Archive for July 5, 2011

Influenza vaccination is associated with reduced severity of community-acquired pneumonia

European Respiratory Journal July 2011 V.38  N.1 P.147-153

A. Tessmer*, T. Welte#, R. Schmidt-Ott¶, S. Eberle¶, G. Barten+, N. Suttorp* and T. Schaberg§ for the CAPNETZ study groupf

*Dept of Infectious Disease and Respiratory Medicine, Charité-University Medicine, Berlin

#Dept of Pulmonary Medicine, Medical University Hanover

+CAPNETZ Office, Medical University Hanover, Hanover

¶Medical Dept GlaxoSmithKline, Munich

§Dept of Pulmonary Medicine, Diakonie Hospital Rotenburg – Wümme, Rotenburg, Germany

fA full list of the CAPNETZ study group members can be found in the Acknowledgements section

Abstract

Pneumonia is an important cause of influenza-associated morbidity and mortality. Influenza vaccination has been shown to reduce morbidity and mortality during influenza seasons. Protection from severe pneumonia may contribute to the beneficial effect of influenza vaccination. Therefore, we investigated the impact of prior influenza vaccination on disease severity and mortality in patients with community-acquired pneumonia (CAP).

Analysis from an observational, multicentre cohort study initiated by the German competence network for CAP was performed. Patients were analysed separately as an influenza season and off-season cohort. Associations between vaccination status and outcome parameters were evaluated by multivariate analyses.

In the season cohort (2,368 patients) CAP in vaccinated patients was significantly less severe according to most analysed parameters (CURB index ≥1: OR 0.76, 95% CI 0.60–0.98; procalcitonin ≥2.0 ng·mL−1: OR 0.53, 95% CI 0.35–0.81; procalcitonin ≥0.5 ng·mL−1: OR 0.71, 95% CI 0.51–0.99) and these patients showed a significantly better overall survival within the 6-month follow-up period (HR 0.63, 95% CI 0.45–0.89). Within the off-season cohort (2,632 patients) there was no significant influence of vaccination status on CAP severity or disease outcome.

In conclusion, prior influenza vaccination was associated with less severe clinical course and improved overall long-term survival in patients with CAP during influenza seasons.

abstract

http://erj.ersjournals.com/content/38/1/147.abstract?etoc

July 5, 2011 at 5:42 pm Leave a comment

Antitrypanosomal Therapy for Chronic Chagas’ Disease

New Engl J of Med June 30, 2011

Clinical Therapeutics

Caryn Bern, M.D., M.P.H.

A 42-year-old woman presents to her physician with a letter stating that after she made a recent blood donation, a serologic test of her donated blood was positive for Chagas’ disease. The patient was born inEl Salvadorand moved to theUnited Stateswhen she was 18 years of age. Her three children are 8, 13, and 16 years of age. Her medical history is remarkable only for a cholecystectomy 2 years earlier; she reports no cardiac or gastrointestinal symptoms. Her physical examination is unremarkable. Electrocardiography (ECG) shows sinus rhythm at a rate of 72 beats per minute and a complete right bundle-branch block. An echocardiogram shows mild left ventricular segmental wall-motion abnormalities, but a normal ejection fraction and left ventricular diameter. The patient is referred to an infectious-disease consultant, who recommends antitrypanosomal therapy….

FULL TEXT

http://www.nejm.org/doi/full/10.1056/NEJMct1014204

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMct1014204

July 5, 2011 at 5:41 pm Leave a comment

A 30-Year-Old Man with Diarrhea after a Trip to the Dominican Republic

N Engl J of Med June 30, 2011

Case 20-2011 —

Edward T. Ryan, M.D., Lawrence C. Madoff, M.D., and Mary Jane Ferraro, Ph.D., M.P.H.

Presentation of Case

Dr. Stephen M. Carpenter (Infectious Diseases): A 30-year-old man was seen in the emergency room at this hospital in January 2011 because of diarrhea.

The patient had been well 5 days earlier, when he traveled to a resort in theDominican Republicfor a social event. On his fourth day in theDominican Republic, 2 days before this presentation, he flew back to theUnited States, arriving at1 a.m. the day before presentation. Four hours later, he was awakened by the urge to defecate, and he had watery diarrhea. He reported having approximately 12 watery bowel movements during the next 35 hours. He consumed chicken broth and took bismuth solution, without improvement. The night before this presentation, relatives informed him that 13 other attendees of the event had diarrhea. On the day of this presentation, he noted that stool frequency and volume were decreasing. He took a combination of ampicillin and sulbactam (375 mg) orally, which he had obtained inSouth America. He called the Massachusetts Department of Public Health and was referred to the emergency department at this hospital….

FULL TEXT

http://www.nejm.org/doi/full/10.1056/NEJMcpc1100928?query=TOC

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMcpc1100928

 

July 5, 2011 at 5:39 pm Leave a comment

Post-splenectomy and hyposplenic states

Lancet July 02, 2011  V.378 N.9785 P.86 – 97

Review

Antonio Di Sabatino, Rita Carsetti, Gino Roberto Corazza 

Summary

The spleen is crucial in regulating immune homoeostasis through its ability to link innate and adaptive immunity and in protecting against infections. The impairment of splenic function is defined as hyposplenism, an acquired disorder caused by several haematological and immunological diseases. The term asplenia refers to the absence of the spleen, a condition that is rarely congenital and mostly post-surgical. Although hyposplenism and asplenia might predispose individuals to thromboembolic events, in this Review we focus on infectious complications, which are the most widely recognised consequences of these states. Because of the high mortality, the fulminant course, and the refractoriness to common treatment of overwhelming infections caused by encapsulated bacteria, prevention through vaccination and antibiotic prophylaxis is the basis of the management of patients who have had splenectomy or have hyposplenism. In this Review, we critically assess clinical and diagnostic aspects of splenic dysfunction and highlight new perspectives in the prevention of overwhelming post-splenectomy infections.

abstract

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2961493-6/abstract?elsca1=TL-010711&elsca2=email&elsca3=segment

July 5, 2011 at 5:37 pm Leave a comment


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