Archive for October, 2010

Cholera Outbreak – Haiti, October 2010

MMWR Dispatch  October 28, 2010  Volume 59

An outbreak of cholera is ongoing in Haiti. As of October 27, a total of 4,722 cholera cases and 303 deaths had been reported. Most cases have been reported from the Artibonite Department, a rural but densely settled area with several small urban centers. In addition, probable cases have been identified elsewhere in Haiti, including Ouest Department, where the capital city of Port-au-Prince is located. An international public health response, led by the Ministry of Public Health and Population in Haiti and including technical support from the Pan American Health Organization, CDC, and other governmental and nongovernmental organizations, is under way.

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October 31, 2010 at 9:37 pm Leave a comment

Transmission of Hemagglutinin D222G Mutant Strain of Pandemic (H1N1) 2009 Virus

Emerging Infectious Diseases May 2010  V.16  N.5  p.863-865

Simona Puzelli,  Marzia Facchini, Domenico Spagnolo, Maria A. De Marco, Laura Calzoletti, Alessandro Zanetti, Roberto Fumagalli, Maria L. Tanzi, Antonio Cassone, Giovanni Rezza, Isabella Donatelli, and the Surveillance Group for Pandemic A (H1N1) 2009 Influenza Virus in Italy1

National Institute of Health, Rome, Italy (S. Puzelli, M. Facchini, D. Spagnolo, M.A. De Marco, L. Calzoletti, A. Cassone, G. Rezza, I. Donatelli); Università degli Studi di Milano, Milan, Italy (A. Zanetti); Università degli Studi di Milano-Bicocca, Milan (R. Fumagalli); and Università degli Studi di Parma, Parma, Italy (M.L. Tanzi)


A pandemic (H1N1) 2009 virus strain carrying the D222G mutation was identified in a severely ill man and was transmitted to a household contact. Only mild illness developed in the contact, despite his obesity and diabetes. The isolated virus reacted fully with an antiserum against the pandemic vaccine strain.

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October 31, 2010 at 9:36 pm Leave a comment

Possible Transmission of Pandemic (HIN1) 2009 Virus with Oseltamivir Resistance

Emerging Infectious Diseases May 2010  V.16  N.5  p.873


Michal Mandelboim,  Musa Hindiyeh, Tal Meningher, and Ella Mendelson

Chaim Sheba Medical Center, Ramat-Gan, Israel (M. Mandelboim, M. Hindiyeh, T. Meningher, E. Mendelson); Bar-Ilan University, Ramat-Gan (T. Meningher); and Tel-Aviv University, Ramat Aviv, Israel (E. Mendelson)

To the Editor: In March 2009, a new strain of influenza A (H1N1) virus of swine origin emerged; the virus had crossed the species barrier to humans and acquired the capability of human-to-human transmission. Soon after, the World Health Organization raised the worldwide pandemic alert to level 6 (, declaring the first influenza pandemic in the past 42 years. The virus was named influenza A pandemic (H1N1) 2009 virus. The illness caused by this virus is particularly dangerous for pregnant women and for patients with chronic diseases (1). The preferred treatment is a neuraminidase inhibitor, zanamivir or oseltamivir

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October 31, 2010 at 9:34 pm Leave a comment

Co-infection with Dengue Virus and Pandemic (H1N1) 2009 Virus

Emerging Infectious Diseases May 2010  V.16  N.5  p.882-883


Eric Lopez Rodriguez, Kay M. Tomashek,  Christopher J. Gregory, Jorge Munoz, Elizabeth Hunsperger, Olga D. Lorenzi, Jorge Gutierrez Irizarry, and Carlos Garcia-Gubern

Hospital San Lucas/Ponce School of Medicine, Ponce, Puerto Rico, USA (E.L. Rodriguez, J.G. Irizarry, C. Garcia-Gubern); and Centers for Disease Control and Prevention, San Juan, Puerto Rico, USA (K.M. Tomashek, C.J. Gregory, J. Munoz, E. Hunsperger, O.D. Lorenzi)

To the Editor: Dengue is a mosquito-borne viral infection caused by 4 related dengue viruses. Each of these viruses is capable of causing classic dengue fever or dengue hemorrhagic fever (DHF), but may also cause nonspecific febrile illnesses. As a result, dengue is often difficult to diagnose clinically, especially because peak dengue season often coincides with that of other common febrile illnesses in tropical regions (1). Concurrent outbreaks of influenza and dengue have been reported (2,3); this circumstance often leads to delayed recognition of the presence of one or other disease in the community…

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October 31, 2010 at 9:33 pm Leave a comment

Triatoma infestans Bugs in Southern Patagonia, Argentina

Emerging Infectious Diseases May 2010  V.16  N.5  p.887-889


Romina V. Piccinali,  Delmi M. Canale, Alejandra E. Sandoval, Marta V. Cardinal, Oscar Jensen, Uriel Kitron, and Ricardo E. Gürtler

Universidad de Buenos Aires, Buenos Aires, Argentina (R.V. Piccinali, M.V. Cardinal, R.E. Gürtler); Coordinación Nacional de Control de Vectores, Córdoba, Argentina (D.M. Canale); Secretaría de Salud de Chubut, Chubut, Argentina (A.E. Sandoval, O. Jensen); and Emory University, Atlanta, Georgia, USA (U. Kitron)

To the Editor: Triatoma infestans bugs, the main vector of Chagas disease, historically occupied a large area from northeastern Brazil to Chubut Province in Patagonia, Argentina (1). Large-scale insecticide spraying during the 1980s and 1990s reduced its geographic range and abundance and interrupted transmission of Trypanosoma cruzi, mainly in Uruguay, Chile, and Brazil (2). However, T. infestans and transmission of T. cruzi persist in the Gran Chaco, a large ecoregion in Argentina, Bolivia, and Paraguay …

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October 31, 2010 at 9:32 pm Leave a comment

Guideline-concordant therapy and reduced mortality and length of stay in adults with community-acquired pneumonia: playing by the rules.

Arch Intern Med. 14 Sept 2009  V.169  N.16   p.1525-31

Caitlin McCabe, BSc; Cheryl Kirchner, RN, BSN, MS; Huiling Zhang, MD, MPH, MBA; Jennifer Daley, MD, MPH; David N. Fisman, MD, MPH, FRCPC

Research Institute of the Hospital for Sick Children, Toronto, Ontario, Canada (Ms McCabe and Dr Fisman); Division of Clinical Quality, Tenet Healthcare, Dallas, Texas (Ms Kirchner and Dr Zhang); Partners Community Healthcare Inc and the Institute of Health Policy, Massachusetts General Hospital and Partners Healthcare, Harvard Medical School, Boston (Dr Daley); and Department of Epidemiology, Dalla Lana School of Public Health, and Department of Health Policy, Management, and Evaluation, University of Toronto, and Ontario Agency for Health Protection and Promotion, Toronto (Dr Fisman).


Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality worldwide. Clinical practice guidelines for empirical CAP treatment, formulated jointly by the Infectious Diseases Society of America (IDSA) and American Thoracic Society (ATS), remain controversial and inconsistently applied. We evaluated the impact of guideline-concordant therapy on in-hospital survival and other outcomes using a large database including adults treated for CAP in both community and tertiary care hospitals.


We evaluated the association between in-hospital survival and guideline-concordant therapy using logistic regression models. Time until discharge from hospital and discontinuation of parenteral therapy were evaluated using survival analysis.


Of 54 619 non–intensive care unit inpatients with CAP hospitalized at 113 community hospitals and tertiary care centers, 35 477 (65%) received initial guideline-concordant therapy. After adjustment for severity of illness and other confounders, guideline-concordant therapy was associated with decreased in-hospital mortality (odds ratio [OR], 0.70; 95% confidence interval [CI], 0.63-0.77), sepsis (OR, 0.83; 95% CI, 0.72-0.96), and renal failure (OR, 0.79; 95% CI, 0.67-0.94), and reduced both length of stay and duration of parenteral therapy by approximately 0.6 days (P < .001 for both comparisons). These findings were robust with alternate definitions of “concordance” and were linked to treatment with fluoroquinolone or macrolide agents.


Guideline-concordant therapy for CAP is associated with improved health outcomes and diminished resource use in adults. The mechanisms underlying this finding remain speculative and warrant further study, but our findings nonetheless support compliance with CAP clinical practice guidelines as a benchmark of quality of care.



October 27, 2010 at 12:45 pm Leave a comment

Update in Pulmonary and Critical Care Medicine

Annals of Internal Medicine 4 May 2010 V.152 N.9 p.601-608

Anthony F. Suffredini, MD; Henry Masur, MD; and Joseph P. Lynch III, MD

This article summarizes studies published in 2009 that have important implications for the practice of pulmonary and critical care medicine….


October 27, 2010 at 12:09 pm Leave a comment

An International Prospective Study of Pneumococcal Bacteremia: Correlation with In Vitro Resistance, Antibiotics Administered, and Clinical Outcome

Clinical Infectious Diseases 15 July 2003  V.37 N.2 p.230-237

Victor L. Yu,1 Christine C. C. Chiou,5 Charles Feldman,8 Ake Ortqvist,10 Jordi Rello,11 Arthur J. Morris,15 Larry M. Baddour,2 Carlos M. Luna,13 David R. Snydman,3 Margaret Ip,7 Wen Chien Ko,6 M. Bernadete F. Chedid,14 Antoine Andremont,12 and Keith P. Klugman,4,9 for the International Pneumococcal Study Group

1Division of Infectious Disease, University of Pittsburgh, Pennsylvania; 2Mayo Clinic, Rochester, Minnesota; 3Division of Geographic Medicine and Infectious Diseases, Tufts–New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts; 4Department of International Health, Rollins School of Public Health, Emory University, Atlanta, Georgia; 5Department of Pediatrics, Veterans General Hospital–Kaohsiung, National Yang Ming University, Taipei, and 6Division of Infectious Diseases, National Cheng Kung University Hospital, Tainan, Taiwan; 7Department of Microbiology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong; 8Pulmonology Division, Department of Medicine, Johannesburg Hospital and University of the Witwaterstrand, and 9Wits/Medical Research Council/National Health Laboratory Service Respiratory and Meningeal Pathogens Research Unit, Johannesburg, South Africa; 10Unit of Infectious Diseases, Department of Communicable Diseases and Prevention, Karolinska Institute, Karolinska Hospital, Department of Communicable Diseases and Prevention, Stockholm, Sweden; 11University Hospital Joan XXIII, University Rovira and Virgili, Tarragona, Spain; 12Laboratorie de Bacteriologie, Hopital Bichat–Claude Bernard AP‐HP, Paris, France; 13Division of Pulmonary Medicine, Hospital de Clinicas, Universidad de Buenos Aires, Buenos Aires, Argentina; 14Postgraduate Program in Pulmonology, Federal University of Rio Grande do Sol, Hospital de Clinicas de Porto Alegre, Brazil; and 15Clinical Microbiology Laboratory, Auckland Hospital, Auckland, New Zealand

We performed a prospective, international, observational study of 844 hospitalized patients with blood cultures positive for Streptococcus pneumoniae. Fifteen percent of isolates had in vitro intermediate susceptibility to penicillin (minimum inhibitory concentration [MIC], 0.12–1 μg/mL), and 9.6% of isolates were resistant (MIC, 2 μg/mL). Age, severity of illness, and underlying disease with immunosuppression were significantly associated with mortality; penicillin resistance was not a risk factor for mortality. The impact of concordant antibiotic therapy (i.e., receipt of a single antibiotic with in vitro activity against S. pneumoniae) versus discordant therapy (inactive in vitro) on mortality was assessed at 14 days. Discordant therapy with penicillins, cefotaxime, and ceftriaxone (but not cefuroxime) did not result in a higher mortality rate. Similarly, time required for defervescence and frequency of suppurative complications were not associated with concordance of β-lactam antibiotic therapy. β-Lactam antibiotics should still be useful for treatment of pneumococcal infections that do not involve cerebrospinal fluid, regardless of in vitro susceptibility, as determined by current NCCLS breakpoints.



October 27, 2010 at 12:06 pm Leave a comment

Sexually Transmitted Diseases Treatment Guidelines, 2006

MMW Report Recommendations and Reports Aug 4, 2006  V.55  N. RR-11  p.1-100

Department of health and human services – Centers for Disease Control and Prevention (CDC)


October 26, 2010 at 3:31 pm Leave a comment

Pielonefritis enfisematosa aguda bilateral.

Medicina 05/2007  V.67  p.282-284

Un desafío terapéutico


1Unidad de Internación del Departamento de Medicina, 2División Terapia Intensiva, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires


La pielonefritis enfisematosa es una forma poco común de infección renal, caracterizada por la presencia de bacterias coliformes productoras de gas que afecta preferentemente a los pacientes diabéticos. Comunicamos el caso de una mujer diabética de 57 años de edad que ingresó en el hospital por un shock séptico, signos de pielonefritis enfisematosa aguda bilateral y cetoacidosis diabética. En los cultivos de las muestras de orina y sangre desarrolló Escherichia coli. La paciente fue tratada exitosamente con antibióticos de amplio espectro por un tiempo prolongado, control diabético y medidas de sostén solamente. No fue necesario el drenaje con catéteres o la nefrectomía para superar esta situación potencialmente letal.


October 26, 2010 at 12:12 pm Leave a comment

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