Archive for July, 2013

HIV Coinfection With Hepatitis C Virus: Evolving Epidemiology and Treatment Paradigms

CID 2012:55 (Suppl 1)

Lynn E. Taylor,1 Tracy Swan,2 and Kenneth H. Mayer3,4,5

1Department of Medicine, Brown University, Providence, Rhode Island;

2Treatment Action Group, New York, New York;

3Beth Israel DeaconessMedical Center,

4Harvard Medical School, and

5The Fenway Institute, Fenway Health, Boston, Massachusetts

Chronic hepatitis C virus (HCV) infection has become a major threat to the survival of human immunodeficiency virus (HIV)–infected persons in areas where antiretroviral therapy is available. In coinfection, viral eradication has been difficult to attain, and HCV therapy is underused. Novel therapies may be particularly beneficial for this population, yet studies lag behind those for HCV monoinfection. Increasingly, incident

HCV among HIV-infected men who have sex with men is associated with sexual risk behavior further research should be performed to refine understanding of the causal mechanism of this association. The phenomenon of aggressive hepatic fibrogenesis when HIV infection precedes HCV acquisition requires longer-term observation to ensure optimal timing of HCV therapy. Medical management in coinfection will be improved by enhancing HCV detection, with annual serologic testing, screening with HCV RNA to detect acute infection, and HIV testing of HCV-infected individuals; by addressing HCV earlier in coinfected persons; and by universal consideration for HCV therapy. HCV drug trials in individuals coinfected with HIV should be expedited. HIV/HCV coinfection remains a growing and evolving epidemic; new developments in therapeutics and improved care models offer promise.


July 28, 2013 at 7:12 pm

Guidance of antibiotic therapy with procalcitonin in lower respiratory tract infections: insights into the ProHOSP study.

Virulence. 2010 Mar-Apr;1(2):88-92.

Schuetz P, Christ-Crain M, Albrich W, Zimmerli W, Mueller B; ProHOSP Study Group.

Collaborators (45)


Department of Internal Medicine, Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Basel, Basel, Switzerland.


In the recently published ProHOSP trial, we investigated the safety and external validity of procalcitonin (PCT) guidance for antibiotic therapy in patients with different severities of lower respiratory tract infections, mainly pneumonia. In this addendum, we aim to extend the initial report by reinforcing the rational of the PCT algorithm and by presenting more detailed data on antibiotic therapy in different severities of infection. In milder, mostly viral respiratory infections (i.e. acute or chronic bronchitis) initial prescription of antibiotics was markedly reduced by PCT guidance because PCT remained low in most patients. In pneumonia, PCT showed a severity-dependent increase and highest levels in patients with positive blood cultures. Thus, the main effect in pneumonia was a severity- and bacteremia-adapted reduction of the duration of antibiotic courses. In lower respiratory tract infections, PCT guidance had a differential effect on antibiotic exposure depending on the underlying type and severity of respiratory tract infection.


July 28, 2013 at 3:06 pm

Protecting the tuberculosis drug pipeline: stating the case for the rational use of fluoroquinolones.

Eur Respir J. 2012 Oct;40(4):814-22.

Migliori GB, Langendam MW, D’Ambrosio L, Centis R, Blasi F, Huitric E, Manissero D, van der Werf MJ.


WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate, Italy.


The use of fluoroquinolones (FQs) to treat lower respiratory tract infections (LTRI) other than tuberculosis (TB) allows selection of FQ-resistant TB when TB is misdiagnosed. This study maps national guidelines on the use of FQs for LRTI in Europe and determines the risk of FQ-resistant TB upon FQ treatment before TB diagnosis. A questionnaire was developed to map existing national LRTI and community-acquired pneumonia (CAP) guidelines. A systematic review and meta-analysis were performed to determine the risk of FQ-resistant TB if prescribed FQs prior to TB diagnosis. 15 (80%) out of 24 responding European Respiratory Society national delegates reported having national LRTI management guidelines, seven including recommendations on FQ use and one recommending FQs as the first-choice drug. 18 out of 24 countries had national CAP management guidelines, two recommending FQ as the drug of choice. Six studies investigating FQ exposure and the risk of FQ-resistant TB were analysed. TB patients had a three-fold higher risk of having FQ-resistant TB when prescribed FQs before TB diagnosis, compared to non FQ-exposed patients (OR 2.81, 95% CI 1.47-5.39). Although the majority of European countries hold national LRTI/CAP guidelines, our results suggest that a risk of developing FQ resistance exists. Further strengthening of, and adherence to, guidelines is needed to ensure rational use of FQs.


July 28, 2013 at 3:04 pm

Edema palpebral como expresión oligosintomática de Mononucleosis Infecciosa

Rev Pediatr Aten Primaria 2012; 14:139-143

(Eyelid edema as an oligosymptomatic expression of Infectious Mononucleosis)

C.Remón García, M. A. Palacios Soria, M. Praena Crespo

Unidad de Pediatria, Hospital Infantil Virgen del Rocío, Sevilla (España)

La MI es una enfermedad frecuente en edad pediátrica, cuya máxima incidencia se encuentra en la 1ra infancia y en la adoescencia ó inicio de edad adulta. El edema palpebral bilateral (EPB) puede ser un hallazgo clínico sutil en el curso de dicha entidad, y aunque no forma parte de los síntomas característicos, puede estar presente al inicio del cuadro hasta en un tercio de los pacientes. Presentamos cuatro casos clínicos, en los cuales el EPB es el síntoma guía que orienta al diagnóstico, reflexionando así sobre la necesidad de incluir la MI dentro del diagnóstico diferencial planteado frente al edema palpebral.


July 28, 2013 at 3:00 pm

Novel therapies for treatment of multi-drug resistant Acinetobacter baumannii skin infections.

Virulence. 2011 Mar-Apr;2(2):97-102.

Mihu MR, Martinez LR.


Department of Medicine, Sound Shore Medical Center of Westchester, New Rochelle, NY, USA.


The Gram-negative coccobacillus Acinetobacter baumannii (Ab) has become an increasingly prevalent cause of hospital-acquired infections during the last two decades primarily resulting in pneumonia and complicated infections, including wound infections in troops injured in Afghanistan and Iraq. Moreover, the majority of clinical Ab isolates display high-level resistance to commonly utilized antimicrobial drugs, which severely compromises our capacity to care for patients with Ab disease. Thus, radically new approaches are urgently needed. This review focuses on novel therapies that can challenge the evolving ability of Ab to develop resistance and cause disease.




Acinetobacter baumannii, nosocomial infections, multidrug-resistant, antimicrobial therapy

July 28, 2013 at 2:58 pm

Multidrug-resistant Acinetobacter spp.: increasingly problematic nosocomial pathogens.

Yonsei Med J. 2011 Nov;52(6):879-91.

Lee K, Yong D, Jeong SH, Chong Y.


Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea.


Pathogenic bacteria have increasingly been resisting to antimicrobial therapy. Recently, resistance problem has been relatively much worsened in Gram-negative bacilli. Acinetobacter spp. are typical nosocomial pathogens causing infections and high mortality, almost exclusively in compromised hospital patients. Acinetobacter spp. are intrinsically less susceptible to antibiotics than Enterobacteriaceae, and have propensity to acquire resistance. A surveillance study in Korea in 2009 showed that resistance rates of Acinetobacter spp. were very high: to fluoroquinolone 67%, to amikacin 48%, to ceftazidime 66% and to imipenem 51%. Carbapenem resistance was mostly due to OXA type carbapenemase production in A. baumannii isolates, whereas it was due to metallo-β-lactamase production in non-baumannii Acinetobacter isolates. Colistin-resistant isolates were rare but started to be isolated in Korea. Currently, the infection caused by multidrug-resistant A. baumannii is among the most difficult ones to treat. Analysis at tertiary care hospital in 2010 showed that among the 1,085 isolates of Acinetobacter spp., 14.9% and 41.8% were resistant to seven, and to all eight antimicrobial agents tested, respectively. It is known to be difficult to prevent Acinetobacter spp. infection in hospitalized patients, because the organisms are ubiquitous in hospital environment. Efforts to control resistant bacteria in Korea by hospitals, relevant scientific societies and government agencies have only partially been successful. We need concerted multidisciplinary efforts to preserve the efficacy of currently available antimicrobial agents, by following the principles of antimicrobial stewardship.




Acinetobacter baumannii, multidrug resistance, OXA type carbapenemase, metallo-β-lactamase

July 28, 2013 at 2:57 pm

Colistin resistance of Acinetobacter baumannii: clinical reports, mechanisms and antimicrobial strategies.

J Antimicrob Chemother. 2012 Jul;67(7):1607-15.

Cai Y, Chai D, Wang R, Liang B, Bai N.


Department of Clinical Pharmacology, PLA General Hospital, Beijing 100853, People’s Republic of China.


Colistin is the last resort for treatment of multidrug-resistant Acinetobacter baumannii. Unfortunately, resistance to colistin has been reported all over the world. The highest resistance rate was reported in Asia, followed by Europe. The heteroresistance rate of A. baumannii to colistin is generally higher than the resistance rate. The mechanism of resistance might be loss of lipopolysaccharide or/and the PmrAB two-component system. Pharmacokinetic/pharmacodynamic studies revealed that colistin monotherapy is unable to prevent resistance, and combination therapy might be the best antimicrobial strategy against colistin-resistant A. baumannii. Colistin/rifampicin and colistin/carbapenem are the most studied combinations that showed promising results in vitro, in vivo and in the clinic. New peptides showing good activity against colistin-resistant A. baumannii are also being investigated.


multidrug resistance, heteroresistance, combination therapy

July 28, 2013 at 2:52 pm

Herpes Zoster

N Engl J of Medic July 18, 2013 V.369 P.255-263


Jeffrey I. Cohen, M.D.

From the Medical Virology Section, Laboratory of Infectious Diseases, National Institutes of Health, Bethesda, MD.

A 65-year-old man presents with a rash of 2 days’ duration over the right forehead with vesicles and pustules, a few lesions on the right side and tip of the nose, and slight blurring of vision in the right eye. The rash was preceded by tingling in the area and is now associated with aching pain. How should this patient be evaluated and treated?……


July 28, 2013 at 2:48 pm

Efficacy of single dose of gentamicin in combination with metronidazole versus multiple doses for prevention of post-caesarean infection: study protocol for a randomized controlled trial.

Trials. 2012 Jun 21;13:89.

Lyimo FM, Massinde AN, Kidenya BR, Konje E, Mshana SE.


Department of Obstetrics and Gynaecology, Catholic University of Health Sciences and Allied Science and Bugando Medical Centre, Box 1464, Mwanza, Tanzania.



Caesarean section is a commonly performed operation worldwide. It has been found to increase rates of maternal infectious morbidities more than five times when compared to vaginal delivery. Provision of intravenous prophylactic antibiotics 30 to 60 minutes prior to caesarean section has been found to reduce post-caesarean infection tremendously. Many centers recommend provision of a single dose of antibiotics, as repeated doses offer no benefit over a single dose. At Bugando Medical Centre post caesarean infection is among the top five causes of admission at the post-natal ward. Unfortunately, there is no consistent protocol for the administration of antibiotic prophylaxis to patients who are designated for caesarean section. Common practice and generally the clinician’s preference are to provide repeated dosages of antibiotic prophylaxis after caesarean section to most of the patients. This study aims to determine the comparative efficacy of a single dose of gentamicin in combination with metronidazole versus multiple doses for prevention of post caesarean infection.


The study is an interventional, open-label, two-armed, randomized, single-center study conducted at Bugando Medical Centre Mwanza, Tanzania. It is an ongoing trial for the period of seven months; 490 eligible candidates will be enrolled in the study. Study subjects will be randomly allocated into two study arms; “A” and “B”. Candidates in “A” will receive a single dose of gentamicin in combination with metronidazole 30 to 60 minutes prior to the operation and candidates in “B” will receive the same drugs prior to the operation and continue with gentamicin and metronidazole for 24 hours. The two groups will be followed up for a period of one month and assessed for signs and symptoms of surgical site infection. Data will be extracted from a case record form and entered into Epi data3.1 software before being transferred to SPSS version 17.0 for analysis. The absolute difference in proportion of women who develop surgical site infection in the two study arms will be the effectiveness of one regime over the other.


Current Controlled Trials ISRCTN44462542.


July 27, 2013 at 10:11 am

Antibiotics prophylaxis in connection with caesarean section–guidelines at Norwegian maternity departments.

Tidsskr Nor Laegeforen. 2011 Nov 29;131(23):2355-8.

Eriksen HM, Sæther AR, Økland I, Langen E, Sandness Y, Bødtker A, Skjeldestad FE.


Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, Norway.



The frequency of caesarean sections is increasing. Infection in operation wounds and/or underlying spaces and organs is a common complication. In Veileder I fødselshjelp [Clinical Guidelines in Obstetrics], 2008, antibiotic prophylaxis is recommended in the form of single dose ampicillin or first generation cephalosporins in connection with acute caesarean sections and under special conditions such as prolonged operations. We wanted to find out whether Norwegian maternity departments follow these recommendations.


All head senior consultants at maternity departments that carried out more than one caesarean section in 2008 were invited to take part in a survey of the department’s written guidelines for use of antibiotic prophylaxis in connection with caesarean section. The extent to which the guidelines were followed was evaluated using data from the Norwegian Surveillance System for Hospital-Associated Infections (NOIS).


38 of the 42 maternity wards in the investigation had written guidelines for antibiotic prophylaxis. Four of these maternity wards gave prophylaxis in all Caesarean sections, one only on indication, and 33 in acute Caesarean section. The guidelines varied as regards choice of type of antibiotic and time of administration. In the maternity wards with written guidelines recommending use of antibiotic prophylaxis in all Caesarean sections, were practice in accordance with the guidelines. When the guidelines recommended prophylactic use only in acute operations, there was agreement between practice and guidelines in 71 % to 97 % of the patients in the ward.


Most Norwegian maternity wards have written guidelines on antibiotic prophylaxis in Caesarean section. The contents of the guidelines varied but are mainly in agreement with current Norwegian recommendations


July 27, 2013 at 10:09 am

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