Archive for June, 2009

Acute Pericarditis

N Engl J of Medicine November 18, 2004  V.351  N.21  p.2195-2202

Clinical Practice

Richard A. Lange, M.D., and L. David Hillis, M.D.

Full Text

http://content.nejm.org/cgi/content/full/351/21/2195

PDF

http://content.nejm.org/cgi/reprint/351/21/2195.pdf

CORRECTION

Full Text

http://content.nejm.org/cgi/content/full/352/11/1163-a

PDF

http://content.nejm.org/cgi/reprint/352/11/1163-a.pdf

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June 24, 2009 at 11:48 am Leave a comment

Recomendaciones y Guías de la Sociedad Argentina de Infectología – SADI –

Actualización: 18/06/2009

Temas:

Guía para la Profilaxis Antibiótica Prequirúrgica

Guía intersociedades de Neumonía Adquirida en la Comunidad

Neumonía Nosocomial: Guía Clínica aplicable a Latinoamérica preparada en común por diferentes especialistas (2005)

Actualización Recomendaciones de Diagnóstico y Tratamiento de OI

Guía de Endocarditis Infecciosa (Intersociedades)

Autores

Editorial I

Editorial II

Diagnóstico y Evaluación

Tratamiento I

Tratamiento II

Tratamiento III

Profilaxis

Información para el paciente

CONSENSO ARGENTINO HIV – HCV 2005 (Intersociedades)

Recomendaciones en Tratamiento Antirretroviral y Profilaxis EO 2006  (anexo)

Primer Consenso Argentino de Terapia Antirretroviral 2006 (anexo)

Recomendaciones para el Diagnóstico y Tratamiento de Infecciones Urinarias

Consenso Diagnóstico y Tratamiento en Toxoplasmosis Congénita

Normas del Programa Nacional de Garantía de Calidad

Recomendaciones en Vacunación (parte I)

Manual de Diagnóstico y Tratamiento de la Enfermedad de Chagas-Mazza

Recomendaciones en el manejo de infecciones en pacientes con Cancer-Parte I-

Recomendaciones en el manejo de infecciones en pacientes con Cancer -Parte II-

Evaluación Infectológica para Donantes de Organo Sólido

Recomendaciones de Tratamiento Antirretroviral -2007

Recomendaciones en Tratamiento Antirretroviral y Profilaxis EO 2008

Actualizaciones en Vacunas (NUEVO!)

Consenso SADI – INE – SATI: Guía para el manejo racional de la antibióticoterapia en la Unidad de Terapia Intensiva (2008) Parte I  Parte II ( NUEVO!)

Historial

Guía para el Manejo de la Faringitis Aguda

Guía para el manejo de la exposición a Antrax

Recomendaciones sobre Tratamiento Antirretroviral (2003)

 

link

http://www.sadi.org.ar/mod-htmlpages-display-pid-11.html

 

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June 22, 2009 at 12:49 pm Leave a comment

Increasing Burden of Invasive Group B Streptococcal Disease in Nonpregnant Adults, 1990–2007

Clinical Infectious Diseases  July 1, 2009  V.49  N.1  p.85–92

Tami H. Skoff,1 Monica M. Farley,2,3 Susan Petit,4 Allen S. Craig,5 William Schaffner,6 Ken Gershman,7 Lee H. Harrison,8 Ruth Lynfield,9 Janet Mohle-Boetani,10 Shelley Zansky,11 Bernadette A. Albanese,12 Karen Stefonek,13 Elizabeth R. Zell,1 Delois Jackson,1 Terry Thompson,1 and

Stephanie J. Schrag1

1Respiratory Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 2Emory University School of Medicine and 3Atlanta Veterans Affairs Medical Center, Atlanta, Georgia; 4Connecticut Department of Public Health, Hartford; 5Tennessee Department of Health and 6Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; 7Colorado Department of Public Health and Environment, Denver; 8Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; 9Minnesota Department of Health, St. Paul; 10California Department of Health Services, Berkeley; 11New York State Department of Health, Albany; 12New Mexico Department of Health, Santa Fe; and 13Oregon Department of Human Services, Portland

Background. Group B Streptococcus (GBS), traditionally considered to be a neonatal pathogen, is an important cause of morbidity and mortality among older adults and among those with underlying medical conditions. We used population-based surveillance to examine trends in adult GBS disease during the period 1990–2007 and to describe the epidemiology of adult GBS disease to guide prevention efforts.

Methods. Active Bacterial Core surveillance was conducted in selected counties in 10 US states. A case was defined as isolation of GBS from a normally sterile site in a nonpregnant resident of a surveillance area who was 18 years of age. Rates were calculated using US Census data. Demographic and clinical information was abstracted from medical records. Serotyping and susceptibility testing were performed on isolates collected from a subset of case patients.

Results. A total of 19,512 GBS cases were identified in nonpregnant adults during 1990–2007 (median patient age, 63 years); the incidence of adult GBS disease doubled from 3.6 cases per 100,000 persons during 1990 to 7.3 cases per 100,000 persons during 2007 ( ). The mean difference in incidence between black and white persons was 4.6 cases per 100,000 persons (range, 3.1 cases per 100,000 persons during 1991 to 5.8 cases per 100,000 persons during 1999). Common clinical syndromes in 2007 included bacteremia without focus (39.3%), skin and/or soft-tissue infection (25.6%), and pneumonia (12.6%). Most (88.0%) GBS cases in adults had 1 underlying condition; diabetes was present in 44.4% of cases. Serotypes V, Ia, II, and III accounted for 80.8% of infections during 1998–1999 and 78.5% of infections during 2005–2006.

Conclusions. Invasive GBS disease in nonpregnant adults represents a substantial and increasing burden, particularly among older persons, black persons, and adults with diabetes. Prevention strategies are needed.

abstract

http://www.journals.uchicago.edu/doi/abs/10.1086/599369

June 21, 2009 at 8:26 pm Leave a comment

Clinical Practice Guidelines for the Diagnosis and Management of Intravascular Catheter-Related Infection: 2009 Update by the Infectious Diseases Society of America

Clinical Infectious Diseases  July 1, 2009  V.49  N.1  p.1–45

IDSA GUIDELINES

Leonard A. Mermel,1 Michael Allon,2 Emilio Bouza,9 Donald E. Craven,3 Patricia Flynn,4 Naomi P. O’Grady,5 Issam I. Raad,6 Bart J. A. Rijnders,10 Robert J. Sherertz,7 and David K. Warren8

1Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, Rhode Island; 2University of Alabama-Birmingham Hospital, Birmingham, Alabama; 3Tufts University School of Medicine, Lahey Clinic Medical Center, Burlington, Massachusetts; 4St. Jude Children’s Research Hospital, Children’s Infection Defense Center, Memphis, Tennessee; 5National Institutes of Health, Critical Care Medicine Department, Bethesda, Maryland; 6Section of Infectious Diseases, University of Texas-Cancer Center, Houston; 7Section of Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, North Carolina; 8Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri; 9Servicio de Microbiología Cliínica y E. Infecciosas Hospital General “Gregorio Marañón,” Madrid, Spain; and 10Internal Medicine and Infectious Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands

These updated guidelines replace the previous management guidelines published in 2001. The guidelines are intended for use by health care providers who care for patients who either have these infections or may be at risk for them.

abstract

http://www.journals.uchicago.edu/doi/abs/10.1086/599376

PDF

http://www.journals.uchicago.edu/doi/pdf/10.1086/599376

June 21, 2009 at 8:24 pm Leave a comment

Methicillin-Resistant Staphylococcus aureus Colonization, Behavioral Risk Factors, and Skin and Soft-Tissue Infection at an Ambulatory Clinic Serving a Large Population of HIV-Infected Men Who Have Sex with Men

Clinical Infectious Diseases  July 1, 2009  V.49  N.1  p.118–121

BRIEF REPORT

John D. Szumowski,1 Kenneth M. Wener,3 Howard S. Gold,1 Michael Wong,1 Lata Venkataraman,1

Carrie A. Runde,4 Daniel E. Cohen,5 Kenneth H. Mayer,2,6,7 and Sharon B. Wright1

1Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, and 2Fenway Community Health, Boston, and 3Department of Infectious Diseases, Division of Medicine, Lahey Clinic, Burlington, Massachusetts; 4Bastyr University, Seattle, Washington; 5Abbott Laboratories, Abbott Park, Illinois and Departments of 6Medicine and 7Community Health, Brown University School of Medicine, Providence, Rhode Island

We conducted a prospective cohort study of 795 outpatients, many of whom were human immunodeficiency virus–infected men who have sex with men, to characterize risk of skin and soft-tissue infection (SSTI) associated with methicillin-resistant Staphylococcus aureus (MRSA) nares and perianal colonization. Multivariate analysis revealed that perianal colonization, drug use, and prior SSTIs were strongly associated with development of an SSTI. Of the patients who were colonized with MRSA at study entry, 36.7% developed an SSTI during the ensuing 12 months, compared with 8.1% of persons who were not colonized with MRSA.

abstract

http://www.journals.uchicago.edu/doi/abs/10.1086/599608

June 21, 2009 at 8:22 pm Leave a comment

Increasing Burden of Invasive Group B Streptococcal Disease in Nonpregnant Adults, 1990–2007

Clinical Infectious Diseases  July 1, 2009  V.49  N.1  p.85–92

Tami H. Skoff,1 Monica M. Farley,2,3 Susan Petit,4 Allen S. Craig,5 William Schaffner,6 Ken Gershman,7 Lee H. Harrison,8 Ruth Lynfield,9 Janet Mohle-Boetani,10 Shelley Zansky,11 Bernadette A. Albanese,12 Karen Stefonek,13 Elizabeth R. Zell,1 Delois Jackson,1 Terry Thompson,1 and

Stephanie J. Schrag1

1Respiratory Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 2Emory University School of Medicine and 3Atlanta Veterans Affairs Medical Center, Atlanta, Georgia; 4Connecticut Department of Public Health, Hartford; 5Tennessee Department of Health and 6Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; 7Colorado Department of Public Health and Environment, Denver; 8Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; 9Minnesota Department of Health, St. Paul; 10California Department of Health Services, Berkeley; 11New York State Department of Health, Albany; 12New Mexico Department of Health, Santa Fe; and 13Oregon Department of Human Services, Portland

Background. Group B Streptococcus (GBS), traditionally considered to be a neonatal pathogen, is an important cause of morbidity and mortality among older adults and among those with underlying medical conditions. We used population-based surveillance to examine trends in adult GBS disease during the period 1990–2007 and to describe the epidemiology of adult GBS disease to guide prevention efforts.

Methods. Active Bacterial Core surveillance was conducted in selected counties in 10 US states. A case was defined as isolation of GBS from a normally sterile site in a nonpregnant resident of a surveillance area who was 18 years of age. Rates were calculated using US Census data. Demographic and clinical information was abstracted from medical records. Serotyping and susceptibility testing were performed on isolates collected from a subset of case patients.

Results. A total of 19,512 GBS cases were identified in nonpregnant adults during 1990–2007 (median patient age, 63 years); the incidence of adult GBS disease doubled from 3.6 cases per 100,000 persons during 1990 to 7.3 cases per 100,000 persons during 2007 ( ). The mean difference in incidence between black and white persons was 4.6 cases per 100,000 persons (range, 3.1 cases per 100,000 persons during 1991 to 5.8 cases per 100,000 persons during 1999). Common clinical syndromes in 2007 included bacteremia without focus (39.3%), skin and/or soft-tissue infection (25.6%), and pneumonia (12.6%). Most (88.0%) GBS cases in adults had 1 underlying condition; diabetes was present in 44.4% of cases. Serotypes V, Ia, II, and III accounted for 80.8% of infections during 1998–1999 and 78.5% of infections during 2005–2006.

Conclusions. Invasive GBS disease in nonpregnant adults represents a substantial and increasing burden, particularly among older persons, black persons, and adults with diabetes. Prevention strategies are needed.

abstract

http://www.journals.uchicago.edu/doi/abs/10.1086/599369

June 21, 2009 at 8:18 pm Leave a comment

Seven-Year Surveillance of North American Pediatric Group A Streptococcal Pharyngitis Isolates

Clinical Infectious Diseases  July 1, 2009  V.49  N.1  p.78–84

Stanford T. Shulman,1,3 Robert R Tanz,2,3 James B. Dale,4,5 Bernard Beall,6 William Kabat,1

Kathleen Kabat,1 Emily Cederlund,1 Devendra Patel,1 Jason Rippe,1 Zhongya Li,6 Varja Sakota,6 and the North American Streptococcal Pharyngitis Surveillance Groupa

Divisions of 1Infectious Diseases and 2General Academic Pediatrics, Children’s Memorial Hospital, and 3Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Departments of 4Medicine and 5Molecular Sciences, University of Tennessee Health Science Center and VA Medical Center, Memphis; and 6Centers for Disease Control and Prevention, Respiratory Diseases Branch, Atlanta, Georgia

Background. Pharyngeal group A streptococcal (GAS) emm type surveillance enhances understanding of the epidemiology of pharyngitis and invasive GAS disease and formulation of multivalent type-specific vaccines. In addition, such surveillance provides pre-GAS vaccine baseline data. We assessed geographic and temporal trends in GAS emm-type distribution among pediatric pharyngeal isolates collected systematically in the United States and Canada from 2000 to 2007.

Methods. We collected 100 acute GAS pharyngitis isolates from each of 13 widely scattered sites (10 in the United States and 3 in Canada) annually for 7 seasons (2000–2007) from 3- to 18-year-old children. We assessed emm type and subtype by DNA sequencing and analyzed temporal and geographic trends.

Results. A total of 7040 US and 1434 Canadian GAS isolates were studied. The 6 most prevalent emm types (in descending order) were 1, 12, 28, 4, 3, and 2 in the United States and 12, 1, 28, 4, 3, 2, and 77 in Canada, constituting 70%–71% of isolates in each country; 10 emm types constituted 87%–89% total. Fifty-six emm types were identified in the United States, including 8 new types, and 33 types in Canada. Although a few types predominated nationally, marked variability among individual sites and at individual sites from year to year was observed. US-Canadian differences in type distribution were apparent. Twenty percent of isolates represented emm subtypes that differed slightly from reference types; 110 new subtypes were identified. An experimental 26-valent M protein vaccine covers 85% of pharyngitis isolates.

Conclusions. Although overall US and Canadian emm type distribution was consistent and relatively few types dominated nationally, striking intersite and temporal variations within individual sites in prevalent emm types of GAS occurred. These results have important implications for the development and formulation of type-specific GAS vaccines.

abstract

http://www.journals.uchicago.edu/doi/abs/10.1086/599344

June 21, 2009 at 8:15 pm Leave a comment

Changing Epidemiology of Invasive Pneumococcal Disease in Canada, 1998–2007: Update from the Calgary-Area Streptococcus pneumoniae Research (CASPER) Study

Clinical Infectious Diseases  15 July 2009  V.49  N.2  p.205–212

James D. Kellner,1,2 Otto G. Vanderkooi,1,2,3 Judy MacDonald,1,4 Deirdre L. Church,1,3 Gregory J. Tyrrell,5,6 and David W. Scheifele7,8

1University of Calgary, 2Alberta Children’s Hospital, 3Calgary Laboratory Services, and 4Public Health Portfolio, Calgary Health Region, Calgary, and 5National Centre for Streptococcus and 6University of Alberta, Edmonton, Alberta; and 7Vaccine Evaluation Centre, BC Children’s Hospital, and 8University of British Columbia, Vancouver, British Columbia, Canada

Background. Routine infant vaccination with 7-valent pneumococcal conjugate vaccine (PCV7) began in the Calgary Health Region (Alberta, Canada) in 2002. We measured the impact of this vaccine program on invasive pneumococcal disease (IPD).

Methods. Prospective, population-based surveillance of all cases of IPD (with culture specimens obtained from sterile sites) was conducted from January 1998 through December 2007. Demographic and clinical data were collected. All viable isolates were saved and serotyped.

Results. There were 1182 IPD cases over the 10-year period. Comparison of the vaccine period (2003–2007) with the prevaccine period (1998–2001) revealed that the incidence of IPD due to PCV7 serotypes decreased significantly by 86%, 59%, 38%, and 78% in the 6–23-month, 2–4-year, 16–64-year, and 65–84-year age groups, respectively. The total number of IPD cases decreased by 77%, 45%, and 34% in the 6–23-month, 2–4-year, and 65–84-year age groups, respectively. The incidence of IPD due to non-PCV7 serotypes increased by 183%, and the total incidence of IPD increased by 73% among adults aged 16–64 years; however, this increase was primarily attributed to a large outbreak of serotype 5 IPD among homeless adults during the period 2005–2007. There were 5 cases of IPD due to PCV7 serotypes among vaccinated children in the vaccine period.

Conclusions. Since the introduction of PCV7 vaccine, there has been a profound decrease in the total number of cases of IPD among children and in cases due to PCV7 serotypes among subjects of all ages in Calgary, indicating a strong direct effect and herd effect of the vaccine. The serotypes that now cause IPD have changed significantly. The magnitude and impact of replacement IPD caused by non-PCV7 serotypes is not yet known.

abstract

http://www.journals.uchicago.edu/doi/abs/10.1086/599827

June 21, 2009 at 6:08 pm Leave a comment

Hepatitis C Virus Infection and the Risk of Coronary Disease

Clinical Infectious Diseases  15 July 2009  V.49  N.2  p.225–232

Adeel A. Butt,1,2,3 Wang Xiaoqiang,2,3 Matthew Budoff,5 David Leaf,6,7 Lewis H. Kuller,4 and Amy C. Justice8,9

1University of Pittsburgh School of Medicine, 2Center for Health Equity Research and Promotion, 3VA Pittsburgh Healthcare System, and 4Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania; 5Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 6VA Greater Los Angeles Healthcare System, and 7David Geffen School of Medicine at UCLA, Los Angeles, California; and 8VA Connecticut Healthcare System, West Haven, and 9Yale University School of Medicine and Public Health, New Haven, Connecticut

Background. The association between hepatitis C virus (HCV) infection and coronary artery disease (CAD) is controversial. We conducted this study to determine and quantify this association.

Methods. We used an established, national, observational cohort of all HCV-infected veterans receiving care at all Veterans Affairs facilities, the Electronically Retrieved Cohort of HCV Infected Veterans, to identify HCV-infected subjects and HCV-uninfected control subjects. We used the Cox proportional-hazards model to determine the risk of CAD among HCV-infected subjects and control subjects.

Results. We identified 82,083 HCV-infected and 89,582 HCV-uninfected subjects. HCV-infected subjects were less likely to have hypertension, hyperlipidemia, and diabetes but were more likely to abuse alcohol and drugs and to have renal failure and anemia. HCV-infected subjects had lower mean (± standard deviation) total plasma cholesterol (175 ± 40.8 mg/dL vs. 198 ± 41.0 mg/dL), low-density lipoprotein cholesterol (102 ± 36.8 mg/dL vs. 119 ± 38.2 mg/dL), and triglyceride (144 ± 119 mg/dL vs. 179 ± 151 mg/dL) levels, compared with HCV-uninfected subjects ( for all comparisons). In multivariable analysis, HCV infection was associated with a higher risk of CAD (hazard ratio, 1.25; 95% confidence interval, 1.20–1.30). Traditional risk factors (age, hypertension, chronic obstructive pulmonary disease, diabetes, and hyperlipidemia) were associated with a higher risk of CAD in both groups, whereas minority race and female sex were associated with a lower risk of CAD.

Conclusions. HCV-infected persons are younger and have lower lipid levels and a lower prevalence of hypertension. Despite a favorable risk profile, HCV infection is associated with a higher risk of CAD after adjustment for traditional risk factors.

abstract

http://www.journals.uchicago.edu/doi/abs/10.1086/599371

June 21, 2009 at 6:06 pm Leave a comment

Infection with Panresistant Klebsiella pneumoniae: A Report of 2 Cases and a Brief Review of the Literature

Clinical Infectious Diseases  15 July 2009  V.49  N.2  p.271–274

BRIEF REPORT

Azza Elemam, Joseph Rahimian, and William Mandell

Section of Infectious Diseases, Saint Vincent’s Hospital, New York, New York

Infections caused by carbapenemase-producing Klebsiella pneumoniae have been reported with increasing frequency, thereby limiting the choice of effective antimicrobial agents available to clinicians. This has prompted the increased use of polymyxins and tigecycline, but resistance to these agents is already emerging. We report 2 cases of infection with panresistant K. pneumoniae.

abstract

http://www.journals.uchicago.edu/doi/abs/10.1086/600042

June 21, 2009 at 6:05 pm Leave a comment

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