Archive for July, 2012

Methicillin-resistant Staphylococcus aureus: changes in the susceptibility pattern to daptomycin during a 10-year period (2001-2010).

Rev Esp Quimioter. 2011 Jun  V.24 N.2 P.107-11.

Picazo JJ, Betriu C, Culebras E, Rodríguez-Avial I, Gómez M, López-Fabal F; Grupo VIRA.

Servicio de Microbiología Clínica. Hospital Clínico San Carlos, Madrid.

Abstract

INTRODUCTION:

The objective of this study was to evaluate the activity of daptomycin and other agents against methicillin-resistant Staphylococcus aureus (MRSA) isolates collected from 2001 to 2010, in order to determine changes and to detect resistance trends.

METHODS:

The study included a total of 1,130 MRSA isolates collected as part of a multicenter surveillance program for antibiotic resistance, Estudio de Vigilancia de Resistencia a los Antimicrobianos (VIRA study), from 51 medical centers throughout Spain between 2001 and 2010. Broth microdilution test was performed according to the Clinical Laboratory Standards Institute guidelines.

RESULTS:

Daptomycin showed excellent activity and maintained its activity over time; only one MRSA isolate collected in 2001 was nonsusceptible to this agent (MIC=2 mg/L). Based on the MIC90, daptomycin was 2-4 dilutions more active than vancomycin, teicoplanin and linezolid. Daptomycin retained activity against MRSA isolates that were resistant to linezolid, to quinupristin-dalfopristin, or showed intermediate susceptibility to vancomycin.

CONCLUSIONS:

Our data and those of other studies, coupled with daptomycin’s rapid bactericidal activity, suggest that this antimicrobial could be an alternative in the treatment of severe infections caused by multiresistant S. aureus.

PDF

http://seq.es/seq/0214-3429/24/2/picazo.pdf

 

July 31, 2012 at 2:20 pm

Cytomegalovirus colitis.

Cleve Clin J Med. 2012 Jan V.79 N.1  P.12-3.

Hashash JG, Refaat M, Abdulbaki A, Aoun EG, Baidoo L.

Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA. alhashashj@upmc.edu

PDF

http://www.ccjm.org/content/79/1/12.full.pdf+html

July 31, 2012 at 2:16 pm

FDA approval of expanded age indication for a tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine.

MMWR Morb Mortal Wkly Rep. 2011 Sep 23 V.60 N.37 P.1279-80.

Centers for Disease Control and Prevention (CDC).

Abstract

On July 8, 2011, the Food and Drug Administration (FDA) approved an expanded age indication for the tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) Boostrix (GlaxoSmithKline Biologicals, Rixensart, Belgium). Originally, Boostrix was licensed in 2005 for persons aged 10 through 18 years, but in 2008, FDA approved an expanded age indication for Boostrix to include persons aged 19 through 64 years. FDA has now expanded the age indication to include persons aged 65 years and older. Boostrix is now licensed for use in persons aged 10 years and older as a single-dose booster vaccination. This notice summarizes the indications for use of Boostrix. Recommendations of the Advisory Committee on Immunization Practices (ACIP) for Tdap vaccines have been published previously. Publication of revised Tdap recommendations within the next year is anticipated.

PDF

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6037a3.htm

http://www.cdc.gov/mmwr/pdf/wk/mm6037.pdf

July 31, 2012 at 2:13 pm

HIV-infected persons continue to lose kidney function despite successful antiretroviral therapy.

AIDS. 2009 Oct 23 V.23 N.16 P.2143-9.

Choi AI, Shlipak MG, Hunt PW, Martin JN, Deeks SG.

Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California 94121, USA. andy.choi@ucsf.edu

Abstract

OBJECTIVE:

To identify risk factors associated with kidney function decline in a contemporary cohort of treated and untreated HIV-infected patients.

METHODS:

We followed individuals enrolled in the Study of the Consequences Of the Protease inhibitor Era cohort for longitudinal changes in kidney function, defined as glomerular filtration rate estimated from serum creatinine (eGFR). eGFR slope was calculated using linear mixed effects models adjusted for age, sex, race, and time-updated CD4 cell count, viral load, antiretroviral therapy (ART), and comorbid conditions.

RESULTS:

We followed 615 patients for a mean of 3.4 (+/- 2.5) years. In multivariable adjusted analyses, predictors of eGFR decline included female sex, diabetes, and hyperlipidemia; CD4 cell count and viral load were not associated with eGFR loss. Among patients who initiated treatment, antiretroviral exposure was associated with a +2.8 (95% confidence interval 0.8-4.7) ml/min per 1.73 m per year effect on eGFR slope. Although these patients appeared to benefit from ART based on the slowing of their eGFR decline, they continued to lose kidney function at a rate of -1.9 (95% confidence interval -3.7 to -0.1) ml/min per 1.73 m per year. In the subgroup of individuals receiving suppressive ART with viral loads maintained below 500 copies/ml, intermittent viremic episodes (blips) were strongly associated with more rapid rates of eGFR loss [-6.7 (95% confidence interval -11.1 to -2.4) ml/min per 1.73 m per year].

CONCLUSION:

Although ART appears to help curb kidney function decline, patients who achieved durable viral suppression continue to manifest substantial loss of eGFR. Loss of kidney function may be attributable to treatment-related factors, intermittent viremia, and traditional risk factors for kidney disease.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2839451/pdf/nihms-175850.pdf

 

July 31, 2012 at 2:10 pm

Latent microsporidial infection in immunocompetent individuals – a longitudinal study.

PLoS Negl Trop Dis. 2011 May  V.5 N.5  e1162.

Sak B, Kváč M, Kučerová Z, Květoňová D, Saková K.

Biology Centre of the Academy of Sciences of the Czech Republic, v.v.i., Institute of Parasitology, České Budějovice, Czech Republic.

Abstract

BACKGROUND:

Microsporidia (Fungi) have been repeatedly identified as the cause of opportunistic infections predominantly in immunodeficient individuals such as AIDS patients. However, the global epidemiology of human microsporidiosis is poorly understood and the ability of microsporidia to survive and multiply in immunocompetent hosts remains unsolved.

AIMS:

To determine the presence of latent microsporidia infections in apparently healthy humans in the Czech Republic, the authors tested sera, urine and stool originating from fifteen persons within a three month period examined on a weekly basis.

METHODS:

Sera, stool and urine samples originating from fifteen HIV-negative people at risk with occupational exposure to animals, aged 22-56 years, living in the Czech Republic were tested by indirect immunofluorescence assay (IFA) for the presence of specific anti-microsporidial antibodies, standard Calcofluor M2R staining for the detection of microsporidian spores in all urine sediments and stool smears and molecular methods for the microsporidial species determination.

RESULTS:

Specific anti-microsporidial antibodies were detected in fourteen individuals, asymptomatic Encephalitozoon spp. infection was found in thirteen and E. bieneusi infection was detected in seven of those examined. While E. hellem 1A and E. cuniculi II were the major causative agents identified, seven different genotypes of E. bieneusi were recorded.

CONCLUSIONS:

These findings clearly show that exposure to microsporidia is common and chronic microsporidiosis is not linked to any clinical manifestation in healthy population. Moreover, our results indicate much higher incidence of microsporidial infections among an apparently healthy population than previously reported. These results open the question about the potential risk of reactivation of latent microsporidiosis in cases of immunosupression causing life-threatening disease.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101169/pdf/pntd.0001162.pdf

 

July 31, 2012 at 2:06 pm

Anthony Fauci: The Tools to End AIDS (Video)

From International Foundation for Alternative Research in AIDS

The XIX International AIDS Conference (AIDS 2012)

Washington DC July 22-27

July 24, 2012

Anthony Fauci, M.D., director of National Institute of Allergy and Infectious Diseases (NIAID), sits down with Fred Schaich to reflect on the advances of HIV research. He also discusses how we can implement all our existing HIV treatment and prevention methods to end the AIDS pandemic.

http://www.thebodypro.com/content/68121/anthony-fauci-tools-to-end-aids.html

July 30, 2012 at 10:37 pm

Cytomegalovirus complicating inflammatory bowel disease: a 10-year experience in a community-based, university-affiliated hospital.

Gastroenterol Hepatol (N Y). 2012 Apr  V.8 N.4 P.230-9.

Al-Zafiri R, Gologan A, Galiatsatos P, Szilagyi A.

Dr. Al-Zafiri is a Gastroenterology Fellow, Dr. Galiatsatos is a Physician, and Dr. Szilagyi is a Physician in the Division of Gastroenterology at Sir Mortimer B. Davis Jewish General Hospital and McGill University in Montreal, Quebec. Dr. Gologan is a Pathologist in the Department of Pathology at Sir Mortimer B. Davis Jewish General Hospital and McGill University in Montreal, Quebec.

Abstract

There is an ongoing debate regarding the signifcance of cytomegalovirus (CMV) in colonic biopsies and the effect of antiviral therapy in patients with infammatory bowel disease (IBD). In order to evaluate the possible impact of CMV disease on IBD patients, we reviewed charts of patients admitted through the emergency department with diagnoses of IBD and CMV over a 10-year period (January 2000 to November 2009). Laboratory test results and pharmacology databases were scrutinized, and pathology slides were re-evaluated when possible. The control group consisted of a historical group of IBD patients with fares who had been similarly evaluated in the emergency department but who did not have a diagnosis of CMV. Both chi-square tests and the student’s t-test were used for analysis. The study consisted of 31 patients with IBD and CMV (median age, 60 years; 65% male; 58% ulcerative colitis patients). Immunohistochemistry confirmed the diagnosis in 19 cases (61%). Nine patients with CMV and IBD underwent a colectomy (29%) compared to 65 of the 581 patients in the control group (11.2%), who were evaluated during the same time period but did not have CMV (P=.007). Mortality was similar in both groups. Of the patients with CMV, 11 received ganciclovir. No significant differences in outcomes were noted with antiviral therapy. Although CMV disease is relatively uncommon in IBD patients, its presence may designate an increased risk for colectomy for reasons that are not yet clear. Patient outcomes may be independently affected by age and comorbidities. Systematic prospective studies could help determine the true effects of CMV on IBD patients.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3380257/pdf/GH-08-230.pdf

July 30, 2012 at 10:13 pm

Pertussis booster vaccine for adolescents and young adults in São Paulo, Brazil.

Rev Saude Publica. 2011 Dec V.45 N.6 P.1062-71.

Freitas AC, Okano V, Pereira JC.

Departamento de Epidemiologia, Universidade de São Paulo, São Paulo, Brasil. angelacf.freitas@gmail.com

Abstract

OBJECTIVE:

To develop a model to assess different strategies of pertussis booster vaccination in the city of São Paulo.

METHODS:

A dynamic stationary age-dependent compartmental model with waning immunity was developed. The “Who Acquires Infection from Whom” matrix was used to modeling age-dependent transmission rates. There were tested different strategies including vaccine boosters to the current vaccination schedule and three of them were reported: (i) 35% coverage at age 12, or (ii) 70% coverage at age 12, and (iii) 35% coverage at age 12 and 70% coverage at age 20 at the same time.

RESULTS:

The strategy (i) achieved a 59% reduction of pertussis occurrence and a 53% reduction in infants while strategy (ii) produced 76% and 63% reduction and strategy (iii) 62% and 54%, respectively.

CONCLUSION:

Pertussis booster vaccination at age 12 proved to be the best strategy among those tested in this study as it achieves the highest overall reduction and the greatest impact among infants who are more susceptible to pertussis complications.

PDF

http://www.scielosp.org/pdf/rsp/v45n6/2334.pdf

 

July 30, 2012 at 10:11 pm

Renal disease associated with antiretroviral therapy in the treatment of HIV.

Nephron Clin Pract. 2011 V.118 N.3  c262-8.

Cooper RD, Tonelli M.

Department of Medicine, University of Alberta, Edmonton, Alta., Canada.

Abstract

The introduction of potent combination antiretroviral therapy (ART) in the treatment of HIV infection has permitted reliable control of disease progression and has markedly improved survival among people with HIV. As a result, health care providers and patients have shifted clinical priorities; whereas once delaying opportunistic illness was a primary focus, increasing emphasis is now placed on preventative health, management of comorbid chronic disease and avoiding long-term toxicities of ART. Although renal disease is common in people with HIV, renal disease specifically due to ART remains relatively rare. Still, as the use of ART continues to increase, health care providers are likely to encounter this potentially serious complication with increasing frequency. Distinguishing ART-related nephrotoxicity from the myriad of other potential causes of renal disease in people with HIV is important in order to avoid unnecessary discontinuation of an appropriate ART regimen. This review focuses on the early recognition of renal disease associated with ART and suggests strategies for management and prevention.

PDF

http://content.karger.com/produktedb/produkte.asp?DOI=000321646&typ=pdf

July 30, 2012 at 10:09 pm

What should we know about metabolic syndrome and lipodystrophy in AIDS?

Rev Assoc Med Bras. 2012 Jan-Feb V.58 N.1 P.70-5.

Signorini DJ, Monteiro MC, Andrade Mde F, Signorini DH, Eyer-Silva Wde A.

Escola Nacional de Saúde Pública, Fiocruz, Brazil. dariohart@terra.com.br

Abstract

OBJECTIVE:

Prevalence of chronic complications of HIV infection is increasing and early recognition and treatment of the components of metabolic syndrome (MS) are essential to prevent cardiovascular and metabolic complications. Considering this, we performed a cross-sectional study on the prevalence and risk-factors for MS among HIV-infected subjects.

METHODS:

A total of 819 patients followed at a large outpatient HIV unit were assessed by an interviewer-administered questionnaire that recorded several demographic, epidemiologic, clinical, laboratory, and social variables. Lipodystrophy diagnosis relied on agreement between patient’s self-report and physician’s observation of altered body-fat deposits. The presence of three or more of the following characteristics identified MS: increased waist circumference, hypertriglyceridemia, low HDL cholesterol level, hypertension, and hyperglycemia. We used logistic regression analyses to study variables independently associated with MS.

RESULTS:

The prevalence of MS was 20.6% and that of lipodystrophy was 38.5%. 61 (36.1%) out of 169 patients with MS had also lipodystrophy. Patients with metabolic syndrome were significantly more likely to be older (OR = 1.08), had higher CD4 counts (OR = 1.001), had an increased body mass index (OR = 1.27) and had longer exposure to antiretroviral therapy (OR = 1.01) than those without metabolic syndrome.

CONCLUSION:

Both traditional risk factors for cardiovascular disease and factors associated with HIV infection itself, such as an increased CD4 cell count and a longer exposure to antiretroviral therapy, seem to be associated with metabolic syndrome in the present study population.

PDF

http://www.scielo.br/pdf/ramb/v58n1/v58n1a17.pdf

July 30, 2012 at 10:06 pm

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