Archive for April, 2012

Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Mar 27 , 2012.

Panel on Antiretroviral Guidelines for Adults and Adolescents.

Developed by the HHS Panel on Antiretroviral Guidelines for Adults and Adolescents – A Working Group of the Office of AIDS Research Advisory Council (OARAC)




April 30, 2012 at 1:46 pm Leave a comment

Efficacy of the new cephalosporin ceftaroline in the treatment of experimental methicillin-resistant Staphylococcus aureus acute osteomyelitis.

J Antimicrob Chemother. 2010 Aug V.65 N.8 P.1749-52.

Jacqueline C, Amador G, Caillon J, Le Mabecque V, Batard E, Miègeville AF, Biek D, Ge Y, Potel G, Hamel A.

Université de Nantes, Faculté de Médecine, Thérapeutiques Cliniques et Expérimentales des Infections, EA3826, F-44000 Nantes, France.



To evaluate the activity of a new cephalosporin, ceftaroline, in comparison with other antistaphylococcal drugs (linezolid and vancomycin) at projected human therapeutic doses against methicillin-resistant Staphylococcus aureus (MRSA) and glycopeptide-intermediate S. aureus (GISA) strains.


Using a rabbit experimental model of acute osteomyelitis, efficacy was assessed following 4 days of treatment by colony counts of infected bone tissues (joint fluid, femoral bone marrow and bone).


Although vancomycin remains the standard treatment for MRSA osteomyelitis, it was ineffective against the MRSA strain and poorly active against GISA infections in this model. Ceftaroline and linezolid demonstrated significant activity in bone marrow and bone, and were significantly better than vancomycin treatment. However, ceftaroline was the only drug to exhibit significant activity against MRSA in infected joint fluid.


The present study supports ceftaroline as a promising therapeutic option for the treatment of severe MRSA infections, including osteomyelitis.


April 28, 2012 at 7:48 pm Leave a comment

Activity of Ceftaroline and Epidemiologic Trends in Staphylococcus aureus Isolates Collected from 43 Medical Centers in the United States in 2009

Antimicrobial Agents and Chemotherapy  Sept  2011 V.55 N.9 P.4154-4160

Sandra S. Richter1,*, Kristopher P. Heilmann2, Cassie L. Dohrn2, Fathollah Riahi2, Andrew J. Costello2, Jennifer S. Kroeger2, Donald Biek3, Ian A. Critchley3, Daniel J. Diekema2 and Gary V. Doern2

1Cleveland Clinic, Cleveland, Ohio

2University of Iowa Carver College of Medicine, Iowa City, Iowa

3Cerexa, Inc., Oakland, California


A Staphylococcus aureus surveillance program was initiated in theUnited Statesto examine the in vitro activity of ceftaroline and epidemiologic trends. Susceptibility testing by Clinical and Laboratory Standards Institute broth microdilution was performed on 4,210 clinically significant isolates collected in 2009 from 43 medical centers. All isolates were screened for mecA by PCR and evaluated by pulsed-field gel electrophoresis. Methicillin-resistant S. aureus (MRSA) were analyzed for Panton-Valentine leukocidin (PVL) genes and the staphylococcal cassette chromosome mec (SCCmec) type. All isolates had ceftaroline MICs of ≤2 μg/ml with an MIC50 of 0.5 and an MIC90 of 1 μg/ml. The overall resistance rates, expressed as the percentages of isolates that were intermediate and resistant (or nonsusceptible), were as follows: ceftaroline, 1.0%; clindamycin, 30.2% (17.4% MIC ≥ 4 μg/ml; 12.8% inducible); daptomycin, 0.2%; erythromycin, 65.5%; levofloxacin, 39.9%; linezolid, 0.02%; oxacillin, 53.4%; tetracycline, 4.4%; tigecycline, 0%; trimethoprim-sulfamethoxazole, 1.6%; vancomycin, 0%; and high-level mupirocin, 2.2%. The mecA PCR was positive for 53.4% of the isolates. The ceftaroline MIC90s were 0.25 μg/ml for methicillin-susceptible S. aureus and 1 μg/ml for MRSA. Among the 2,247 MRSA isolates, 51% were USA300 (96.9% PVL positive, 99.7% SCCmec type IV) and 17% were USA100 (93.4% SCCmec type II). The resistance rates for the 1,137 USA300 MRSA isolates were as follows: erythromycin, 90.9%; levofloxacin, 49.1%; clindamycin, 7.6% (6.2% MIC ≥ 4 μg/ml; 1.4% inducible); tetracycline, 3.3%; trimethoprim-sulfamethoxazole, 0.8%; high-level mupirocin, 2.7%; daptomycin, 0.4%; and ceftaroline and linezolid, 0%. USA300 is the dominant clone causing MRSA infections in theUnited States. Ceftaroline demonstrated potent in vitro activity against recent S. aureus clinical isolates, including MRSA, daptomycin-nonsusceptible, and linezolid-resistant strains.


April 28, 2012 at 1:46 am Leave a comment

Pharmacokinetics of Once-Daily Darunavir-Ritonavir and Atazanavir-Ritonavir over 72 Hours following Drug Cessation

Antimicrobial Agents and Chemotherapy  Sept  2011 V.55 N.9 P.4218-4223

Marta Boffito1,*, Akil Jackson1, Alieu Amara2, David Back2, Saye Khoo2, Chris Higgs1, Natalia Seymour1, Brian Gazzard1 and Graeme Moyle1

1St. Stephen’s Centre, Chelsea and Westminster Hospital, London, United Kingdom

2Department of Pharmacology, University of Liverpool, Liverpool, United Kingdom


The object of this study was to investigate the pharmacokinetics of darunavir-ritonavir and atazanavir-ritonavir once-daily dosing over 72 h (h) following drug intake cessation. Volunteers received darunavir-ritonavir at 800 and 100 mg, respectively, once daily for 10 days, followed by a 7-day washout period, and atazanavir-ritonavir at 300 and 100 mg, respectively, once daily for 10 days. Full pharmacokinetic profiles were assessed for each phase for the 72 h following day 10. Pharmacokinetic parameters were determined over 24 h and to the last measurable concentration by noncompartmental methods. Seventeen subjects completed the study. The geometric mean (GM) terminal elimination half-life to 72 h of darunavir was 6.48 h, which was lower than the 0- to 24-h half-life (10.70 h). The terminal elimination half-life of atazanavir was 6.74 h, which was lower than the 0- to 24-h half-life (13.72 h). All subjects but one had darunavir concentrations higher than the target of 550 ng/ml for protease-resistant HIV isolates (equivalent to 10 times the protein-binding-corrected 50% inhibitory concentration [IC50] for wild-type virus) at 24 h postdose, and 14 out of 17 had concentrations higher than the target at 30 h postdose (GM of 1,088 and 851 ng/ml). All subjects had atazanavir concentrations above the suggested minimum effective concentration of 150 ng/ml (equivalent to 10 times the protein-binding-corrected IC50 for wild-type virus) at 24 and 30 h postdose (GM of 693 and 392 ng/ml). Two of 17 and 5 of 17 subjects were above target at 48 h postdose while on darunavir-ritonavir and atazanavir-ritonavir. Ritonavir half-life to 72 h was 6.84 h with darunavir and 6.07 with atazanavir. This study investigated the pharmacokinetic forgiveness of two boosted protease inhibitors. Although the rates of decline of darunavir and atazanavir slightly increased as ritonavir concentrations declined, most individuals had concentrations 6 h after the end of the ideal dosing interval of 24 h which were above the cutoff used to define therapeutic concentrations.


April 28, 2012 at 1:40 am Leave a comment

Diagnosis, management, and treatment of hepatitis C: an update.

Hepatology 2009 Apr  V.49 N.4 P.1335-74.

Ghany MG, Strader DB, Thomas DL, Seeff LB; American Association for the Study of Liver Diseases.

Collaborators (18)


Department of Health and Human Services, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA.



Comment in


Hepatology. 2009 Jul;50(1):322; author reply 324-5.


Hepatology. 2009 Jul;50(1):323-4; author reply 324-5.


Hepatology. 2009 Jul;50(1):323; author reply 324-5.

April 26, 2012 at 10:28 pm Leave a comment

Severe Coinfection with Seasonal Influenza A (H3N2) Virus and Staphylococcus aureus

MMWR Weekly  April 27, 2012 V.61 N.16 P.289-291

Maryland, February–March 2012

On March 5, 2012, the Maryland Department of Health and Mental Hygiene (DHMH) and the Calvert County Health Department were notified of three deaths following respiratory illness among members of aMarylandfamily. One family member (patient A) experienced upper-respiratory symptoms and died unexpectedly at home. Two others (patients B and C) sought medical care for fever, shortness of breath, and cough productive of bloody sputum and died during their hospitalizations. All three family members had confirmed infection with seasonal influenza A (H3N2) virus. Patients B and C had confirmed coinfection with methicillin-resistant Staphylococcus aureus (MRSA), which manifested in both patients as MRSA pneumonia and bacteremia. DHMH and the Calvert County Health Department, in collaboration with the District of Columbia Department of Health, local hospitals, and CDC, conducted an investigation to determine the cause of the illnesses and identify additional related cases….

PDF (see pag. 289)

April 26, 2012 at 5:34 pm Leave a comment

Coexistent Kaposi’s sarcoma and atypical mycobacterial infection involving lymph node: a case report and review of literature.

Indian J Pathol Microbiol. 2010 Oct-Dec V.53 N.4 P.805-7.

Bodhireddy H, Rivas S, Seshadri T.


Texas Tech University Health Sciences Center, Lubbock, TX, USA.


Patients infected with human immunodeficiency virus frequently manifest with rare infections as well as neoplasms. We report an unusual and interesting case of an intranodal Kaposi’s sarcoma (KS) with coexistent/concurrent granulomatous lymphadenitis secondary to atypical mycobacteria in a groin lymph node. “Mycobacterium pseudotumor” is a nonneoplastic condition and should be distinguished from true KS as these 2 entities differ in their prognosis and treatment. In this article, we discuss the diagnosis and differential diagnosis of this exceptional clinical and pathologic manifestation.

FULL TEXT;year=2010;volume=53;issue=4;spage=805;epage=807;aulast=Bodhireddy

April 26, 2012 at 5:32 pm Leave a comment

Linfadenomegalia superficial (LAS): Correlato clínico patológico en 154 pacientes del Hospital Nacional Cayetano Heredia, Lima, Perú.

Acta Med Perú 2007  V.24 N.3 P.159-166

Fernando Osores Plenge1,2, Raúl Gutiérrez Rodríguez2,3, Oscar Guerra Amaya2,3,4, Juan Cortez-Escalante5, Juan C. Ferrufino Lach6, Leandro Huayanay7, Isaias Rodríguez8, Betty Bustamante2,3, Ciro  Maguiña Vargas3,9


La linfadenomegalia superficial (LAS) son hallazgos clínicos frecuentes en la práctica  médica que pueden ser las primeras manifestaciones de una enfermedad de trascendencia o de un síndrome clínico específico.


Realizar un correlato clínico-patológico en pacientes con LAS que acudieron por primera vez a la consulta médica sin un diagnóstico conocido.

Materiales y Métodos

Estudio prospectivo transversal  en el que se incluyeron pacientes con linfoadenomegalia  superficial (LAS)  mayor de1 centímetrocon sospecha de TBC ganglionar. Se realizaron biopsias ganglionares, aspirados por aguja fina, test diagnósticos complementarios; del mismo modo se estructuró una clasificación histopatológica en la que fueron distribuidos los pacientes para luego correlacionarse  con los hallazgos clínicos.


Fueron evaluados 154 pacientes de los cuales 55 de 70 (45,5%), tuvieron diagnóstico de certeza para micobacteriosis ganglionar gracias a la histopatología sumada al cultivo. Treinta y uno (20,1%) tuvieron linfadenomegalia categorizada como inespecífica en la cual no se pudo hallar ninguna causa etiológica de enfermedad. En el resto de pacientes los hallazgos etiológicos fueron diversos entre los que destacaron la enfermedad por arañazo de gato, micosis ganglionares, sarcoma de Kaposi, linfomas, metástasis neoplásicas y sindrome retroviral agudo por VIH.


Las linfadenomegalias superficiales son valiosos signos para el diagnóstico clínico en muchas enfermedades a veces no sospechadas. El médico debe saber decidir cuando ordenar una biopsia ganglionar y como interpretar los resultados histopatológicos de la misma a fin de tener el mayor grado de  certeza etiológica


April 24, 2012 at 5:31 pm Leave a comment

Úlceras genitales con adenopatía inguinal supurativa


Ana Isabel Bernal Ruiz y Antonio González Ruiz

Servicio de Dermatología. Hospital Universitario de Valladolid

Varón de 27 años de edad con antecedentes personales de uretritis hace 2 años y frecuentes episodios de faringoamigdalitis. Soltero. Reconoce una actividad sexual intensa e irregular con uso esporádico del preservativo.

Fumador de un paquete al día y bebedor ocasional. Carece de otros antecedentes médicos de interés….



April 24, 2012 at 5:28 pm Leave a comment

Progress in management of typhoid perforation.

Ann Afr Med. 2011 Oct-Dec V.10 N.4 P.259-65.

Ukwenya AY, Ahmed A, Garba ES.


Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.


Case fatality rate (CFR) for typhoid perforation (TP) has been on gradual but variable decline world wide. This review highlights the progress in management of TP from 1960 including the controversies, current principles of management and the advances associated with the best results of treatment. This is a review of publications on TP from 1960 to 2010 principally from Medline and Ovid databases. Main search terms used are typhoid and perforation. The median CFR by decade was estimated from studies that reported CFR. With advances in surgery and supportive care, median CFR for TP declined from over 50% in 1960 to single digits in the last decade in some countries but withWest Africalagging behind at 16%. Variations in CFR are attributed to differences in perforation-operation interval and quality of care. Opportunities now exist for patients with TP to recover from the disease but priority remains with prevention of enteric fever in endemic areas

FULL TEXT;year=2011;volume=10;issue=4;spage=259;epage=265;aulast=Ukwenya

April 24, 2012 at 5:26 pm Leave a comment

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