, origin, clinical features, course, and outcome of IE were comprehensively analyzed.

Results  Elderly patients reported more frequently a hospitalization or an invasive procedure before IE onset. Diabetes mellitus and genitourinary and gastrointestinal cancer were the major predisposing conditions. Blood culture yield was higher among elderly patients with IE. The leading causative organism was Staphylococcus aureus, with a higher rate of methicillin resistance. Streptococcus bovis and enterococci were also significantly more prevalent. The clinical presentation of elderly patients with IE was remarkable for lower rates of embolism, immune-mediated phenomena, or septic complications. At both echocardiography and surgery, fewer vegetations and more abscesses were found, and the gain in the diagnostic yield of transesophageal echocardiography was significantly larger. Significantly fewer elderly patients underwent cardiac surgery (38.9% vs 53.5%; P < .001). Elderly patients with IE showed a higher rate of in-hospital death (24.9% vs 12.8%; P < .001), and age older than 65 years was an independent predictor of mortality.

Conclusions  In this large prospective study, increasing age emerges as a major determinant of the clinical characteristics of IE. Lower rates of surgical treatment and high mortality are the most prominent features of elderly patients with IE. Efforts should be made to prevent health care–associated acquisition and improve outcomes in this major subgroup of patients with IE.


October 29, 2008 at 3:56 pm Leave a comment

Preadmission Use of Statins and Outcomes After Hospitalization With Pneumonia

Archives of Internal Medicine  October 27, 2008  V.168  N.19  p.2081-2087

Population-Based Cohort Study of 29 900 Patients

Reimar W. Thomsen, MD, PhD; Anders Riis, MSc; Jette B. Kornum, MD; Steffen Christensen, MD; Søren P. Johnsen, MD, PhD; Henrik T. Sørensen, MD, DMSc

Departments of Clinical Epidemiology (Drs Thomsen, Kornum, Christensen, Johnsen, and Sørensen and Mr Riis) and Clinical Microbiology (Dr Thomsen) and Center of Cardiovascular Research (Dr Johnsen), Aarhus University and Aalborg Hospital, Aalborg, Denmark; and Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts(Dr Sørensen).

Background While some experimental and clinical research suggests that statins improve outcomes after severe infections, the evidence for pneumonia is conflicting. We examined whether preadmission statin use decreased risk of death, bacteremia, and pulmonary complications after pneumonia.

Methods We conducted a population-based cohort study of 29 900 adults hospitalized with pneumonia for the first time between January 1, 1997, and December 31, 2004 in northern Denmark. Data on statin and other medication use, comorbidities, socioeconomic markers, laboratory findings, bacteremia, pulmonary complications, and death were obtained from medical databases. We used regression analyses to compute adjusted mortality rate ratios within 90 days and relative risks of bacteremia and pulmonary complications after hospitalization in both statin users and nonusers.

Results Of patients with pneumonia, 1371 (4.6%) were current statin users. Mortality among statin users was lower than among nonusers: 10.3% vs 15.7% after 30 days and 16.8% vs 22.4% after 90 days, corresponding to adjusted 30- and 90-day mortality rate ratios of 0.69 (95% confidence interval, 0.58-0.82) and 0.75 (0.65-0.86). Decreased mortality associated with statin use remained robust in various subanalyses and in a supplementary analysis using propensity score matching. In contrast, former use of statins and current use of other prophylactic cardiovascular drugs were not associated with decreased mortality from pneumonia. In statin users, adjusted relative risk for bacteremia was 1.07 (95% confidence interval, 0.69-1.67) and for pulmonary complications was 0.69 (0.42-1.14).

The use of statins is associated with decreased mortality after hospitalization with pneumonia.


October 29, 2008 at 9:58 am Leave a comment

Contamination of Hospital Curtains With Healthcare-Associated Pathogens

Infection Control and Hospital Epidemiology  November 2008  V.29  N.11  p.1074-1076

Concise Communication

Floyd Trillis, III, BS; Elizabeth C. Eckstein, RN; Rachel Budavich, BS; Michael J. Pultz, BS; Curtis J. Donskey, MD

From the Research Service (F.T., R.B., M.J.P.), the Infection Control Department (E.C.E., C.J.D), and the Geriatric Research Education and Clinical Center (C.J.D.), Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.

In a culture survey, we found that 42% of hospital privacy curtains were contaminated with vancomycin-resistant enterococci, 22% with methicillin-resistant Staphylococcus aureus, and 4% with Clostridium difficile. Hand imprint cultures demonstrated that these pathogens were easily acquired on hands. Hospital curtains are a potential source for dissemination of healthcare-associated pathogens.


October 29, 2008 at 9:57 am Leave a comment

Possible New Hepatitis B Virus Genotype, Southeast Asia

Emerging Infectious Diseases Journal  Nov.2008  V.14  N.11

Christophe M. Olinger, Prapan Jutavijittum, Judith M. Hübschen, Amnat Yousukh, Bounthome Samountry, Te Thammavong, Kan Toriyama, and Claude P. Muller

National Public Health Laboratory/Centre de Recherche Public–Santé, Luxembourg (C.M. Olinger, J.M. Hübschen, C.P. Muller); Chiang Mai University, Chiang Mai, Thailand (P. Jutavijittum, A. Yousukh); National University of Lao, Vientiane, Laos (B. Samountry); Lao Red Cross, Vientiane (T. Thammavong); and Nagasaki University, Nagasaki, Japan (K. Toriyama)

We conducted a phylogenetic analysis of 19 hepatitis B virus strains from Laos that belonged to 2 subgenotypes of a new genotype I. This emerging new genotype likely developed outside Southeast Asia and is now found in mixed infections and in recombinations with local strains in a geographically confined region.



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October 29, 2008 at 9:51 am Leave a comment

Isoniazid or Moxifloxacin in Rifapentine-based Regimens for Experimental Tuberculosis?

American J of Resp and Crit Care Medicine 1 Nov 2008 V.178  N.9  p.989-993

Ian M. Rosenthal1,2, Ming Zhang1, Deepak Almeida1, Jacques H. Grosset1 and Eric L. Nuermberger1,2

1 Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and 2 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

Rationale: Recent studies have demonstrated that combined substitutions of rifapentine for rifampin and moxifloxacin for isoniazid in the standard, daily, short-course regimen of rifampin, isoniazid, and pyrazinamide produces stable cure in 12 weeks or less. This study was designed to more precisely evaluate the contribution of moxifloxacin and isoniazid to rifapentine-based regimens.

Objectives: We compared bactericidal activity and treatment-shortening potential between regimens consisting of isoniazid or moxifloxacin plus rifapentine and pyrazinamide administered either thrice-weekly or daily.

Methods: Using a mouse model of tuberculosis, we assessed bactericidal activity by performing quantitative cultures of lung homogenates over the first 12 weeks of treatment. Relapse rates were assessed after completing 8, 10, and 12 weeks of treatment to determine the duration of treatment necessary for stable cure.

Measurements and Main Results: After 4 weeks of treatment, daily and thrice-weekly therapy with rifapentine, moxifloxacin, and pyrazinamide was significantly more active than treatment with rifapentine, isoniazid, and pyrazinamide. By 8 weeks of treatment, all mice receiving the moxifloxacin-containing regimens were lung culture negative, whereas those mice receiving the isoniazid-containing regimens continued to be lung culture positive. However, the duration of treatment necessary to achieve stable cure was 10 weeks for daily regimens and 12 weeks for thrice-weekly regimens, regardless of whether isoniazid or moxifloxacin was used. All mice receiving standard daily therapy with rifampin, isoniazid, and pyrazinamide relapsed after 12 weeks of treatment.

Conclusions: These results suggest that regimens consisting of isoniazid or moxifloxacin plus rifapentine and pyrazinamide may dramatically shorten the duration of treatment needed to cure human tuberculosis.


October 29, 2008 at 9:49 am Leave a comment

Narrative Review: Diseases That Masquerade as Infectious Cellulitis

Annals of Internal Medicine  4 January 2005  V.142  N.1  p.47-55


Matthew E. Falagas, MD, MSc, and Paschalis I. Vergidis, MD

From Alfa HealthCare, Athens, Greece, and Tufts University School of Medicine, Boston, Massachusetts.

For cellulitis that does not respond to conventional antimicrobial treatment, clinicians should consider, among other explanations, several noninfectious disorders that might masquerade as infectious cellulitis. Diseases that commonly masquerade as this condition include thrombophlebitis, contact dermatitis, insect stings, drug reactions, eosinophilic cellulitis (the Wells syndrome), gouty arthritis, carcinoma erysipelatoides, familial Mediterranean fever, and foreign-body reactions. Diseases that uncommonly masquerade as infectious cellulitis include urticaria, lymphedema, lupus erythematosus, sarcoidosis, lymphoma, leukemia, Paget disease, and panniculitis. Clinicians should do an initial diagnostic work-up directed by the findings from a detailed history and complete physical examination. In many cases, skin biopsy is the only tool that helps identify the correct diagnosis. Special tests may also be needed.



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October 29, 2008 at 9:43 am Leave a comment

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