Archive for July 14, 2010

Human Brucella canis Infections Diagnosed by Blood Culture

EID July 2010 V.16 N.7 

Letter

Atsushi Nomura,  Koichi Imaoka, Hajime Imanishi, Hideaki Shimizu, Fumiko Nagura, Kayaho Maeda, Tatsuhito Tomino, Yoshiro Fujita, Masanobu Kimura, and Gerald H. Stein

 Chubu Rosai Hospital, Nagoya, Japan (A. Nomura, H. Imanishi, H. Shimizu, F. Nagura, K. Maeda, T. Tomino); National institute of Infectious Diseases, Tokyo, Japan (K. Imaoka, M. Kimura); Toyota Memorial Hospital, Toyota, Japan (Y. Fujita); and University of Florida, Gainesville, Florida, USA (G. Stein)

To the Editor: Brucellosis is a worldwide zoonosis caused by Brucella spp. The 4 species known to infect humans are B. melitensis, B. suis, B. abortus, and B. canis (1). Since 1999, 11 cases in Japan have been reported. Although no bacteria were isolated, serum antibody detection indicated that 4 were caused by B. melitensis or B. abortus acquired abroad and the other 7 by B. canis (2). Of these 7 patients, 2 were presumed to have received their infection from dogs, and the sources of infection for the other 5 are unclear. We report 2 cases of B. canis infection diagnosed by blood culture….

Full Text

http://www.cdc.gov/eid/content/16/7/1183.htm

PDF

http://www.cdc.gov/eid/content/16/7/pdfs/1183.pdf

July 14, 2010 at 5:54 pm Leave a comment

Oseltamivir-Resistant Pandemic (H1N1) 2009 in Patient with Impaired Immune System

EID July 2010 V.16 N.7 

Letter

Grant A. Hill-Cawthorne, Silke Schelenz, Matthew Lawes, and Samir Dervisevic

University of East Anglia, Norwich, UK; and Norfolk and Norwich University Hospital, Norwich

To the Editor: We detail the development of oseltamivir-resistant pandemic (H1N1) 2009 in a chronically immunocompromised patient and the pitfalls encountered when treating such patients with neuraminidase inhibitors. On August 6, 2009, a 56-year-old man was seen in the emergency room of a local hospital with a 24-hour history of fever, myalgia, coryzal symptoms, and cough. He was on day 3 of a postexposure course of oseltamivir (75 mg 1×/d); influenza A had been presumptively diagnosed for his wife after she had similar symptoms….

Full Text

http://www.cdc.gov/eid/content/16/7/1185.htm

PDF

http://www.cdc.gov/eid/content/16/7/pdfs/1185.pdf

July 14, 2010 at 5:52 pm Leave a comment

Procalcitonin Levels Predict Bacteremia in Patients With Community-Acquired Pneumonia – A Prospective Cohort Trial

Chest  1 July 2010  V.138  N.1  p.121-129

Fabian Müller, MD, Mirjam Christ-Crain, MD, Thomas Bregenzer, MD, Martin Krause, MD, Werner Zimmerli, MD, Beat Mueller, MD, Philipp Schuetz, MD and for the ProHOSP Study Group*

From the Department of Internal Medicine (Drs Müller, Christ-Crain, and Schuetz), Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Basel, Basel, Switzerland; Department of Internal Medicine (Drs Bregenzer and Mueller), Kantonsspital Aarau, Aarau, Switzerland; Department of Internal Medicine (Dr Krause), Kantonsspital Münsterlingen, Münsterlingen , Switzerland; and Department of Internal Medicine (Dr Zimmerli), Kantonsspital Liestal, Liestal, Switzerland.

Background

Guidelines recommend blood culture sampling from hospitalized patients with suspected community-acquired pneumonia (CAP). However, the yield of true-positive results is low. We investigated the benefit of procalcitonin (PCT) on hospital admission to predict blood culture positivity in CAP.

Methods

This was a prospective cohort study with a derivation and validation set including 925 patients with CAP who underwent blood culture sampling on hospital admission.

Results

A total of 73 (7.9%) patients had true bacteremia (43 of 463 in the derivation cohort, 30 of 462 in the validation cohort). The area under the receiver operating characteristics curve of PCT in the derivation and validation cohorts was similar (derivation cohort, 0.83; 95% CI, 0.78-0.89; validation cohort, 0.79; 95% CI, 0.72-0.88). Overall, PCT was a significantly better predictor for blood culture positivity than WBC count, C-reactive protein, and other clinical parameters. In multivariate regression analysis, only antibiotic pretreatment (adjusted odds ratio, 0.25; P < .05) and PCT serum levels (adjusted odds ratio, 3.72; P < .001) were independent predictors. Overall, a PCT cutoff of 0.1 μg/L would enable reduction of the total number of blood cultures by 12.6% and still identify 99% of the positive blood cultures. Similarly, 0.25 μg/L and 0.5 μg/L cutoffs would enable reduction of blood cultures by 37% and 52%, respectively, and still identify 96% and 88%, respectively, of positive blood cultures.

Conclusions

Initial PCT level accurately predicted blood culture positivity in patients with CAP. PCT measurement has the potential to reduce the number of drawn blood cultures in the emergency department and to implement a more targeted allocation of limited health-care resources.

abstract

http://chestjournal.chestpubs.org/content/138/1/121.abstract?etoc

July 14, 2010 at 5:50 pm Leave a comment

Expanded Clinical Presentation of Community-Acquired Methicillin-Resistant Staphylococcus aureus Pneumonia

Chest  1 July 2010  V.138  N.1  p.130-136

L. Jason Lobo, MD, Kurt D. Reed, MD and Richard G. Wunderink, MD, FCCP

From the Department of Medicine (Drs Lobo and Wunderink), the Department of Pathology (Dr Reed), and the Division of Pulmonary and Critical Care Medicine (Dr Wunderink), Northwestern University Feinberg School of Medicine, Chicago, IL.

Background

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has been documented to cause community-acquired pneumonias (CAP), notable for necrotizing features. The frequency of occurrence, risk factors, and optimal treatment of CA-MRSA CAP are unclear.

Methods

This was a retrospective analysis of patients admitted to Northwestern Memorial Hospital from January 2005 to April 2007 with initial clinical presentation of pneumonia and respiratory or blood culture positive for CA-MRSA. Definition of CA-MRSA was based on sensitivity to trimethoprim/sulfamethoxazole and clindamycin.

Results

Fifteen patients with CA-MRSA CAP were identified during the 28-month period. Only one of the 14 patients tested had evidence of preceding influenza, and no seasonal pattern was seen. Seven patients were never admitted to the ICU. Eight of 14 with chest CT scans had evidence of lung necrosis. Nine of 15 had evidence of pleural effusions early in their hospital course, and five of nine required at least one pleural drainage procedure. Seven of 15 were immunocompromised (three HIV, one acute lymphocytic leukemia [ALL], one high-dose steroids, and two immunoglobulin deficiency) with an additional three patients with diabetes. Mortality was only 13% (two of 15); both deaths occurred in patients with severe immunocompromise (ALL post chemotherapy and AIDS). Fourteen of 15 patients were treated with antimicrobials that inhibit exotoxin production (clindamycin or linezolid).

Conclusions

CA-MRSA pneumonia is not necessarily a post-influenza infection. Despite necrotizing features in many, the mortality of CA-MRSA pneumonia in our series is lower than previously reported, and patients do not routinely require ICU care. Treatment with antibiotics that inhibit exotoxin production and/or nontoxigenic strains may explain this improved outcome.

abstract

http://chestjournal.chestpubs.org/content/138/1/130.abstract?etoc

July 14, 2010 at 5:49 pm Leave a comment

High Prevalence of Pseudomonas aeruginosa From Oropharyngeal Biofilm in Patients With Cerebrovascular Infarction and Dysphagia

Chest  1 July 2010  V.138  N.1  p.237-238

Katsuhiko Hirota, DDS, PhDTokushima, Japan, Takeyoshi Yoneyama, DDS, PhDShizuoka, Japan, Mayumi Sakamoto, RDH, Hiroshi Miyamoto, MD, Masanori Kurihara, MD, PhDKochi, Japan, Shizuo Kayama, DDS, PhD, Keiji Murakami, DDS, PhD, Hiromichi Yumoto, DDS, PhD, Takashi Matsuo, DDS, PhD and Yoichiro Miyake, DDS, PhDTokushima, Japan

From the Tokushima University Graduate School (Drs Hirota, Kayama, Murakami, Yumoto, Matsuo, and Miyake); the Yoneyama Dental Clinic (Dr Yoneyama); and the Chikamori Rehabilitation Hospital (Ms Sakamoto and Drs Miyamoto and Kurihara).

To the Editor:

Aspiration pneumonia develops after the aspiration of colonized oropharyngeal contents. The elderly or patients with cerebrovascular disease (CVD) are often subjected to aspiration pneumonia because bacteria colonized in the oral cavity and oropharynx easily enter the lung during sleep and usually undergo repeated silent aspiration. Aspiration pneumonia is increasing in patients with dysphagia, and aspiration pneumonia-associated mortality is a most serious problem in elderly patients. Interestingly, it has been reported that oral health care for elderly patients in nursing homes reduces bacterial pneumonia. Therefore, it is very important to determine the characteristics of oropharyngeal microflora in patients with CVD to plan the optimum oral care to prevent aspiration pneumonia….

abstract

http://chestjournal.chestpubs.org/content/138/1/237.full?etoc

July 14, 2010 at 5:47 pm Leave a comment


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