Archive for March, 2012

TOXOPLASMOSIS OCULAR

Arch Soc Esp Oftalmol  Madrid oct. 2003  V.78  N.10

Propósito

Realizar una actualización sobre los aspectos más salientes de la toxoplasmosis ocular.

Métodos

En base a publicaciones recientes, reuniones científicas e interpretación de la literatura se intenta clarificar los conceptos sobre distintos aspectos de la toxoplasmosis ocular.

Resultados

Se pone un especial énfasis en la transmisión de la parasitosis y en la enfermedad ocular con sus presentaciones clínicas. Se mencionan además algunas actualizaciones en cuanto al diagnóstico y tratamiento de la enfermedad.

Conclusión

El conocimiento de la epidemiología permitirá limitar la enfermedad ocular y la correcta interpretación permitirá un mejor diagnóstico clínico. Con estos elementos se podrán aplicar las diferentes alternativas de tratamiento que poco han evolucionado en los últimos años.

FULL TEXT

http://scielo.isciii.es/scielo.php?pid=s0365-66912003001000004&script=sci_arttext

March 31, 2012 at 11:55 am Leave a comment

Management of Toxoplasma gondii infection during pregnancy.

Clin Infect Dis. 2008 Aug 15 V.47 N.4 P.554-66.

Montoya JG, Remington JS.

Source

Palo Alto Medical Foundation Toxoplasma Serology Laboratory, Palo Alto, California, USA.

Abstract

Acute infection with Toxoplasma gondii during pregnancy and its potentially tragic outcome for the fetus and newborn continue to occur in theUnited States, as well as worldwide, despite the fact that it can be prevented. The infection can be acquired through ingestion of infected, undercooked meat or contaminated food or water. Transmission to the fetus occurs almost solely in women who acquire their primary infection during gestation and can result in visual and hearing loss, mental and psychomotor retardation, seizures, hematological abnormalities, hepatosplenomegaly, or death. Systematic education and serological screening of pregnant women are the most reliable and currently available strategies for the prevention, diagnosis, and early treatment of the infection in the offspring; this is largely because toxoplasmosis in pregnant women most often goes unrecognized. Treatment of the infection in the fetus and infant during the first year of life has been demonstrated to significantly improve the clinical outcome.

PDF

http://cid.oxfordjournals.org/content/47/4/554.full.pdf+html

 

March 31, 2012 at 11:53 am Leave a comment

Laboratory diagnosis of Toxoplasma gondii infection and toxoplasmosis.

J Infect Dis. 2002 Feb 15 V.185 Suppl 1:S73-82.

Montoya JG.

Source

Department of Immunology and Infectious Diseases, Research Institute, Palo Alto Medical Foundation, Palo Alto, California 94301, USA. gilberto@leland.stanford.edu

Abstract

For the past 40 years, the Toxoplasma Serology Laboratory at the Palo Alto Medical Foundation Research Institute (TSL-PAMFRI) has been dedicated to the laboratory diagnosis of Toxoplasma gondii infection and toxoplasmosis. TSL-PAMFRI is the “brain child” of Jack S. Remington. Jack’s ceaseless devotion to objectivity and uncompromising excellence has made TSL-PAMFRI the Toxoplasma reference laboratory for the Centers for Disease Control and Prevention, the US Food and Drug Administration, and health care providers and clinical laboratories in theUnited Statesand other countries. Jack’s leadership and vision created, defined, and significantly contributed to the development of laboratory methods for the diagnosis of the infection and diseases caused by T. gondii. A summary of the laboratory tests currently available at TSL-PAMFRI for the diagnosis of infection and disease caused by the parasite is presented here.

PDF

http://jid.oxfordjournals.org/content/185/Supplement_1/S73.full.pdf+html

 

March 31, 2012 at 11:51 am Leave a comment

2009 – HIDATIDOSIS – Norma Técnica y Manual de Procedimientos para su control

Ministerio de Salud de la Nación – Rep. Argentina

INDICE

Introducción

Diagnóstico de Situación en Argentina

Objetivo General

Objetivos específicos

Base legal

Normas para Diagnóstico y Vigilancia

Normas de Control

Atención en el hombre

Referencias

Anexos

 

PDF

http://www.msal.gov.ar/images/stories/epidemiologia/pdf/NormasHidatidosis.pdf

March 31, 2012 at 11:49 am Leave a comment

Vancomycin Dosing in Critically Ill Patients: Robust Methods for Improved Continuous-Infusion Regimens

Antimicrobial Agents and Chemotherapy  June 2011 V.55 N.6 P.2704-2709

Jason A. Roberts1,*, Fabio Silvio Taccone2, Andrew A. Udy1, Jean-Louis Vincent2, Frédérique Jacobs3 and Jeffrey Lipman1

1Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia

2Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium

3Department of Infectious Diseases, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium

ABSTRACT

Despite the development of novel antibiotics active against Gram-positive bacteria, vancomycin generally remains the first treatment, although rapidly achieving concentrations associated with maximal efficacy provides an unresolved challenge. The objective of this study was to conduct a population pharmacokinetic analysis of vancomycin in a large population of critically ill patients. This was a retrospective data collection of 206 adult septic critically ill patients who were administered vancomycin as a loading dose followed by continuous infusion. The concentration-versus-time data for vancomycin in serum was analyzed by a nonlinear mixed-effects modeling approach using NONMEM.Monte Carlosimulations were performed using the final covariate model. We found that the best population pharmacokinetic model consisted of a one-compartment linear model with combined proportional and additive residual unknown variability. The volume of distribution of vancomycin (1.5 liters/kg) was described by total body weight and clearance (4.6 liters/h) by 24-hour urinary creatinine clearance (CrCl), normalized to body surface area. Simulation data showed that a 35-mg/kg loading dose was necessary to rapidly achieve vancomycin concentrations of 20 mg/liter. Daily vancomycin requirements were dependent on CrCl, such that a patient with a CrCl of 100 ml/min/1.73 m2 would require at least 35 mg/kg per day by continuous infusion to maintain target concentrations. In conclusion, we have found that higher-than-recommended loading and daily doses of vancomycin seem to be necessary to rapidly achieve therapeutic serum concentrations in these patients.

PDF

http://aac.asm.org/content/55/6/2704.full.pdf+html

 

March 24, 2012 at 9:26 pm Leave a comment

Optimization of Aminoglycoside Therapy

Antimicrobial Agents and Chemotherapy  June 2011 V.55 N.6 P.2528-2531

G. L. Drusano* and Arnold Louie

Ordway Research Institute, 150 New Scotland Avenue, Albany, New York 12208

ABSTRACT

Aminoglycosides are experiencing a resurgence in use because of the spread of multiresistant Gram-negative pathogens. Use of these agents is attended by the occurrence of nephrotoxicity. Aminoglycoside optimization of dose can be defined as the dose having the highest likelihood of a good outcome and the lowest likelihood of toxicity. We have defined the metric Δ as the difference between the likelihoods of good outcome and toxicity, with higher values being better. We developed a method for explicitly evaluating Δ for different daily doses of drug and different schedules of administration. In the empirical therapy setting, when aminoglycosides are administered every 12 h, treatment of infections caused by microbes with MIC values greater than 1 mg/liter cannot attain a high enough likelihood of a good outcome without engendering an unacceptable toxicity likelihood. Daily administration, by decrementing the likelihood of toxicity, allows higher doses to be employed with more acceptable probabilities of toxicity. Obtaining patient-specific information (concentration-time data) allows better identification of the patient’s specific pharmacokinetic parameters and dispersion. As these become better identified, optimal doses become rapidly identified so that optimal outcomes are attained. Optimization of therapy for aminoglycosides requires understanding the relationship between exposure and response as well as that between exposure and toxicity. Furthermore, daily administration is much preferred, and stopping therapy as quickly as possible (a week or less may be optimal) will contribute to the ability to optimize therapy.

PDF

http://aac.asm.org/content/55/6/2528.full.pdf+html

March 24, 2012 at 9:24 pm Leave a comment

Case Report of a Successful Treatment of Methicillin-Resistant Staphylococcus aureus (MRSA) Bacteremia and MRSA/Vancomycin-Resistant Enterococcus faecium Cholecystitis by Daptomycin▿

Antimicrobial Agents and Chemotherapy 1 May 2011 V.55 N.5 P.2458-2459

Carlo Tascini1,†, Antonello Di Paolo2,†,*, Marialuisa Polillo2, Mauro Ferrari3, Paola Lambelet4, Romano Danesi2 and Francesco Menichetti1

1Infectious Diseases Unit, Santa Chiara University Hospital, Pisa, Italy

2Division of Pharmacology, Department of Internal Medicine, University of Pisa, Pisa, Italy

3Division of Vascular Surgery, Department of Oncology, Transplants and New Technologies in Medicine, University of Pisa, Pisa, Italy

4Division of Medicine, Versilia Hospital, Camaiore, Italy

ABSTRACT

A 72-year-old man, receiving 8 mg daptomycin/kg body weight/day for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, was diagnosed with MRSA/vancomycin-resistant Enterococcus faecium (VRE) cholecystitis (daptomycin MIC values, 1 and 2 mg/liter, respectively). After the fifth drug dose, the bile concentration of daptomycin was 66 mg/liter 5 min after drug administration, with the biliary concentration/MIC values higher than 30 for both bacterial strains. Therefore, daptomycin achieved therapeutic levels in bile, hence suggesting a role for the drug in the treatment of MRSA/VRE cholecystitis.

PDF

http://aac.asm.org/content/55/5/2458.full.pdf+html

March 20, 2012 at 9:56 pm Leave a comment

Mupirocin Resistance in Staphylococcus aureus Causing Recurrent Skin and Soft Tissue Infections in Children▿

Antimicrobial Agents and Chemotherapy 1 May 2011 V.55 N.5 P2431-2433

J. Chase McNeil, Kristina G. Hulten, Sheldon L. Kaplan and Edward O. Mason*

Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas

ABSTRACT

Staphylococcus aureus resistance to mupirocin is often caused by acquisition of a novel isoleucyl-tRNA synthetase encoded on the plasmid gene mupA. We tested S. aureus isolates from children at Texas Children’s Hospital with recurrent skin and soft tissue infections for mupirocin resistance and mupA. Of 136 isolates, 20 were resistant to mupirocin (14.7%). Fifteen isolates (11%) carried mupA, and the gene was more common in methicillin-susceptible S. aureus (21.4%) than methicillin-resistant S. aureus (8.3%; P = 0.03). Seven of 20 mupirocin-resistant isolates displayed clindamycin resistance.

PDF

http://aac.asm.org/content/55/5/2431.full.pdf+html

 

March 20, 2012 at 9:44 pm Leave a comment

Combinatorial Approaches to the Prevention and Treatment of HIV-1 Infection▿†

Antimicrobial Agents and Chemotherapy 1 May 2011 V.55 N.5 P.1831-1842

MINIREVIEW

Vanessa Pirrone1,2,3, Nina Thakkar1,2,3, Jeffrey M. Jacobson1,2,3,4,5, Brian Wigdahl1,2,3 and Fred C. Krebs1,2,3,*

1Department of Microbiology and Immunology and Institute for Molecular Medicine and Infectious Disease

2Center for Sexually Transmitted Disease

3Center for Molecular Therapeutics and Resistance

4Center for Clinical and Translational Medicine

5Department of Medicine, Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania 19102

ABSTRACT

The discovery of the human immunodeficiency virus type 1 (HIV-1) in 1982 soon led to the identification and development of antiviral compounds to be used in treatment strategies for infected patients. Early in the epidemic, drug monotherapies frequently led to treatment failures because the virus quickly developed resistance to the single drug. Following the advent of highly active antiretroviral therapy (HAART) in 1995, dramatic improvements in HIV-1-infected patient health and survival were realized as more refined combination therapies resulted in reductions in viral loads and increases in CD4+ T-cell counts. In the absence of an effective vaccine, prevention of HIV-1 infection has also gained traction as an approach to curbing the pandemic. The development of compounds as safe and effective microbicides has intensified and has focused on blocking the transmission of HIV-1 during all forms of sexual intercourse. Initial preclinical investigations and clinical trials of microbicides focused on single compounds effective against HIV-1. However, the remarkable successes achieved using combination therapy to treat systemic HIV-1 infection have subsequently stimulated the study and development of combination microbicides that will simultaneously inhibit multiple aspects of the HIV-1 transmission process by targeting incoming viral particles, virus-infected cells, and cells susceptible to HIV-1 infection. This review focuses on existing and developing combination therapies, covering preclinical development, in vitro and in vivo efficacy studies, and subsequent clinical trials. The shift in focus within the microbicide development field from single compounds to combination approaches is also explored.

PDF

http://aac.asm.org/content/55/5/1831.full.pdf+html

March 20, 2012 at 9:43 pm Leave a comment

Clinical Impact of Antimicrobial Resistance in European Hospitals: Excess Mortality and Length of Hospital Stay Related to Methicillin-Resistant Staphylococcus aureus Bloodstream Infections

Antimicrobial Agents and Chemotherapy 1 April 2011 V.55 N.4 P.1598-1605

Marlieke E. A. de Kraker1,2,*, Martin Wolkewitz3, Peter G. Davey4, Hajo Grundmann1,2 and on behalf of the BURDEN Study Group †

1Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands

2Department of Medical Microbiology, University Medical Centre Groningen, P.O. Box 30.001, 9700 RB Groningen, Netherlands

3Institute of Medical Biometry and Medical Informatics, University Medical Centre Freiburg, Freiburg, Germany

4Division of Community Health Sciences, Health Informatics Centre, Dundee, United Kingdom

ABSTRACT

Antimicrobial resistance is threatening the successful management of nosocomial infections worldwide. Despite the therapeutic limitations imposed by methicillin-resistant Staphylococcus aureus (MRSA), its clinical impact is still debated. The objective of this study was to estimate the excess mortality and length of hospital stay (LOS) associated with MRSA bloodstream infections (BSI) in European hospitals. Between July 2007 and June2008, amulticenter, prospective, parallel matched-cohort study was carried out in 13 tertiary care hospitals in as many European countries. Cohort I consisted of patients with MRSA BSI and cohort II of patients with methicillin-susceptible S. aureus (MSSA) BSI. The patients in both cohorts were matched for LOS prior to the onset of BSI with patients free of the respective BSI. Cohort I consisted of 248 MRSA patients and 453 controls and cohort II of 618 MSSA patients and 1,170 controls. Compared to the controls, MRSA patients had higher 30-day mortality (adjusted odds ratio [aOR] = 4.4) and higher hospital mortality (adjusted hazard ratio [aHR] = 3.5). Their excess LOS was 9.2 days. MSSA patients also had higher 30-day (aOR = 2.4) and hospital (aHR = 3.1) mortality and an excess LOS of 8.6 days. When the outcomes from the two cohorts were compared, an effect attributable to methicillin resistance was found for 30-day mortality (OR = 1.8; P = 0.04), but not for hospital mortality (HR = 1.1; P = 0.63) or LOS (difference = 0.6 days; P = 0.96). Irrespective of methicillin susceptibility, S. aureus BSI has a significant impact on morbidity and mortality. In addition, MRSA BSI leads to a fatal outcome more frequently than MSSA BSI. Infection control efforts in hospitals should aim to contain infections caused by both resistant and susceptible S. aureus.

PDF

http://aac.asm.org/content/55/4/1598.full.pdf+html

ERRATA

http://aac.asm.org/content/55/7/3646.short

March 20, 2012 at 9:40 pm Leave a comment

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