Archive for November, 2012

Ehrlichioses in humans: epidemiology, clinical presentation, diagnosis, and treatment.

Clin Infect Dis. 2007 Jul 15;45 Suppl 1:S45-51.

Dumler JS, Madigan JE, Pusterla N, Bakken JS.

Source

Division of Medical Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA. sdumler@jhmi.edu

Abstract

Human ehrlichioses are emerging tickborne infections. “Human ehrlichiosis” describes infections with at least 5 separate obligate intracellular bacteria in 3 genera in the family Anaplasmataceae. Since 1986, these agents and infections (human monocytic ehrlichiosis [HME], caused by Ehrlichia chaffeensis; human granulocytic anaplasmosis [HGA], caused by Anaplasma phagocytophilum; and human ewingii ehrlichiosis, caused by Ehrlichia ewingii) are the causes of most human ehrlichioses. Their prevalence and incidence are increasing where the appropriate tick vectors are found. The diseases generally present as undifferentiated fever, but thrombocytopenia, leukopenia, and increased serum transaminase activities are important laboratory features. Despite clinical similarities, each disease has unique features: a greater severity and a higher case-fatality rate for HME and a higher prevalence of opportunistic infections for HGA. Once an ehrlichiosis is suspected on historical and clinical grounds, doxycycline treatment should be initiated concurrently with attempts at etiologic confirmation using laboratory methods such as blood smear examination, polymerase chain reaction, culture, and serologic tests.

PDF

http://cid.oxfordjournals.org/content/45/Supplement_1/S45.full.pdf+html

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November 30, 2012 at 7:13 pm

A critical appraisal of “chronic Lyme disease”.

N Engl J Med. 2007 Oct 4;357(14):1422-30.

Feder HM Jr, Johnson BJ, O’Connell S, Shapiro ED, Steere AC, Wormser GP; Ad Hoc International Lyme Disease Group, Agger WA, Artsob H, Auwaerter P, Dumler JS, Bakken JS, Bockenstedt LK, Green J, Dattwyler RJ, Munoz J, Nadelman RB, Schwartz I, Draper T, McSweegan E, Halperin JJ, Klempner MS, Krause PJ, Mead P, Morshed M, Porwancher R, Radolf JD, Smith RP Jr, Sood S, Weinstein A, Wong SJ, Zemel L.

Source

Department of Family Medicine and Pediatrics, Connecticut Children’s Medical Center, Hartford, CT, USA. hfeder@nso2.uchc.edu

Lyme disease, the most common tick-borne infection in the northern hemisphere, is a serious public health problem. In North America, it is caused exclusively by Borrelia burgdorferi sensu stricto (hereafter referred to as B. burgdorferi), whereas in Europe it is caused by B. afzelii, B. garinii, B. burgdorferi, and occasionally by other species of borrelia….

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMra072023

November 30, 2012 at 12:03 pm

The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America.

Clin Infect Dis. 2006 Nov 1;43(9):1089-134.

Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS, Krause PJ, Bakken JS, Strle F, Stanek G, Bockenstedt L, Fish D, Dumler JS, Nadelman RB.

Source

Division of Infectious Diseases, Department of Medicine, New York Medical College, Valhalla, NY 10595, USA. Gary_Wormser@nymc.edu

Erratum in

Clin Infect Dis. 2007 Oct 1;45(7):941.

Abstract

Evidence-based guidelines for the management of patients with Lyme disease, human granulocytic anaplasmosis (formerly known as human granulocytic ehrlichiosis), and babesiosis were prepared by an expert panel of the Infectious Diseases Society of America. These updated guidelines replace the previous treatment guidelines published in 2000 (Clin Infect Dis 2000; 31[Suppl 1]:1-14).

The guidelines are intended for use by health care providers who care for patients who either have these infections or may be at risk for them. For each of these Ixodes tickborne infections, information is provided about prevention, epidemiology, clinical manifestations, diagnosis, and treatment. Tables list the doses and durations of antimicrobial therapy recommended for treatment and prevention of Lyme disease and provide a partial list of therapies to be avoided. A definition of post-Lyme disease syndrome is proposed.

PDF

http://cid.oxfordjournals.org/content/43/9/1089.full.pdf+html

November 30, 2012 at 12:01 pm

ENFERMEDADES TRANSMITIDAS POR GARRAPATAS al HOMBRE

GUIA DE ZOONOSIS DE GARRAPATAS 2011

MVZ Bibiana Vega Galindo y MVZ Patricia Luévano Martínez

Cd. Victoria, Tamaulipas  – Mexico

Existen  patologías que pueden ser transmitidas al hombre a través de las garrapatas, no siendo éste su hospedador habitual, pero sí accidental. Tomando como referencia el mencionado Boletín de alertas epidemiológicas internacionales, éstas son algunas de ellas:

Enfermedad de Lyme

Fiebre Recurrente

Fiebres por rickettsias

Ehrlichiosis

Anaplasmosis

Tularemia

Babesiosis

Encefalitis por virus

Fiebre de Colorado

 

FULL TEXT

http://www.exavetuat.org/wp-content/uploads/2011/01/GUIA-DE-ZOONOSIS-DE-LA-GARRAPATA.pdf

 

November 30, 2012 at 11:59 am

Changing prophylactic antibiotic protocol for reducing Clostridium difficile-associated diarrhoeal infections.

J Orthop Surg (Hong Kong). 2010 Dec;18(3):320-3.

Al-Obaydi W, Smith CD, Foguet P.

Source

Department of Orthopaedics, University Hospital Coventry and Warwickshire, Coventry, UK.

Abstract

PURPOSE:

To determine whether a change in prophylactic antibiotic protocol for orthopaedic surgeries may reduce the frequency of Clostridium difficile-associated diarrhoeal infections.

METHODS:

Records of 1331 patients who underwent trauma or elective surgeries involving implantation of metalwork were reviewed. 231 trauma and 394 elective patients who received intravenous cefuroxime-based antibiotic prophylaxis between August 2006 and January 2007 were compared with 216 trauma and 490 elective patients who received a single dose of gentamicin and flucloxacillin or teicoplanin for antibiotic prophylaxis between August 2007 and January 2008. Diarrhoeal faecal specimens of 148 (33%) trauma patients and 106 (12%) elective patients were examined. The outcome variables were the rates of C difficile infection and early deep wound infection.

RESULTS:

There were 32 cases of C difficile-associated diarrhoeal infection and 28 cases of early deep wound infection. The frequency of C difficile-associated diarrhoeal infection decreased after use of the new antibiotic protocol (from 4 to 1%, p = 0.004), particularly in the trauma patients (from 8 to 3%, p = 0.02); in the elective patients the difference was not significant (from 1 to 0.5%, p = 0.27). The change of antibiotic protocol did not significantly affect the incidence of deep wound infections in the trauma (p = 0.46) or elective (p = 0.90) patients. The rate of C difficile infection was 8-fold higher in the trauma than elective patients, both before and after the change of protocol.

CONCLUSION:

Changing antibiotic protocol is one way of reducing the incidence of C difficile-associated diarrhoeal infections in orthopaedic patients, without increasing the rate of deep wound infections.

PDF

http://www.josonline.org/pdf/v18i3p320.pdf

November 29, 2012 at 2:13 pm

Questions over human papillomavirus vaccine in the US and Australia.

BMJ. 2007 Jun 9;334(7605):1182-3.

Tanne JH.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1889933/pdf/bmj-334-7605-news-01182.pdf

 

November 29, 2012 at 2:11 pm

Quadrivalent HPV vaccination reactions–more hype than harm.

Aust Fam Physician. 2009 Mar;38(3):139-42.

Douglas RJ.

Source

Emergency Medicine and General Practice, Royal Adelaide Hospital, South Australia. rabs01@hotmail.com

Abstract

BACKGROUND:

The quadrivalent human papillomavirus (HPV) vaccine Gardasil was licensed for use in June 2006. Since its approval more than 26 million doses of the vaccine have been distributed worldwide. There is ongoing debate as to the safety of the vaccine, with suggestions of a link between the vaccine and syncopal events, and the aetiology of more chronic conditions such as Guillain-Barre syndrome.

OBJECTIVE:

A case of subcutaneous emphysema secondary to quadrivalent HPV vaccination is described, and reported adverse events to quadrivalent HPV vaccination in both Australia and the United States are examined.

DISCUSSION:

On the basis of published peer reviewed literature, and from data analysis conducted by reputable agencies, the conclusion is drawn that adverse events are mild and self limiting and quadrivalent HPV vaccine is safe when administered according to the manufacturer’s recommendations.

PDF

http://www.racgp.org.au/afpbackissues/2009/200903/200903douglas.pdf

November 29, 2012 at 2:10 pm

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