Archive for January, 2013

Acute viral infections in immunocompetent patients.

Med Intensiva. 2011 Apr;35(3):179-85.

Díaz A, Zaragoza R, Granada R, Salavert M.


Servicio de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España.


Viruses play a significant role in serious infections in adults and sometimes lead to the need for hospitalization and admission to intensive care units, especially in cases of severe respiratory distress or encephalopathy. Influenza and parainfluenza viruses, syncytial respiratory virus, herpes viruses and adenovirures are the most frequent causes of these severe infections. A review of the literature has been performed in order to update the epidemiology, pathogenesis and therapeutic approach of viral infections affecting immunocompetent patients. Furthermore, ventilator-associated pneumonia (VAP) is the most frequent nosocomial infection in intensive care units and has a high morbidity and mortality rate. It is mainly a bacterial disease, although the potential role of viruses as pathogens or copathogens in VAP is under discussion. Therefore, a brief review of the potential pathogenic role of viruses in VAP has also been performed.


January 31, 2013 at 5:59 pm

Clinical and temporal patterns of severe pneumonia causing critical illness during Hajj.

BMC Infect Dis. 2012 May 16;12:117.

Mandourah Y, Al-Radi A, Ocheltree AH, Ocheltree SR, Fowler RA.


Department of Intensive Care, Riyadh Military Hospital, P.O. Box 789711159, Riyadh, Kingdom of Saudi Arabia.



Pneumonia is a leading cause of hospitalization during Hajj and susceptibility and transmission may be exacerbated by extreme spatial and temporal crowding. We describe the number and temporal onset, co-morbidities, and outcomes of severe pneumonia causing critical illness among pilgrims.


A cohort study of all critically ill Hajj patients, of over 40 nationalities, admitted to 15 hospitals in 2 cities in 2009 and 2010. Demographic, clinical, and laboratory data, and variables necessary for calculation of the Acute Physiology and Chronic Health Evaluation IV scores were collected.


There were 452 patients (64.6% male) who developed critical illness. Pneumonia was the primary cause of critical illness in 123 (27.2%) of all intensive care unit (ICU) admissions during Hajj. Pneumonia was community (Hajj)-acquired in 66.7%, aspiration-related in 25.2%, nosocomial in 3.3%, and tuberculous in 4.9%. Pneumonia occurred most commonly in the second week of Hajj, 95 (77.2%) occurred between days 5-15 of Hajj, corresponding to the period of most extreme pilgrim density. Mechanical ventilation was performed in 69.1%. Median duration of ICU stay was 4 (interquartile range [IQR] 1-8) days and duration of ventilation 4 (IQR 3-6) days. Commonest preexisting co-morbidities included smoking (22.8%), diabetes (32.5%), and COPD (17.1%). Short-term mortality (during the 3-week period of Hajj) was 19.5%.


Pneumonia is a major cause of critical illness during Hajj and occurs amidst substantial crowding and pilgrim density. Increased efforts at prevention for at risk pilgrim prior to Hajj and further attention to spatial and physical crowding during Hajj may attenuate this risk.


January 31, 2013 at 5:57 pm

Human coronaviruses: insights into environmental resistance and its influence on the development of new antiseptic strategies.

Viruses. 2012 Nov 12;4(11):3044-68.

Geller C, Varbanov M, Duval RE.


UMR 7565, SRSMC, Université de Lorraine-CNRS, Faculty of Pharmacy, 5 rue Albert Lebrun, BP 80403, 54001 Nancy Cedex, France.


The Coronaviridae family, an enveloped RNA virus family, and, more particularly, human coronaviruses (HCoV), were historically known to be responsible for a large portion of common colds and other upper respiratory tract infections. HCoV are now known to be involved in more serious respiratory diseases, i.e. bronchitis, bronchiolitis or pneumonia, especially in young children and neonates, elderly people and immunosuppressed patients. They have also been involved in nosocomial viral infections. In 2002-2003, the outbreak of severe acute respiratory syndrome (SARS), due to a newly discovered coronavirus, the SARS-associated coronavirus (SARS-CoV); led to a new awareness of the medical importance of the Coronaviridae family. This pathogen, responsible for an emerging disease in humans, with high risk of fatal outcome; underline the pressing need for new approaches to the management of the infection, and primarily to its prevention. Another interesting feature of coronaviruses is their potential environmental resistance, despite the accepted fragility of enveloped viruses. Indeed, several studies have described the ability of HCoVs (i.e. HCoV 229E, HCoV OC43 (also known as betacoronavirus 1), NL63, HKU1 or SARS-CoV) to survive in different environmental conditions (e.g. temperature and humidity), on different supports found in hospital settings such as aluminum, sterile sponges or latex surgical gloves or in biological fluids. Finally, taking into account the persisting lack of specific antiviral treatments (there is, in fact, no specific treatment available to fight coronaviruses infections), the Coronaviridae specificities (i.e. pathogenicity, potential environmental resistance) make them a challenging model for the development of efficient means of prevention, as an adapted antisepsis-disinfection, to prevent the environmental spread of such infective agents. This review will summarize current knowledge on the capacity of human coronaviruses to survive in the environment and the efficacy of well-known antiseptic-disinfectants against them, with particular focus on the development of new methodologies to evaluate the activity of new antiseptic-disinfectants on viruses.


January 31, 2013 at 5:55 pm

An unprecedented outbreak investigation for nosocomial and community-acquired legionellosis in Hong Kong.

Chin Med J (Engl). 2012 Dec;125(23):4283-90.

Cheng VC, Wong SS, Chen JH, Chan JF, To KK, Poon RW, Wong SC, Chan KH, Tai JW, Ho PL, Tsang TH, Yuen KY.


Department of Microbiology, Queen Mary Hospital, Hong Kong, China.



The environmental sources associated with community-acquired or nosocomial legionellosis were not always detectable in the mainland of China and Hong Kong, China. The objective of this study was to illustrate the control measures implemented for nosocomial and community outbreaks of legionellosis, and to understand the environmental distribution of legionella in the water system in Hong Kong, China.


We investigated the environmental sources of two cases of legionellosis acquired in the hospital and the community by extensive outbreak investigation and sampling of the potable water system using culture and genetic testing at the respective premises.


The diagnosis of nosocomial legionellosis was suspected in a patient presenting with nosocomial pneumonia not responsive to multiple beta-lactam antibiotics with subsequent confirmation by Legionella pneumophila serogroup 1 antigenuria. High counts of Legionella pneumophila were detected in the potable water supply of the 70-year-old hospital building. Another patient on continuous ambulatory peritoneal dialysis presenting with acute community-acquired pneumonia and severe diarrhoea was positive for Legionella pneumophila serogroup 1 by polymerase chain reaction (PCR) testing on both sputum and nasopharyngeal aspirate despite negative antigenuria. Paradoxically the source of the second case was traced to the water system of a newly commissioned office building complex. No further cases were detected after shock hyperchlorination with or without superheating of the water systems. Subsequent legionella counts were drastically reduced. Point-of-care infection control by off-boiled or sterile water for mouth care and installation of water filter for showers in the hospital wards for immunocompromised patients was instituted. Territory wide investigation of the community potable water supply showed that 22.1% of the household water supply was positive at a mean legionella count of 108.56 CFU/ml (range 0.10 to 639.30 CFU/ml).


Potable water systems are open systems which are inevitably colonized by bacterial biofilms containing Legionella species. High bacterial counts related to human cases may occur with stagnation of flow in both old or newly commissioned buildings. Vigilance against legionellosis is important in healthcare settings with dense population of highly susceptible hosts.


January 31, 2013 at 5:53 pm

MEDICINA (Buenos Aires) 2012; 72: 484-494



Sociedad Argentina de Infectología (SADI),2Sociedad Argentina de Pediatría (SAP), 3Sociedad Argentina de Medicina (SAM), 4Sociedad Argentina de Bacteriología, Micología y Parasitología Clínica (SADEBAC)

Las infecciones respiratorias altas son la primera causa de prescripción de antibióticos. La faringitis aguda es de origen viral en la mayoría de los casos; los episodios virales pueden diferenciarse de  los de origen bacteriano producidos por Streptococcus pyogenes por criterios clínico-epidemiológicos (criterios  de Centor), por pruebas diagnósticas rápidas o por el cultivo de fauces. Cuando la etiología es estreptocócica,  la droga de elección es penicilina V (cada 12 horas). La otitis media aguda (OMA) es una de las causas más  frecuentes de prescripción de antibióticos en niños. Los patógenos principales son Streptococcus pneumoniae,  Haemophilus influenzae no tipable y Moraxella catarrhalis. Los antecedentes, la evaluación clínica junto con la otoscopía permiten establecer el diagnóstico. En niños menores de 2 años se recomienda tratamiento antibiótico precoz al igual que en niños mayores de 2 años con otitis bilateral, otorrea, presencia de comorbilidad o cuadro clínico grave. En la Argentina, debido a los bajos niveles de resistencia de S. pneumoniae a penicilina la droga de elección es amoxicilina; ante falta de respuesta al tratamiento puede utilizarse amoxicilina/clavulánico para cubrir cepas de H. influenzae y de M. catarrhalis productoras de betalactamasas. Las rinosinusitis son virales en la mayoría de los casos y menos del 5% se complican con sinusitis bacteriana. El diagnóstico es clínico y en general no se requieren estudios complementarios. Los patógenos bacterianos implicados son los mismos que causan OMA, por esta razón también se recomienda la amoxicilina como droga de elección…


January 31, 2013 at 5:51 pm

Clinical features and the role of atypical pathogens in nursing and healthcare-associated pneumonia (NHCAP): differences between a teaching university hospital and a community hospital.

Intern Med. 2012;51(6):585-94.

Miyashita N, Kawai Y, Akaike H, Ouchi K, Hayashi T, Kurihara T, Okimoto N.


Department of Internal Medicine I, Kawasaki Medical School, Japan.



The Japan Respiratory Society documented a new category of guidelines for nursing and healthcare-associated pneumonia (NHCAP), which is distinct from community acquired pneumonia (CAP). The objective of this study was to determine the epidemiological differences between NHCAP patients in a teaching university hospital and a community hospital. In addition, to clarify the strategy for treatment of NHCAP, we investigated the role of atypical pathogens.


We analyzed 250 NHCAP and 421 CAP cases in a university hospital and 349 NHCAP and 374 CAP cases in a community hospital.


Patient age and the incidences of poor general condition were significantly higher in the community hospital compared with those in the university hospital. The distribution and frequency of pathogens, especially multidrug-resistant (MDR) pathogens, were significantly different between the two hospitals. Central nervous system disorders, dementia and poor performance status, which was possibility related to aspiration pneumonia, were significantly more frequent in patients with NHCAP compared with those with CAP in both hospitals. Atypical pathogens were detected in a few cases in patients with NHCAP.


There were many differences in the clinical characteristics between NHCAP patients in a university hospital and a community hospital even for hospitals located in the same area. Aspiration pneumonia was thought to be the main characteristic of NHCAP in both hospitals. Thus, all NHCAP patients did not need the same empiric therapy with a multidrug regimen directed against MDR pathogens. In addition, physicians rarely need to consider atypical pathogens in NHCAP treatment.


January 24, 2013 at 3:08 pm

The Future of Antibiotics and Resistance

N Engl J of Med  January 2013 V.368 P.299-302


Brad Spellberg, M.D., John G. Bartlett, M.D., and David N. Gilbert, M.D.

From the Division of General Internal Medicine, Los Angeles Biomedical Research Institute at Harbor–University of California Los Angeles (UCLA) Medical Center and the David Geffen School of Medicine at UCLA, Los Angeles (B.S.); the Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore (J.G.B.); and the Department of Medical Education, Providence Portland Medical Center and Oregon Health Sciences University, Portland (D.N.G.).

In its recent annual report on global risks, the World Economic Forum (WEF) concluded that “arguably the greatest risk . . . to human health comes in the form of antibiotic-resistant bacteria. We live in a bacterial world where we will never be able to stay ahead of the mutation curve. A test of our resilience is how far behind the curve we allow ourselves to fall….


January 24, 2013 at 3:07 pm

Risk of Fetal Death after Pandemic Influenza Virus Infection or Vaccination

N Engl J of Med  January 2013 V.368 P.333-340

Siri E. Håberg, M.D., Ph.D., Lill Trogstad, M.D., Ph.D., Nina Gunnes, Ph.D., Allen J. Wilcox, M.D., Ph.D., Håkon K. Gjessing, Ph.D., Sven Ove Samuelsen, Ph.D., Anders Skrondal, Ph.D., Inger Cappelen, Ph.D., Anders Engeland, Ph.D., Preben Aavitsland, M.D., Steinar Madsen, M.D., Ingebjørg Buajordet, Ph.D., Kari Furu, Ph.D., Per Nafstad, M.D., Ph.D., Stein Emil Vollset, M.D., Dr.P.H., Berit Feiring, M.Sc.Pharm., Hanne Nøkleby, M.D., Per Magnus, M.D., Ph.D., and Camilla Stoltenberg, M.D., Ph.D.


During the 2009 influenza A (H1N1) pandemic, pregnant women were at risk for severe influenza illness. This concern was complicated by questions about vaccine safety in pregnant women that were raised by anecdotal reports of fetal deaths after vaccination.


We explored the safety of influenza vaccination of pregnant women by linking Norwegian national registries and medical consultation data to determine influenza diagnosis, vaccination status, birth outcomes, and background information for pregnant women before, during, and after the pandemic. We used Cox regression models to estimate hazard ratios for fetal death, with the gestational day as the time metric and vaccination and pandemic exposure as time-dependent exposure variables.


There were 117,347 eligible pregnancies in Norway from 2009 through 2010. Fetal mortality was 4.9 deaths per 1000 births. During the pandemic, 54% of pregnant women in their second or third trimester were vaccinated. Vaccination during pregnancy substantially reduced the risk of an influenza diagnosis (adjusted hazard ratio, 0.30; 95% confidence interval [CI], 0.25 to 0.34). Among pregnant women with a clinical diagnosis of influenza, the risk of fetal death was increased (adjusted hazard ratio, 1.91; 95% CI, 1.07 to 3.41). The risk of fetal death was reduced with vaccination during pregnancy, although this reduction was not significant (adjusted hazard ratio, 0.88; 95% CI, 0.66 to 1.17).


Pandemic influenza virus infection in pregnancy was associated with an increased risk of fetal death. Vaccination during pregnancy reduced the risk of an influenza diagnosis. Vaccination itself was not associated with increased fetal mortality and may have reduced the risk of influenza-related fetal death during the pandemic. (Funded by the Norwegian Institute of Public Health.)


January 24, 2013 at 3:06 pm

Epidemic Influenza — Responding to the Expected but Unpredictable

N Engl J of Med  January 24, 2013


Joseph Bresee, M.D., and Frederick G. Hayden, M.D.

From the Epidemiology and Prevention Branch, Influenza Division, Centers for Disease Control and Prevention, Atlanta (J.B.); and the Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville (F.G.H.).

In the United States, influenza viruses can be counted on to cause outbreaks sometime between fall and spring each year. However, the timing and severity of these epidemics and the distribution of circulating viruses are highly variable and difficult to predict (see figure). For example, according to the Centers for Disease Control and Prevention (CDC), the estimated number of influenza-associated deaths varies from 3000 to 48,000 during a seasonal U.S. outbreak…


January 24, 2013 at 3:04 pm

Psittacosis outbreak in Tayside, Scotland, December 2011 to February 2012.

Euro Surveill. 2012 May 31;17(22). pii: 20186.

McGuigan CC, McIntyre PG, Templeton K.


Directorate of Public Health, NHS Tayside, Kings Cross Hospital, Dundee, UK.


A Tayside outbreak of psittacosis December 2011–February 2012 involved three confirmed and one probable cases. Confirmed cases were indistinguishable by sequencing of polymerase chain reaction (PCR) products. The epidemiological pattern suggested person-to-person spread as illness onset dates were consistent with the incubation period and no single common exposure could explain the infections. In particular the only common exposure for a healthcare worker case is overlap in place and time with the symptomatic index case.


January 23, 2013 at 9:16 am

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