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.


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


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.


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.


Department of Family Medicine and Pediatrics, Connecticut Children’s Medical Center, Hartford, CT, USA.

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….


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.


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

Erratum in

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


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.


November 30, 2012 at 12:01 pm



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





Encefalitis por virus

Fiebre de Colorado




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.


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



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


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.


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.


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.


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.



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.


Emergency Medicine and General Practice, Royal Adelaide Hospital, South Australia.



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.


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.


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.


November 29, 2012 at 2:10 pm

Fever with rash in a child in India.

Indian J Dermatol Venereol Leprol. 2012 May-Jun;78(3):251-62.

Sarkar R, Mishra K, Garg VK.


Department of Dermatology and Venereology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.


Fever with rash is common among children and are seen by both dermatologists and pediatricians. Most of them are benign viral exanthems without much clinical significance.

This article gives an overview of the infectious and noninfectious causes of fever with rash in children and how to diagnose them, with special emphasis on the Indian scenario as well. It also differentiates them from fever with rash caused by drugs.

This review emphasizes that although benign in many cases, it is necessary to identify the signs of serious illnesses to prevent mortality or sequelae.

FULL TEXT;year=2012;volume=78;issue=3;spage=251;epage=262;aulast=Sarkar

November 29, 2012 at 2:09 pm

Tularemia in children: evaluation of clinical, laboratory and therapeutic features of 27 tularemia cases.

Turk J Pediatr. 2012 Mar-Apr;54(2):105-12.

Kaya A, Deveci K, Uysal IO, Güven AS, Demir M, Uysal EB, Gültekin A, Içağasioğlu FD.


Department of Pediatrics, Cumhuriyet University Faculty of Medicine, Sivas, Turkey.


Tularemia is a zoonotic disease caused by Francisella tularensis. We aimed to explicate the clinical and laboratory findings of 27 consecutive tularemia patients who were included into the study. The average duration between onset of symptoms and diagnosis was 19.1 +/- 7.3 days.

Sore throat (100%), fever (93%) and myalgia (100%) were the most frequently observed symptoms, while lymphadenopathy (100%), pharyngeal hyperemia (85%), tonsillitis (74%), and rash (7%) were the most frequently observed physical findings.

Treatment failed in 6 patients: 1/13 streptomycin- (changed to doxycycline + streptomycin), 1/7 ciprofloxacin- (changed to streptomycin), and 4/7 gentamicin- (changed to streptomycin) receiving patients who had longer duration to treatment (26.5 +/- 2.9 days) than the 21 successfully treated cases (17.0 +/- 6.8 days).

Tularemia should to be taken into account in the differential diagnosis in cases having tonsillopharyngitis and cervical lymphadenopathy without response to beta lactam/macrolide-group antibiotics in rural areas.

We believe that streptomycin should be the first-line antibiotic in the treatment of pediatric tularemia cases, but it should be supported by comprehensive studies with larger patient series.


November 29, 2012 at 2:07 pm

The Index Case for the Fungal Meningitis Outbreak in the United States

N Engl J of Medic NOV.29, 2012 V.367 P.2119-2125


April C. Pettit, M.D., M.P.H., Jonathan A. Kropski, M.D., Jessica L. Castilho, M.D., M.P.H., Jonathan E. Schmitz, M.D., Ph.D., Carol A. Rauch, M.D., Ph.D., Bret C. Mobley, M.D., Xuan J. Wang, M.D., Steven S. Spires, M.D., and Meredith E. Pugh, M.D., M.S.C.I.

From the Divisions of Infectious Diseases (A.C.P., J.L.C., S.S.S.) and Allergy, Pulmonary, and Critical Care Medicine (J.A.K., M.E.P.), Department of Medicine, and the Department of Pathology, Microbiology, and Immunology (J.E.S., C.A.R., B.C.M., X.J.W.), Vanderbilt University School of Medicine, Nashville. Address

reprint requests to Dr. Pettit at Vanderbilt University School of Medicine, 1161 21st Ave. S., A2200 Medical Center North, Nashville, TN 37232-2582, or at

Persistent neutrophilic meningitis presents a diagnostic challenge, because the differential diagnosis is broad and includes atypical infectious causes. We describe a case of persistent neutrophilic meningitis due to Aspergillus fumigatus in an immunocompetent man who had no evidence of sinopulmonary or cutaneous disease. An epidural glucocorticoid injection was identified as a potential route of entry for this organism into the central nervous system, and the case was reported to the state health department…..


November 29, 2012 at 8:07 am

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