Archive for April, 2010

Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis

The Lancet, Volume 375, Issue 9725, Pages 1545 – 1555, 1 May 2010

Harish Nair DNB a b, D James Nokes PhD c d, Bradford D Gessner MD e, Mukesh Dherani PhD f, Prof Shabir A Madhi MD g, Rosalyn J Singleton MD h i, Katherine L O’Brien MD j, Anna Roca PhD k l, Prof Peter F Wright MD m, Nigel Bruce PhD f, Aruna Chandran MD j, Evropi Theodoratou PhD a, Agustinus Sutanto MD n, Endang R Sedyaningsih MD o, Mwanajuma Ngama HND c, Patrick K Munywoki MSc c, Prof Cissy Kartasasmita PhD p, Prof Eric AF Simões MD q, Prof Igor Rudan MD a r, Martin W Weber PhD s, Prof Harry Campbell MD

Background

The global burden of disease attributable to respiratory syncytial virus (RSV) remains unknown. We aimed to estimate the global incidence of and mortality from episodes of acute lower respiratory infection (ALRI) due to RSV in children younger than 5 years in 2005.

Methods

We estimated the incidence of RSV-associated ALRI in children younger than 5 years, stratified by age, using data from a systematic review of studies published between January, 1995, and June, 2009, and ten unpublished population-based studies. We estimated possible boundaries for RSV-associated ALRI mortality by combining case fatality ratios with incidence estimates from hospital-based reports from published and unpublished studies and identifying studies with population-based data for RSV seasonality and monthly ALRI mortality.

Findings

In 2005, an estimated 33·8 (95% CI 19·3—46·2) million new episodes of RSV-associated ALRI occurred worldwide in children younger than 5 years (22% of ALRI episodes), with at least 3·4 (2·8—4·3) million episodes representing severe RSV-associated ALRI necessitating hospital admission. We estimated that 66 000—199 000 children younger than 5 years died from RSV-associated ALRI in 2005, with 99% of these deaths occurring in developing countries. Incidence and mortality can vary substantially from year to year in any one setting.

Interpretation

Globally, RSV is the most common cause of childhood ALRI and a major cause of admission to hospital as a result of severe ALRI. Mortality data suggest that RSV is an important cause of death in childhood from ALRI, after pneumococcal pneumonia and Haemophilus influenzae type b. The development of novel prevention and treatment strategies should be accelerated as a priority.

abstract

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2960206-1/abstract?&elsca1=TL-300410-ROW&elsca2=email&elsca3=segment

April 30, 2010 at 3:42 pm Leave a comment

Community-associated meticillin-resistant Staphylococcus aureus

The Lancet, Volume 375, Issue 9725, Pages 1557 – 1568, 1 May 2010

Dr Frank R DeLeo PhD a , Michael Otto PhD a, Prof Barry N Kreiswirth PhD b, Prof Henry F Chambers MD c

Summary

Meticillin-resistant Staphylococcus aureus (MRSA) is endemic in hospitals worldwide, and causes substantial morbidity and mortality. Health-care-associated MRSA infections arise in individuals with predisposing risk factors, such as surgery or presence of an indwelling medical device. By contrast, many community-associated MRSA (CA-MRSA) infections arise in otherwise healthy individuals who do not have such risk factors. Additionally, CA-MRSA infections are epidemic in some countries. These features suggest that CA-MRSA strains are more virulent and transmissible than are traditional hospital-associated MRSA strains. The restricted treatment options for CA-MRSA infections compound the effect of enhanced virulence and transmission. Although progress has been made towards understanding emergence of CA-MRSA, virulence, and treatment of infections, our knowledge remains incomplete. Here we review the most up-to-date knowledge and provide a perspective for the future prophylaxis or new treatments for CA-MRSA infections.

abstract

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2809%2961999-1/abstract?&elsca1=TL-300410-ROW&elsca2=email&elsca3=segment

April 30, 2010 at 3:39 pm Leave a comment

There Is No “Cap” on the Importance of Community-Acquired Pneumonia in the ICU

Chest March 1, 2008 V.133  N.3  p.590-592

Andrew F. Shorr, MD, MPH, FCCP and Richard G. Wunderink, MD, FCCP

Washington, DC Chicago, IL

Community-acquired pneumonia (CAP) remains a major reason for hospitalization and a leading cause of mortality in the United States. Efforts to improve CAP outcomes have generally focused on less severely ill patients not requiring treatment in the ICU. Additionally, quality measures advanced by the Centers for Medicare and Medicaid Services (CMS) address multiple issues but again emphasize aspects of care for patients admitted to the general medicine wards. Despite the lack of strong prospective data indicating that certain quality measures mandated by CMS correlate with enhanced outcomes, financial incentives are being used in order to. . .

Full Text

http://chestjournal.chestpubs.org/content/133/3/590.full

PDF

http://chestjournal.chestpubs.org/content/133/3/590.full.pdf+html

April 28, 2010 at 4:46 pm Leave a comment

Population Structure and Capsular Switching of Invasive Neisseria meningitidis Isolates in the Pre–Meningococcal Conjugate Vaccine Era—United States, 2000–2005

Journal of Infectious Diseases 15 April 2010 V.201  N.8  p.1208–1224

Lee H. Harrison,1,2 Kathleen A. Shutt,2 Susanna E. Schmink,3 Jane W. Marsh,2 Brian H. Harcourt,3 Xin Wang,3 Anne M. Whitney,3 David S. Stephens,4,5 Amanda A. Cohn,3 Nancy E. Messonnier,3 and Leonard W. Mayer3

1Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; 2Infectious Diseases Epidemiology Research Unit, Division of Infectious Diseases, University of Pittsburgh Graduate School of Public Health and School of Medicine, Pittsburgh, Pennsylvania; 3Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, 4Emory University, Robert W. Woodruff Health Sciences Center, and 5Medical Research Service, VA Medical Center, Atlanta, Georgia

Background

A quadrivalent meningococcal conjugate vaccine (MCV4) was licensed in the United States in 2005; no serogroup B vaccine is available. Neisseria meningitidis changes its capsular phenotype through capsular switching, which has implications for vaccines that do not protect against all serogroups.

Methods

Meningococcal isolates from 10 Active Bacterial Core surveillance sites from 2000 through 2005 were analyzed to identify changes occurring after MCV4 licensure. Isolates were characterized by multilocus sequence typing (MLST) and outer membrane protein gene sequencing. Isolates expressing capsular polysaccharide different from that associated with the MLST lineage were considered to demonstrate capsular switching.

Results

Among 1160 isolates, the most common genetic lineages were the sequence type (ST)–23, ST-32, ST-11, and ST-41/44 clonal complexes. Of serogroup B and Y isolates, 8 (1.5%) and 3 (0.9%), respectively, demonstrated capsular switching, compared with 36 (12.9%) for serogroup C (p<.001); most serogroup C switches were from virulent serogroup B and/or serogroup Y lineages.

Conclusions

limited number of genetic lineages caused the majority of invasive meningococcal infections. A substantial proportion of isolates had evidence of capsular switching. The high prevalence of capsular switching requires surveillance to detect changes in the meningococcal population structure that may affect the effectiveness of meningococcal vaccines.

abstract

http://www.journals.uchicago.edu/doi/abs/10.1086/651505

April 28, 2010 at 4:43 pm Leave a comment

Clinical and Virologic Efficacy of Herpes Simplex Virus Type 2 Suppression by Acyclovir in a Multicontinent Clinical Trial

Journal of Infectious Diseases 15 April 2010 V.201  N.8  p.1164–1168

BRIEF REPORT

Jonathan Fuchs,1,2 Connie Celum,3,4,5 Jing Wang,8 James Hughes,6 Jorge Sanchez,10 Frances Cowan,11 Stewart Reid,9,12 Sinead Delany-Moretlwe,13 Lawrence Corey,4,7,8 and Anna Wald,4,5,7,8 for the HIV Prevention Trials Network 039 Protocol Team

1HIV Research Section, San Francisco Department of Public Health, and 2Department of Medicine, University of California, San Francisco; Departments of 3Global Health, 4Medicine, 5Epidemiology, 6Biostatistics, and 7Laboratory Medicine, University of Washington, and 8Vaccine and Infectious Diseases Institute, Fred Hutchinson Cancer Research Center, Seattle, Washington; 9Department of Medicine, University of Alabama, Birmingham; 10Asociación Civil Salud y Educación, Impacta, Lima, Peru; 11Royal Free and University College Medical School, University College London, London, United Kingdom; 12Centre for Infectious Disease Research, Lusaka, Zambia; 13Reproductive Health and HIV Research Unit, University of Witwatersrand, Johannesburg, South Africa

Acyclovir suppressive therapy (400 mg twice daily) reduces herpes simplex virus (HSV) type 2–associated genital ulcer disease and lesional HSV shedding. In an international trial of acyclovir for suppression of HSV type 2 to prevent human immunodeficiency virus (HIV) acquisition (HIV Prevention Trials Network 039), acyclovir had a smaller effect on the frequency of genital ulcer disease as well as a smaller effect on the frequency and quantity of lesional HSV DNA in African women and Peruvian men, compared with its effects in men in the United States. The observed regional variation in the clinical and virologic efficacy of acyclovir for HSV suppression warrants further evaluation of determinants of responses to acyclovir. (ClinicalTrials.gov identifier: NCT00076232.)

abstract

http://www.journals.uchicago.edu/doi/abs/10.1086/651381

PDF

http://www.journals.uchicago.edu/doi/pdf/10.1086/651381

April 28, 2010 at 4:41 pm Leave a comment

Spinal epidural abscess: a meta-analysis of 915 patients.

Neurosurgical Review  Dec 2000  V.23 N.4 p.175-204

Reihsaus E1, Waldbaur H2, Seeling W3.

1 Ludwigsburg-Bietigheim General Hospital, Department of Anesthesiology, Bietigheim-Bissingen, Germany.

2 Neurosurgical Clinic, German Military Hospital, Oberer Eselsberg 40, 89081 Ulm, Germany, DE

3 University Clinic of Anesthesiology, Section of Pain Therapy, University of Ulm, Steinhövelstrasse 9, 89075 Ulm, Germany, DE

Abstract

Spinal epidural abscess (SEA) was first described in the medical literature in 1761 and represents a severe, generally pyogenic infection of the epidural space requiring emergent neurosurgical intervention to avoid permanent neurologic deficits. Spinal epidural abscess comprises 0.2 to 2 cases per 10,000 hospital admissions. This review intends to offer detailed evaluation and a comprehensive meta-analysis of the international literature on SEA between 1954 and 1997, especially of patients who developed it following anesthetic procedures in the spinal canal. In this period, 915 cases of SEA were published. This review is the most comprehensive literature analysis on SEA to date. Most cases of SEA occur in patients aged 30 to 60 years, but the youngest patient was only 10 days old and the oldest was 87. The ratio of men to women was 1:0.56. The most common risk factor was diabetes mellitus, followed by trauma, intravenous drug abuse, and alcoholism. Epidural anesthesia or analgesia had been performed in 5.5% of the patients with SEA. Skin abscesses and furuncles were the most common source of infection. Of the patients, 71% had back pain as the initial symptom and 66% had fever. The second stage of radicular irritation is followed by the third stage, with beginning neurological deficit including muscle weakness and sphincter incontinence as well as sensory deficits. Paralysis (the fourth stage) affected only 34% of the patients. The average leukocyte count was 15,700/µl (range 1,500–42,000/µl), and the average erythrocyte sedimentation rate was 77 mm in the first hour (range 2–50 mm). Spinal epidural abscess is primarily a bacterial infection, and the gram-positive Staphylococcus aureus is its most common causative agent. This is true also for patients who develop SEA following spinal anesthetics. Magnetic resonance imaging (MRI) displays the greatest diagnostic accuracy and is the method of first choice in the diagnostic process. Myelography, commonly used previously to diagnose SEA, is no longer recommended. Lumbar puncture to determine cerebrospinal fluid protein concentrations is not needed for diagnosis and entails the risk of spreading bacteria into the subarachnoid space with consequent meningitis; therefore, it should not be performed. The therapeutic method of choice is laminectomy combined with antibiotics. Conservative treatment alone is justifiable only for specific indications. Laminotomy is a therapeutic alternative for children. The mortality of SEA dropped from 34% in the period of 1954–1960 to 15% in 1991–1997. At the beginning of the twentieth century, almost all patients with SEA died. Parallel to improvements in the mortality rate, today more patients experience complete recovery from SEA. The prognosis of patients who develop SEA following epidural anesthesia or analgesia is not better than that of patients with noniatrogenic SEA, and the mortality rate is also comparable. The essential problem of SEA lies in the necessity of early diagnosis, because only timely treatment is able to avoid or reduce permanent neurologic deficits.

abstract

http://springer.lib.tsinghua.edu.cn/content/tu2m9dy90l1b2eyd/?p=5b1c38546026490d880d8fc9204892f5&pi=1

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April 28, 2010 at 4:37 pm Leave a comment

Influenza Management Guide 2009-2010 (Update March 31, 2010)

University of California – San Francisco – USA

PDF

http://www.nccc.ucsf.edu/docs/H1N1_Flu.pdf

April 26, 2010 at 6:22 pm Leave a comment

Efficacy and Safety of Pegylated Interferon Combined with Ribavirin for the Treatment of Older Patients with Chronic Hepatitis C

The Journal of Infectious Diseases  1 March 2010  V.201  N.5  p.751–759

Chung-Feng Huang,1,2,4 Jeng-Fu Yang,1,3 Chia-Yen Dai,1,2,5 Jee-Fu Huang,4,5,6 Nai-Jen Hou,6Ming-Yen Hsieh,1 Zu-Yau Lin,1,5 Shinn-Cherng Chen,1,5 Ming-Yuh Hsieh,1,5 Liang-Yen Wang,1,5Wen-Yu Chang,1,5 Wan-Long Chuang,1,5 and Ming-Lung Yu1,5,7

1Hepatobiliary Division, Department of Internal Medicine and Departments of 2Occupational Medicine and 3Preventive Medicine, Kaohsiung Medical University Hospital, 4Graduate Institute of Medicine and 5Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, 6Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, and 7Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan

Background

The present study evaluated the efficacy and safety of pegylated interferon (PegIFN)/ribavirin treatment in elderly patients with hepatitis C virus (HCV) infection.

Methods

Seventy elderly patients with hepatitis C virus (HCV) infection (group A; age, 65 years) and 140 sex- and HCV genotype–matched controls (group B; age, 50–64 years) were allocated to receive a PegIFN-α-2a/ribavirin standard-of-care regimen.

Results

Group A had a significantly higher rate of treatment discontinuation (21.4% vs 6.4%;  ) and grade 3 or 4 adverse events (34.3% vs 20%;  ) than group B. In intention-to-treat analysis, the sustained virologic response (SVR) rate was substantially lower in group A than in group B (67.1% vs 78.6%;  ). The inferiority of the SVR rate in group A was observed among patients with HCV genotype 1 (HCV-1) (51.9% vs 75.9%;  ) but not among patients with HCV genotype 2 or 3 (HCV-2/3) (76.7% vs 80.2%;  ). Among patients in group A who had a rapid virologic response, those infected with HCV-1 and those infected with HCV-2/3 had similar SVR rates (80% and 87.9%, respectively). For patients receiving treatment for >80% of its expected duration, SVR rates were similar between the 2 groups (80.4% vs 82.6%, respectively), regardless of viral genotype.

Conclusions

Older patients with HCV infection, especially those in the subgroup infected with HCV-1, had a greater frequency of adverse events and poorer adherence to the standard-of-care regimen, which may be the major reason for treatment inferiority.

Trial registration.Clinicaltrials.gov identifier NCT00629824.

abstract

http://www.journals.uchicago.edu/doi/abs/10.1086/650470

April 25, 2010 at 11:03 pm Leave a comment

Treatment of Shigellosis: V. Comparison of Azithromycin and Ciprofloxacin: A Double-Blind, Randomized, Controlled Trial

Annals of Internal Medicine 1 May 1997 V.126 N.9  p.697-703

Wasif Ali Khan, MB, BS; Carlos Seas, MD; Ujjwal Dhar, MB, BS; Mohammed Abdus Salam, MB, BS; and Michael L. Bennish, MD

From the International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; Universidad Peruana Cayetano Heredia, Lima, Peru; and New England Medical Center, Boston, Massachusetts. Acknowledgments: The authors thank M. Begum for laboratory support; H. Kabir for assistance with data entry; and J.A. Herrington, J.A. Federici, and J.M. Remy for assaying drug concentrations. Grant Support: By the International Centre for Diarrhoeal Disease Research, Bangladesh, and by Pfizer, Inc. Dr. Seas was supported by a fellowship from the Swedish Agency for Research Cooperation with Developing Countries.

Abstract

Background

Treatment of shigellosis is currently limited by the high prevalence of multidrug-resistant strains of Shigella.

Objective

To determine the efficacy of azithromycin in the treatment of shigellosis.

Design

Randomized, double-blind clinical trial.

Setting

Diarrhea treatment center in Dhaka, Bangladesh.

Patients

70 men with shigellosis that had lasted 72 hours or less.

Interventions

Patients stayed in the hospital for 6 days. Thirty-four patients were randomly assigned to receive 500 mg of azithromycin on study day 1, followed by 250 mg once daily for 4 days; 36 patients were assigned to receive 500 mg of ciprofloxacin every 12 hours for 5 days.

Measurements

Clinical treatment failure was considered to have occurred if frank dysentery persisted for 72 hours after therapy began or if on study day 5 a patient had more than six stools, had any bloody-mucoid stools, had more than one watery stool, or had an oral body temperature exceeding 37.8 °C. Bacteriologic treatment failure was considered to have occurred if Shigella strains could be isolated from a stool sample after study day 2. Therapy was considered either clinically or bacteriologically successful in patients who completed therapy and did not meet criteria for failure.

Results

Therapy was clinically successful in 28 (82%) patients who received azithromycin and 32 (89%) patients who received ciprofloxacin (difference, −7%[95% CI, −23% to 10%]). Therapy was bacteriologically successful in 32 (94%) patients receiving azithromycin and 36 (100%) patients receiving ciprofloxacin (difference, −6%[CI, −14% to 2%]). Peak serum concentrations of azithromycin were equal to the minimum inhibitory concentration (MIC) of the infecting Shigella strains, whereas serum concentrations of ciprofloxacin were 28 times the MIC. Stool concentrations of both drugs were more than 200 times the MIC.

Conclusion

Azithromycin is effective in the treatment of moderate to severe shigellosis caused by multidrug-resistant Shigella strains.

abstract

http://www.annals.org/content/126/9/697.abstract

PDF

http://www.annals.org/content/126/9/697.full.pdf+html

April 25, 2010 at 11:01 pm Leave a comment

Treatment of Shigellosis: III. Comparison of One- or Two-Dose Ciprofloxacin with Standard 5-Day Therapy – A Randomized, Blinded Trial

Annals of Internal Medicine 1 Nov 1992 V.117 N.9 p.p.727-734

Michael L. Bennish, MD; Mohammed Abdus Salam, MB, BS; Wasif Ali Khan, MB, BS; and Ali Miraj Khan, MB, BS

From the International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; and New England Medical Center, Boston, Massachusetts.

Abstract

Objective

To determine whether a single dose, or 2 doses, of ciprofloxacin are as effective as 5-day, 10-dose therapy for the treatment of shigellosis in adult men who are moderately to severely ill.

Design

Randomized, double-blind clinical trial.

Setting

A diarrhea treatment center in the capital city of a developing country, Bangladesh.

Patients

A total of 128 adult men with dysentery of less than 96 hours duration. All had Shigella organisms isolated from a culture of stool.

Interventions

Patients were randomly assigned to receive either a single 1-gram dose of ciprofloxacin at admission to the study (single-dose group; n = 40), a 1-gram dose of ciprofloxacin at admission and 24 hours later (2-dose group; n = 43), or 500 mg of ciprofloxacin every 12 hours for 5 days (10 dose group; n = 35). All patients were hospitalized for 6 days.

Measurements

Stools were collected individually; their character and consistency were recorded and cultured daily. A physical examination and recording of symptoms were done daily, and the temperature was measured every 4 hours. Therapy was considered to have failed in patients who did not have improvement in the signs and symptoms of dysentery after 72 hours of therapy or in patients who on study day 5 had more than nine stools, or more than two watery stools, or were febrile.

Results

There were no treatment failures in the 78 patients infected with species of Shigella other than Shigella dysenteriae type 1. Among the 40 patients infected with S. dysenteriae type 1, treatment failed in 4 of the 10 patients who received single-dose therapy, 2 of the 15 patients who received 2-dose therapy, and none of the 15 patients who received 10-dose therapy (P = 0.017, single-dose therapy group compared with 10-dose group; P= 0.15 for the single-dose group compared with the 2-dose group; P > 0.2 for the 2-dose group compared with the 10-dose group).

Conclusions

A single 1-gram dose of ciprofloxacin is effective therapy for patients infected with species of Shigella other than S. dysenteriae type 1. Single-dose therapy is inferior to 10-dose therapy for treating patients infected with S. dysenteriae type 1.

abstract

http://www.annals.org/content/117/9/727.abstract

PDF

http://www.annals.org/content/117/9/727.full.pdf+html

April 25, 2010 at 10:59 pm Leave a comment

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