Archive for February, 2012

Recurrent Guillain-Barré Syndrome Following Vaccination

Clin Infect Dis March 2012 V.54 N.6 P.800-804

Roger Baxter1, Ned Lewis1, Nandini Bakshi2, Claudia Vellozzi3, Nicola P. Klein1, and the CISA Network

1Kaiser Permanente Vaccine Study Center

2The Permanente Medical Group, Oakland, California

3Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia

Background.

Guillain-Barré syndrome (GBS) is an acute polyradiculopathy, thought to be autoimmune, which has been reported following vaccinations. The Advisory Committee on Immunization Practices recommends not administering influenza vaccine to individuals who have had a history of GBS within 6 weeks of a prior influenza vaccination if they are not at high risk of severe complications from influenza illness.

Methods.

We identified GBS cases from the Kaiser Permanente Northern California databases from 1995 into 2006 using hospital discharge codes; each medical record was neurologist-reviewed and only GBS-confirmed cases were included for follow-up. We followed confirmed cases through 2008 for vaccinations and recurrent GBS.

Results.

We identified 550 cases of GBS over 33 million person-years. Following their GBS diagnoses, 989 vaccines were given to 279 of these individuals, including 405 trivalent inactivated influenza vaccines (TIV) administered to 107 individuals with a prior diagnosis of GBS. Among the 550 total cases of GBS, 18 initially had onset within 6 weeks of TIV; of these, 2 were revaccinated with TIV without a recurrence of GBS. Only 6 individuals of 550 (1.1%) had a second (recurrent) diagnosis of GBS. Among these 6 individuals, none had any vaccine exposure at all in the 2 months prior to the second onset of GBS.

Conclusions.

In our population of over 3 million members, during an 11-year period, risk of GBS recurrence was low. There were no cases of recurrent GBS after influenza vaccination and none within 6 weeks after any vaccine.

PDF

http://cid.oxfordjournals.org/content/54/6/800.full.pdf+html

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February 29, 2012 at 12:22 pm Leave a comment

Systemic Antibiotic Therapy for Chronic Osteomyelitis in Adults

Clin Infect Dis Feb 2012 V.54 N.3 P.393-407

Ellie J. C. Goldstein, Section Editor

Brad Spellberg1,2 and Benjamin A. Lipsky3,4

1Division of General Internal Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance

2David Geffen School of Medicine at UCLA, Los Angeles, California

3VA Puget Sound Health Care System

4University of Washington, Seattle

Abstract

The standard recommendation for treating chronic osteomyelitis is 6 weeks of parenteral antibiotic therapy. However, oral antibiotics are available that achieve adequate levels in bone, and there are now more published studies of oral than parenteral antibiotic therapy for patients with chronic osteomyelitis. Oral and parenteral therapies achieve similar cure rates; however, oral therapy avoids risks associated with intravenous catheters and is generally less expensive, making it a reasonable choice for osteomyelitis caused by susceptible organisms. Addition of adjunctive rifampin to other antibiotics may improve cure rates. The optimal duration of therapy for chronic osteomyelitis remains uncertain. There is no evidence that antibiotic therapy for >4–6 weeks improves outcomes compared with shorter regimens. In view of concerns about encouraging antibiotic resistance to unnecessarily prolonged treatment, defining the optimal route and duration of antibiotic therapy and the role of surgical debridement in treating chronic osteomyelitis are important, unmet needs.

PDF

http://cid.oxfordjournals.org/content/54/3/393.full.pdf+html

February 29, 2012 at 12:18 pm Leave a comment

Hospital-acquired infections due to gram-negative bacteria.

N Engl J Med. 2010 May 13 V.362 N.19 P.1804-13.

Peleg AY, Hooper DC.

Source

Division of Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. apeleg@bidmc.harvard.edu

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3107499/pdf/nihms296483.pdf

Comment in

N Engl J Med. 2010 Oct 7;363(15):1482; author reply 1483-4.

http://www.nejm.org/doi/pdf/10.1056/NEJMc1006641

 

February 27, 2012 at 4:33 pm Leave a comment

Burkholderia cepacia complex: beyond pseudomonas and acinetobacter.

Indian J Med Microbiol. 2011 Jan-Mar V.29 N.1 P.4-12.

 

Gautam V, Singhal L, Ray P.

 

Source

Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. r_vg@yahoo.co.uk

 

Abstract

Burkholderia cepacia complex (BCC) is an important nosocomial pathogen in hospitalised patients, particularly those with prior broad-spectrum antibacterial therapy. BCC causes infections that include bacteraemia, urinary tract infection, septic arthritis, peritonitis and respiratory tract infection. Due to high intrinsic resistance and being one of the most antimicrobial-resistant organisms encountered in the clinical laboratory, these infections can prove very difficult to treat and, in some cases, result in death. Patients with cystic fibrosis (CF) and those with chronic granulomatous disease are predisposed to infection by BCC bacteria. BCC survives and multiplies in aqueous hospital environments, including disinfectant agents and intravenous fluids, where it may persist for long periods. Outbreaks and pseudo-outbreaks of BCC septicaemia have been documented in intensive care units, oncology units and renal failure patients. BCC is phenotypically unremarkable, and the complex exhibits an extensive diversity of genotypes. BCC is of increasing importance for agriculture and bioremediation because of their antinematodal and antifungal properties as well as their capability to degrade a wide range of toxic compounds. It has always been a tedious task for a routine microbiological laboratory to identify the nonfermenting gram-negative bacilli, and poor laboratory proficiency in identification of this nonfermenter worldwide still prevails. In India, there are no precise reports of the prevalence of BCC infection, and in most cases, these bacteria have been ambiguously reported as nonfermenting gram-negative bacilli or simply Pseudomonas spp. The International Burkholderia cepacia Working Group is open to clinicians and scientists interested in advancing knowledge of BCC infection/colonisation in persons with CF through the collegial exchange of information and promotion of coordinated approaches to research.

 

FULL TEXT

http://www.ijmm.org/article.asp?issn=0255-0857;year=2011;volume=29;issue=1;spage=4;epage=12;aulast=Gautam

 

February 27, 2012 at 4:31 pm Leave a comment

Isolation of Staphylococcus aureus from the urinary tract: association of isolation with symptomatic urinary tract infection and subsequent staphylococcal bacteremia.

Clin Infect Dis. 2006 Jan 1 V.42 N.1 P.46-50.

Muder RR, Brennen C, Rihs JD, Wagener MM, Obman A, Stout JE, Yu VL.

Source

Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA.Robert.Muder@med.va.gov

Abstract

BACKGROUND:

Staphylococcus aureus is frequently isolated from urine samples obtained from long-term care patients. The significance of staphylococcal bacteriuria is uncertain. We hypothesized that S. aureus is a urinary pathogen and that colonized urine could be a source of future staphylococcal infection.

METHODS:

We performed a cohort study of 102 patients at a long-term care Veterans Affairs facility for whom S. aureus had been isolated from clinical urine culture. Patients were observed via urine and nasal cultures that were performed every 2 months. We determined the occurrence of (1) symptomatic urinary tract infection concurrent with isolation of S. aureus (by predetermined criteria), (2) staphylococcal bacteremia concomitant with isolation of S. aureus from urine, and (3) subsequent episodes of staphylococcal infection.

RESULTS:

Of 102 patients, 82% had undergone recent urinary catheterization. Thirty-three percent of patients had symptomatic urinary tract infection at the time of initial isolation of S. aureus, and 13% were bacteremic. Eight-six percent of the initial urine isolates were methicillin-resistant S. aureus. Seventy-one patients had follow-up culture data; 58% of cultures were positive for S. aureus at > or =2 months (median duration of staphylococcal bacteriuria, 4.3 months). Sixteen patients had subsequent staphylococcal infections, occurring up to 12 months after initial isolation of S. aureus; 8 late-onset infections were bacteremic. In 5 of 8 patients, the late blood isolate was found to have matched the initial urine isolate by pulsed-field gel electrophoresis typing.

CONCLUSIONS:

S. aureus is a cause of urinary tract infection among patients with urinary tract catheterization. The majority of isolates are methicillin-resistant S. aureus. S. aureus bacteriuria can lead to subsequent invasive infection. The efficacy of antistaphylococcal therapy in preventing late-onset staphylococcal infection in patients with persistent staphylococcal bacteriuria should be tested in controlled trials.

PDF

http://cid.oxfordjournals.org/content/42/1/46.full.pdf+html

February 27, 2012 at 4:28 pm Leave a comment

Application of TaqMan low-density arrays for simultaneous detection of multiple respiratory pathogens.

J Clin Microbiol. 2011 Jun V.49 N.6 P.2175-82.

Kodani M, Yang G, Conklin LM, Travis TC, Whitney CG, Anderson LJ, Schrag SJ, Taylor TH Jr, Beall BW, Breiman RF, Feikin DR, Njenga MK, Mayer LW, Oberste MS, Tondella ML, Winchell JM, Lindstrom SL, Erdman DD, Fields BS.

Source

Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. MKodani@cdc.gov

Abstract

The large and growing number of viral and bacterial pathogens responsible for respiratory infections poses a challenge for laboratories seeking to provide rapid and comprehensive pathogen identification. We evaluated a novel application of the TaqMan low-density array (TLDA) cards for real-time PCR detection of 21 respiratory-pathogen targets. The performance of the TLDA was compared to that of individual real-time PCR (IRTP) assays with the same primers and probes using (i) nucleic acids extracted from the 21 pathogen strains and 66 closely related viruses and bacteria and (ii) 292 clinical respiratory specimens. With spiked samples, TLDA cards were about 10-fold less sensitive than IRTP assays. By using 292 clinical specimens to generate 2,238 paired individual assays, the TLDA card exhibited 89% sensitivity (95% confidence interval [CI], 86 to 92%; range per target, 47 to 100%) and 98% specificity (95% CI, 97 to 99%; range per target, 85 to 100%) overall compared to IRTP assays as the gold standard with a threshold cycle (C(T)) cutoff of 43. The TLDA card approach offers promise for rapid and simultaneous identification of multiple respiratory pathogens for outbreak investigations and disease surveillance.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3122721/pdf/zjm2175.pdf

February 27, 2012 at 4:25 pm Leave a comment

Role of Chlamydia pneumoniae in atherosclerosis.

Clin Sci (Lond). 2008 Apr V.114 N.8 P.509-31.

Watson C, Alp NJ.

Source

Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK.

Abstract

Cardiovascular disease, resulting from atherosclerosis, is a leading cause of global morbidity and mortality. Genetic predisposition and classical environmental risk factors explain much of the attributable risk for cardiovascular events in populations, but other risk factors for the development and progression of atherosclerosis, which can be identified and modified, may be important therapeutic targets. Infectious agents, such as Chlamydia pneumoniae, have been proposed as contributory factors in the pathogenesis of atherosclerosis. In the present review, we consider the experimental evidence that has accumulated over the last 20 years evaluating the role of C. pneumoniae in atherosclerosis and suggest areas for future research in this field.

PDF

http://www.clinsci.org/cs/114/0509/1140509.pdf

February 27, 2012 at 4:23 pm Leave a comment

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