Archive for November, 2011

Vital Signs: HIV Prevention Through Care and Treatment — United States

MMWR November 29, 2011 Early Release V.60 Early Release P.1-6

Improving survival of persons with HIV and reducing transmission involve a continuum of services that includes HIV testing, linkage to and retention in HIV medical care, and ongoing HIV prevention interventions, including appropriately timed antiretroviral therapy (ART). CDC used three surveillance datasets to estimate recent HIV testing and HIV prevalence among U.S. adults by state, and the percentages of HIV-infected adults receiving HIV care for whom ART was prescribed, who achieved viral suppression, and who received prevention counseling from health-care providers. This report summarizes the results of those efforts.


An estimated 1.2 million persons in theUnited Stateswere living with human immunodeficiency virus (HIV) infection in 2008. Improving survival of persons with HIV and reducing transmission involve a continuum of services that includes diagnosis (HIV testing), linkage to and retention in HIV medical care, and ongoing HIV prevention interventions, including appropriately timed antiretroviral therapy (ART).


CDC used three surveillance datasets to estimate recent HIV testing and HIV prevalence among U.S. adults by state, and the percentages of HIV-infected adults receiving HIV care for whom ART was prescribed, who achieved viral suppression, and who received prevention counseling from health-care providers. Published data were used to estimate the numbers of persons in theUnited Statesliving with and diagnosed with HIV and, based on viral load and CD4 laboratory reports, linked to and retained in HIV care.


In 2010, 9.6% of adults had been tested for HIV during the preceding 12 months (range by state: 4.9%–29.8%). Of the estimated 942,000 persons with HIV who were aware of their infection, approximately 77% were linked to care, and 51% remained in care. Among HIV-infected adults in care, 45% received prevention counseling, and 89% were prescribed ART, of whom 77% had viral suppression. Thus, an estimated 28% of all HIV-infected persons in theUnited Stateshave a suppressed viral load.


Prevalence of HIV testing and linkage to care are high but warrant continued effort. Increasing the percentages of HIV-infected persons who remain in HIV care, achieve viral suppression, and receive prevention counseling requires additional effort.

Implications for Public Health Practice

Public health officials and HIV care providers should improve engagement at each step in the continuum of HIV care and monitor progress in every community using laboratory reports of viral load and CD4 test results.


November 30, 2011 at 4:12 pm Leave a comment

Comparison of the early fungicidal activity of high-dose fluconazole, voriconazole, and flucytosine as second-line drugs given in combination with amphotericin B for the treatment of HIV-associated cryptococcal meningitis.

Clin Infect Dis 2011 Nov 3

Angela Loyse1,2,3,4, Douglas Wilson3, Graeme Meintjes1,5,6, Joseph N. Jarvis4, Tihana Bicanic4, Leesa Bishop3, Kevin Rebe1,5, Anthony Williams1, Shabbar Jaffar7, Linda-Gail Bekker2, Robin Wood2, and Thomas S Harrison4

1Infectious Diseases Unit, GF Jooste Hospital, Cape Town

2Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town

3Department of Medicine, Edendale Hospital, Pietermaritzburg, South Africa

4International Health Group, Research Centre for Infection and Immunity, Division of Clinical Sciences, St. George’s University of London, United Kingdom

5Division of Infectious Diseases and HIV Medicine, Department of Medicine, and

6Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, South Africa

7Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom


HIV-associated cryptococcal meningitis is associated with an estimated 600 000 deaths worldwide per year. Current standard initial therapy consists of amphotericin B (AmB) plus flucytosine (5-FC), but 5-FC remains largely unavailable in Asia andAfrica. Alternative, more widely available, and/or more effective antifungal combination treatment regimens are urgently needed.


Eighty HIV-seropositive, antiretroviral naive patients presenting with cryptococcal meningitis were randomized to 4 treatment arms of 2 weeks duration: group 1, AmB (0.7–1 mg/kg) and 5-FC (25 mg/kg 4 times daily); group 2, AmB (0.7–1 mg/kg) and fluconazole (800 mg daily); group 3, AmB (0.7–1 mg/kg) and fluconazole (600 mg twice daily); and group 4, AmB (0.7–1 mg/kg) and voriconazole (300 mg twice daily). The primary end point was the rate of clearance of infection from the cerebrospinal fluid (CSF) or early fungicidal activity (EFA), as determined by results of serial, quantitative CSF cryptococcal cultures.


There were no statistically significant differences in the rate of clearance of cryptococcal colony-forming units (CFU) in CSF samples among the 4 treatment groups; the mean (±standard deviation) EFA for treatment groups 1, 2, 3, and 4 were −0.41 ± 0.22 log CFU/mL CSF/day, −0.38 ± 0.18 log CFU/mL CSF/day, −0.41 ± 0.35 log CFU/mL CSF/day, and −0.44 ± 0.20 log CFU/mL CSF/day, respectively. Overall mortality was 12% (9 of 78 patients died) at 2 weeks and 29% (22 of 75 patients died) at 10 weeks, with no statistically significant differences among groups. There were few laboratory abnormalities related to the second agents given; in particular, there were no statistically significant (≥grade 3) increases in alanine transaminase level or decreases in neutrophil count.


There was no statistically significant difference in EFA between AmB in combination with fluconazole and AmB plus 5-FC for the treatment of HIV-associated cryptococcal meningitis. AmB plus fluconazole (800–1200 mg/day) represents an immediately implementable alternative to AmB plus 5-FC. AmB plus voriconazole is an effective alternative combination in patients not receiving interacting medications.


November 30, 2011 at 4:10 pm Leave a comment

Bacteremia Caused by Group G Streptococci, Taiwan

Emerging Infectious Diseases May 2008 V.14 N.5 P.837-

Chun-Hsing Liao*, Liang-Chun Liu†, Yu-Tsung Huang†, Lee-Jeng Teng†, and Po-Ren Hsueh†

*Far-Eastern Memorial Hospital, Taipei, Taiwan; †National Taiwan University College of Medicine, Taipei, Taiwan

A retrospective observational study inTaiwan, 1998–2004, identified 92 patients with group G streptococcal bacteremia; 86 had Streptococcus dysgalactiae subspecies equisimilis. The most common diagnosis was cellulitis (48 cases), followed by primary bacteremia (34 cases). Infection recurred in 9 patients. Mortality rate was low (3.3%); resistance to quinupristin-dalfopristin was high.




November 25, 2011 at 11:36 pm Leave a comment

Enteroaggregative E. coli O104 from an outbreak of HUS in Germany 2011, could it happen again?

J Infect Dev Ctries. 2011 Jul 4 V.5 N.6 P.425-36.

Chattaway MA, Dallman T, Okeke IN, Wain J.


Laboratory of Gastrointestinal Pathogens, Health Protection Agency, London, England.


Enterohaemorrhagic E. coli (EHEC) particularly O157:H7 (Sequence type 11 complex), is the best documented and most well-known of E. coli that cause diarrhoea. The importance of EHEC lies in the severity of disease. Outbreaks can infect thousands of people causing bloody diarrhoea and haemolytic uremic syndrome (HUS) that in turn can result in protracted illness or even death. The ability of EHEC to colonise the human gut is normally associated with the presence of genes from another group of diarrhoeagenic E. coli, the enteropathogenic E. coli (EPEC), via the locus of enterocyte effacement. However, the massive outbreak inGermanywas caused by an EHEC which had acquired virulence genes from yet another group of diarrhoeagenic E. coli, the enteroaggregative E. coli (EAEC). In reality EAEC is probably the most common bacterial cause of diarrhoea but is not identified in most diagnostic laboratories. This outbreak emphasises the importance of being able to detect all diarrhoeagenic E. coli and not to focus on E. coli O157:H7 alone. Routine surveillance systems for EAEC, a once ignored global pathogen, would go a long way to reaching this goal. This review describes methods for identifying non-O157 EHEC and describes the key genetic features of EHEC and EAEC. Our aim is to provide information for laboratories and policy makers which enables them to make informed decisions about the best methods available for detecting newly emergent strains of diarrhoeagenic E. coli.



November 25, 2011 at 11:33 pm Leave a comment

Fluorescent homogeneous immunosensors for detecting pathogenic bacteria.

Anal Biochem. 2010 Jan 15 V.396 N.2 P.:298-303.

Heyduk E, Heyduk T.


Edward A. Doisy Department of Biochemistry and Molecular Biology, St. Louis University Medical School, 1100 S. Grand Boulevard, St. Louis, MO 63104, USA.


We developed a straightforward antibody-based assay for rapid homogeneous detection of bacteria. Our sensors utilize antibody recognizing cell-surface epitopes of the target cell. Two samples of the antibody are prepared, each labeled via nanometer size flexible linkers with short complementary oligonucleotides that are modified with fluorochromes that could participate in fluorescence resonance energy transfer (FRET). The length of the complementary oligonucleotide sequences was designed such that very little annealing occurred in the absence of the target cells. In the presence of the target cells the two labeled antibodies bind to the surface of the cell resulting in a large local concentration of the complementary oligonucleotides that are attached to the antibody. This in turn drives the annealing of the complementary oligonucleotides which brings the fluorescence probes to close proximity producing large FRET signals proportional to the amount of target cells. Long flexible linkers used to attach the oligonucleotides to the antibody enable target-induced oligonucleotide annealing even if the density of surface antigens is only modest. We used Escherichia coli 0157:H7 and Salmonella typhimurium to demonstrate that this design produced sensors exhibiting rapid response time, high specificity, and sensitivity in detecting the target bacteria.



November 25, 2011 at 11:32 pm Leave a comment

Escherichia coli 0157 enterohaemorrhagic colitis associated with pyelonephritis: CT findings.

Br J Radiol. 2009 Apr V.82 N.976 P.63-6.

Heffernan E, Chatur N, Zwirewich C.

Department of Radiology, Vancouver General Hospital, Jim Pattison Pavillion South, 899 West 12th Avenue, Vancouver, BC V5Z1M9, Canada.


Escherichia coli 0157:H7 is increasingly being recognized as a cause of infectious colitis, which typically results in bloody diarrhoea in an afebrile patient. The absence of fever often means that an infectious process is not considered in the differential diagnosis, particularly as this organism will not be detected in routine stool cultures. Inappropriate antibiotic therapy may increase the risk of development of haemolytic uraemic syndrome, a potentially fatal complication of this form of colitis, hence the importance of accurate diagnosis. On CT, it is characterized by severe diffuse colonic wall thickening, with little or no pericolic inflammatory changes. The radiologist may be the first to suspect the correct diagnosis and so should be aware of its imaging appearances. We report the case of a 19-year-old man who presented with typical radiological findings of enterohaemorrhagic colitis and whose CT also showed evidence of acute pyelonephritis; we suggest that this combination of abnormalities should further heighten radiologists’ suspicions of infection due to E. coli 0157:H7, despite the absence of fever.



November 25, 2011 at 11:30 pm Leave a comment

Escherichia coli 0157:H7 infections in children associated with raw milk and raw colostrum from cows–California, 2006.

MMWR Morb Mortal Wkly Rep. 2008 Jun 13 V.57 N.23 P.625-8.

Centers for Disease Control and Prevention (CDC).

California Dept of Public Health, USA.


On September 18, 2006, the California Department of Public Health (CDPH) was notified of two children hospitalized with hemolytic uremic syndrome (HUS). One of the patients had culture-confirmed Escherichia coli O157:H7 infection, and both patients had consumed raw (unpasteurized) cow milk in the week before illness onset. Four additional cases of E. coli O157:H7 infection in children who had consumed raw cow milk or raw cow colostrum produced by the same dairy were identified during the following 3 weeks. InCalifornia, intrastate sale of raw milk and raw colostrum is legal and regulated. This report summarizes the investigation of these cases by CDPH, the California Department of Food and Agriculture (CDFA), and four local health departments and subsequent actions to prevent illnesses. As a result of this and other outbreaks,Californiaenacted legislation (AB 1735), which took effect January 1, 2008, setting a limit of 10 coliforms/mL for raw milk sold to consumers. Raw milk in several forms, including colostrum, remains a vehicle of serious enteric infections, even if the sale of raw milk is regulated.


November 25, 2011 at 11:28 pm Leave a comment

Shiga toxin of enterohemorrhagic Escherichia coli type O157:H7 promotes intestinal colonization.

Proc Natl Acad Sci U S A. 2006 Jun 20 V.103 N.25 P.9667-72.

Robinson CM, Sinclair JF, Smith MJ, O’Brien AD.

Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4799, USA.


Enterohemorrhagic Escherichia coli (EHEC) 0157:H7 is a food-borne pathogen that can cause bloody diarrhea and, occasionally, acute renal failure as a consequence of Shiga toxin (Stx) production by the organism. Stxs are potent cytotoxins that are lethal to animals at low doses. Thus, Stxs not only harm the host but, as reported here, also significantly enhance the capacity of EHEC O157:H7 to adhere to epithelial cells and to colonize the intestines of mice. Tissue culture experiments showed that this toxin-mediated increase in bacterial adherence correlated with an Stx-evoked increase in a eukaryotic receptor for the EHEC O157:H7 attachment factor intimin.



November 25, 2011 at 11:26 pm Leave a comment

Limited Human-to-Human Transmission of Novel Influenza A (H3N2) Virus — Iowa, November 2011

MMWR Dispatch Nov. 23, 2011 V.60 P.1-3

On November 20, 2011, CDC confirmed three cases of swine-origin triple reassortant influenza A (H3N2) (S-OtrH3N2) virus infection in children in two counties inIowa. None of the children were hospitalized, and each has recovered from a mild episode of febrile respiratory illness. All three were in contact with one another, and none had a known recent exposure to swine. No additional human infections with this virus have been detected inIowa, and no evidence of sustained human-to-human transmission of this S-OtrH3N2 virus exists; surveillance is ongoing.



November 24, 2011 at 11:49 am Leave a comment

Immunization of Health-Care Personnel

MMWR RR  Nov.25, 2011  V.60 RR.7 1-45

Recommendations of the Advisory Committee on Immunization Practices (ACIP)   

This report updates the previously published summary of recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC) for vaccinating health-care personnel (HCP) in theUnited States. This report summarizes all current ACIP recommendations for vaccination of HCP and does not contain any new recommendations or policies. The recommendations provided in this report apply, but are not limited, to HCP in acute-care hospitals; long-term–care facilities (e.g., nursing homes and skilled nursing facilities); physician’s offices; rehabilitation centers; urgent care centers, and outpatient clinics as well as to persons who provide home health care and emergency medical services.



November 24, 2011 at 11:47 am Leave a comment

Older Posts


November 2011

Posts by Month

Posts by Category