Archive for March 8, 2013

The Spanish Society of Pediatric Infectious Diseases Guidelines for the diagnosis and treatment of congenital toxoplasmosis.

An Pediatr (Barc). 2013 Jan 22. S1695-4033(12)00541-3.

[Article in Spanish]

Baquero-Artigao F, Del Castillo Martín F, Fuentes Corripio I, Goncé Mellgren A, Fortuny Guasch C, de la Calle Fernández-Miranda M, González-Tomé MI, Couceiro Gianzo JA, Neth O, Ramos Amador JT; Grupo de Trabajo de Infección Congénita y Perinatal de la Sociedad Española de Infectología Pediátrica (SEIP).

Source

Coordinadores del documento, Unidad de Enfermedades Infecciosas, Hospital Infantil La Paz, Madrid, España. Electronic address: fbaquero@terra.es.

Abstract

Congenital toxoplasmosis is the result of transplacental fetal infection by Toxoplasma gondii after the primary maternal infection. The severity of the disease depends on the gestational age at transmission. First trimester infections are more severe, but less frequent, than third trimester infections. Acute maternal infection is diagnosed by seroconversion or by the detection of IgM antibodies and a low IgG avidity test. In these cases, spiramycin should be initiated to prevent transmission to the fetus. For identification of fetal infection, polymerase chain reaction (PCR) testing of amniotic fluid after 18 weeks gestation should be performed. If fetal infection is confirmed, the mothers should be treated with pyrimethamine, sulfadiazine and folinic acid. Most infants infected in utero are born with no obvious signs of toxoplasmosis, but up to 80% developed learning and visual disabilities later in life. Neonatal diagnosis with IgM/IgA antibodies or blood/cerebrospinal fluid PCR may be difficult because false-negative results frequently occur. In these cases diagnosis is possible by demonstrating a rise in IgG titers during follow-up or by the detection of antibodies beyond one year of age. Early treatment with pyrimethamine and sulfadiazine may improve the ophthalmologic and neurological outcome. Congenital toxoplasmosis is a preventable disease. Pre-pregnancy screening and appropriate counseling regarding prevention measures in seronegative women may prevent fetal infection.

PDF

http://apps.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=21569&pident_usuario=0&pcontactid=&pident_revista=37&ty=23&accion=L&origen=elsevier&web=www.elsevier.es&lan=es&fichero=S1695-4033(12)00541-3.pdf&eop=1

March 8, 2013 at 3:13 pm

Acyclovir reduces the duration of fever in patients with infectious mononucleosis-like illness.

Tohoku J Exp Med. 2013;229(2):137-42.

Usami O, Saitoh H, Ashino Y, Hattori T.

Source

Department of Comprehensive Infection, Tohoku University Hospital, Miyagi, Japan.

Abstract

Acyclovir is known for its antiviral activity against some pathogenic viruses such as the Epstein-Barr virus (EBV) that causes infectious mononucleosis (IM) and IM-like illness. Therefore, we empirically administered acyclovir to patients with suspected EBV-IM and IM like-illness, upon their admission to our hospital. We admitted 25 patients, who were hospitalized for fever and lymphadenopathy, to the Tohoku University Hospital Infectious Disease Ward. As part of treatment, 8 of these patients were given acyclovir (750 mg/day) with their consent and were assigned to the acyclovir group; the remaining 17 patients were assigned to the control group. The mean age of acyclovir patients (all men) was 42±5.2 years, and that of control patients (13 men and 4 women) was 31±3.0 years. The cause of illness was confirmed as EBV-IM in 6 patients (1, acyclovir; 5, control), and remained unknown for the other 19 IM-like illness patients (7, acyclovir; 12, control). A shorter duration of hospitalization and fever was observed in the acyclovir compared to that in the control patients (hospitalization duration: 16±3.7 vs. 27±7.7 days, P=0.36; fever duration: 4.5±1.8 vs. 18±6.5 days, P=0.04). Additionally, serum amyloid A (SAA) levels were lower in acyclovir than that in control patients (98±37 vs. 505±204 µg/mL, P=0.02). Therefore, we propose that acyclovir is a potential therapeutic agent for both EBV-IM and IM like-illnesses. Future studies should further examine its mechanism of action.

PDF

https://www.jstage.jst.go.jp/article/tjem/229/2/229_137/_pdf

March 8, 2013 at 3:10 pm

Diarrhoea in adults (acute).

Clin Evid (Online). 2011 Feb 15;2011.

Gottlieb T, Heather CS.

Source

Department of Microbiology and Infectious Diseases, Concord Hospital, Sydney, Australia.

Abstract

INTRODUCTION:

An estimated 4.6 billion cases of diarrhoea occurred worldwide in 2004, resulting in 2.2 million deaths.

METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for acute diarrhoea in adults living in resource-rich countries? What are the effects of treatments for acute mild-to-moderate diarrhoea in adults from resource-rich countries travelling to resource-poor countries? What are the effects of treatments for acute mild-to-moderate diarrhoea in adults living in resource-poor countries? What are the effects of treatments for acute severe diarrhoea in adults living in resource-poor countries? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).

RESULTS:

We found 72 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.

CONCLUSIONS:

In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics, antimotility agents, antisecretory agents, bismuth subsalicylate, diet, intravenous rehydration, nasogastric tube rehydration, oral rehydration solutions (amino acid oral rehydration solution, bicarbonate oral rehydration solution, reduced osmolarity oral rehydration solution, rice-based oral rehydration solution, standard oral rehydration solution), vitamin A supplementation, and zinc supplementation.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3217748/pdf/2011-0901.pdf

March 8, 2013 at 3:07 pm


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