Archive for August, 2011

Immune Reconstitution Syndrome and Exacerbation of Infections after Pregnancy

CID Nov.1, 2007  V.45 N.9 P.1192-1199

Nina Singh1,2 and John R. Perfect3

1Veterans Affairs Medical Center, Pittsburgh, Pennsylvania

2University of Pittsburgh, Pittsburgh, Pennsylvania

3Duke University, Durham,  North Carolina


Pregnancy is a state of subtle immunosuppression characterized by physiologic suppression of proinflammatory host responses that are meant to promote embryonic implantation. Rapid reversal of these changes and a rebound of inflammatory responses during the postpartum period can result in quiescent or latent infection manifesting as symptomatic disease. Infections due to several microbial pathogens and noninfectious diseases with an autoimmune basis have been shown to worsen or begin during the postpartum period. Awareness that symptoms resulting from immune reconstitution can occur in any host with a rapidly changing immunologic repertoire, including women in the postpartum phase, is a critical first step in fully understanding this phenomenon. Future studies to discern the precise pathophysiologic basis of immune reconstitution, to identify pregnant women at risk, and to determine markers that may be diagnostically helpful have significant implications for optimizing treatment of these patients.



August 29, 2011 at 6:49 pm Leave a comment

Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2011

MMWR Aug.18, 2011 V.60 N.30 P.1128-1132 Early Release

This document provides updated guidance for the use of influenza vaccines in the United States for the 2011–12 influenza season. Vaccination of all persons aged ≥6 months continues to be recommended. Although influenza vaccine strains for the 2011–12 season are unchanged from those for the 2010–11 season, annual vaccination is recommended even for those who received the vaccine for the previous season. For issues related to influenza vaccination that are not addressed in this update, refer to the 2010 ACIP statement on prevention and control of influenza with vaccines and associated updates.

Full Text

August 27, 2011 at 9:40 pm Leave a comment

HIV: Just another chronic disease

Cleve Clin J Med 1 August 2010  V.77  N.8  p.489

BRIAN F. MANDELL, MD, PhD, Editor-in-Chief

He was about 30 years old, appearing ill although not gaunt, wearing an oxygen mask and nice pajamas, and breathing hard, in a corner room of the Silverstein Pavilion at theUniversityofPennsylvania. We were on resident morning rounds; it was maybe 1981. His partner was holding his hand; both sets of parents were standing between the bed and the window. We had no clue what was going on, why he had pulmonary hypertension, thrombocytopenia, fevers, and more. We did not know human immunodeficiency virus (HIV), the agent that would shortly be the cause of his death …



August 27, 2011 at 5:26 pm Leave a comment

Efficacy and safety of tigecycline: a systematic review and meta-analysis

Journal of Antimicrobial Chemotherapy Sept 2011 V.66 N.9 P.1963-1971

Dafna Yahav1,2,*, Adi Lador1,2, Mical Paul2,3 and Leonard Leibovici1,2

1Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Israel

2Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel

3Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Israel



Tigecycline is a novel glycylcycline that exhibits broad-spectrum antibacterial activity. Recently, the US FDA issued a warning concerning increased mortality with tigecycline in randomized controlled trials (RCTs).


We conducted a systematic review and meta-analysis of RCTs that compared tigecycline with any other antibiotic regimen for the treatment of any infection. A comprehensive search, without publication status or other restrictions, was conducted. The primary outcome was overall 30 day mortality. The secondary outcome included clinical and microbiological failure, superinfections and adverse events (AEs). The trials’ risks of bias and their effects on results were assessed. Two reviewers independently extracted the data. Individual trials’ relative risks (RRs) were pooled using a fixed effect meta-analysis.


Fifteen trials (7654 patients) were included. Overall mortality was higher with tigecycline compared with other regimens [RR 1.29, 95% confidence interval (CI) 1.02–1.64, without heterogeneity]. The type of infection assessed and the trials’ reported risks of bias did not affect this result. Clinical failure was significantly higher with tigecycline (RR 1.16, 95% CI 1.06–1.27) and non-statistically significant higher rates of microbiological failure were demonstrated (RR 1.13, 95% CI 0.99–1.30). Development of septic shock was significantly more frequent with tigecycline (RR 7.01, 95% CI 1.27–38.66). Superinfections were significantly more common with tigecycline and so were AEs, including all AEs and AEs requiring discontinuation.


In the light of the increased mortality, probably explained by decreased clinical and microbiological efficacy, clinicians should avoid tigecycline monotherapy in the treatment of severe infections and reserve it as a last-resort drug.


August 27, 2011 at 5:24 pm Leave a comment

Effective antibacterials: at what cost? The economics of antibacterial resistance and its control

Journal of Antimicrobial Chemotherapy Sept 2011 V.66 N.9 P.1948-1953

Anthony R. White* and on behalf of the BSAC Working Party on The Urgent Need: Regenerating Antibacterial Drug Discovery and Development†

Tony White Ltd, Newport, Essex CB11 3RS, UK


The original and successful business model of return on investment being sufficiently attractive to the pharmaceutical industry to encourage development of new antibacterial molecules and related diagnostics has been compromised by increasing development costs and regulatory hurdles, resulting in a decreasing chance of success and financial return. The supply of new effective agents is diminishing along with the number of companies engaged in antibacterial research and development. The BSAC Working Party on The Urgent Need:Regenerating Antibacterial Drug Discovery and Development identified the need to establish, communicate and apply the true health and economic value of antibacterials, along with the adoption of meaningful incentives, as part of the future model for antibacterial development. Robust data are needed on the cost of resistance and ineffective treatment of bacterial infection, along with national and local holistic analyses of the cost–benefit of antibacterials. An understanding of the true health and economic value of antibacterials and the cost of resistance across healthcare systems needs to be generated, communicated and used in order to set a pricing and reimbursement structure that is commensurate with value. The development and economic model of antibacterial use needs to be rebuilt based on this value through dialogue with the various stakeholders, including the pharmaceutical industry, and alternative incentives from ‘push’ to ‘pull’ and funding models, such as public/private partnerships, agreed. A research and development model that succeeds in developing and delivering new antibacterial agents that address the health needs of society from start to finish, ‘from cradle to grave’, must be established.




August 27, 2011 at 5:22 pm Leave a comment

Regulatory opportunities to encourage technology solutions to antibacterial drug resistance

Journal of Antimicrobial Chemotherapy Sept 2011 V.66 N.9 P.1945-1947

Roger Finch* and on behalf of the BSAC Working Party on The Urgent Need: Regenerating Antibacterial Drug Discovery and Development†

Nottingham University Hospitals, Department of Microbiology and Infectious Diseases, The Clinical Sciences Building, Hucknall Road, Nottingham NG5 1PB, UK


Regulatory agencies play a critical role in the licensing of new antimicrobial agents. To address the pivotal role played by regulatory agencies, particularly in the context of a paucity of new drugs active against bacteria resistant to currently available drugs, the BSAC formed the ‘Urgent Need’ Working Party to address the regeneration of antibacterial drug discovery and development. The Working Party identified a number of issues, including: increased application of pharmacokinetic/pharmacodynamic principles to expedite drug development; the need to prioritize licensing of drugs (including ‘orphan’ drugs) active in life-threatening infections; and expansion of the use of surrogate markers and rapid point of care diagnostics to facilitate drug development.




August 27, 2011 at 5:21 pm Leave a comment

Hepatitis B & hepatitis C in HIV-infection.

Indian J Med Res. 2005 Apr  V.121 N.4 P.424-50.

Kottilil S, Jackson JO, Polis MA.

Laboratory of Immunoregulation, National Institute of Allergy & Infectious Diseases, National Institutes of Health, Building 10, Rm. 11N204, 9000 Wisconsin Avenue, Bethesda, MD 20892, USA.


Human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) are the three most common chronic viral infections seen in the world. All three viruses share modes of transmission and hence co-exist in the same host at significantly high rates. HIV-induced immunosuppression has deleterious effects on the natural history, pathophysiology, diagnosis, therapeutic responses to hepatitis viruses. Responses to HBV vaccination are impaired in persons with HIV infection. Co-infection with the hepatitis viruses and HIV is likely to become a major health care catastrophe in the coming years. This review discusses the current trends in the understanding of the biology of co-infection and implications for treating these viruses effectively.




August 21, 2011 at 3:11 pm Leave a comment

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