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


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.


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by age, using data from a systematic review of studies published between January, 1995, and June, 2009, and ten unpublished population-based studies.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mortality by combining case fatality ratios with incidence estimates from hospital-based reports from published and unpublished studies and identifying studies with population-based data for RSV seasonality and monthly ALRI mortality.


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.


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.


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


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.


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. . .

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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


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.


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.


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.


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.


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


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. ( identifier: NCT00076232.)



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


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.


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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


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

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