Archive for June 20, 2014

Changing epidemiology of native valve infective endocarditis.

Rev Esp Cardiol. 2011 Jul;64(7):594-8.

Article in Spanish

Castillo JC, Anguita MP, Ruiz M, Peña L, Santisteban M, Puentes M, Arizón JM, Suárez de Lezo J.


Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain.



The aim of our study is to assess changes in the epidemiologic features of patients with native valve infective endocarditis.


We analyzed a prospective series of 228 cases of native valve infective endocarditis in non-intravenous drug users attending our center between 1987 and 2009. We compared three subperiods: 1987-1994 (67 cases), 1995-2002 (74 cases) and 2003-2009 (87 cases).


The mean age of patients has progressively increased (38±22 years in the first subperiod vs 60±16 years in the third; P<.001), as has the proportion of cases without predisposing heart disease (25%, 46% and 67%; P<.001). Incidence of mitral valve prolapse remained stable (12%, 18% and 11%). Percentages of patients with predisposing heart disease and who were aware of their condition have fallen in recent years (45%, 27% and 21%; P<.001). A portal of entry for the infection could not be identified in 64%. Overall, Staphylococcus aureus is the most frequent causative organism (26%) whereas the percentage of cases caused by Streptococcus viridans remains unaltered (22%, 20% and 24%).


We found significant changes in the epidemiology of native valve infective endocarditis. The incidence of patients without predisposing heart disease has increased significantly and staphylococci are the most frequent causative organisms.

Full English text available from:



June 20, 2014 at 4:14 pm

Infectious mononucleosis.

N Engl J Med. 2010 May 27;362(21):1993-2000.

Luzuriaga K, Sullivan JL.


Department of Pediatrics and Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA.



June 20, 2014 at 4:12 pm

Fulminant Epstein Barr virus encephalitis.

Indian Pediatr. 2013 Apr;50(4):418-9.

Mathew AG, Parvez Y.


Department of Pediatrics, Al-Jahra Hospital, Kuwait.


Epstein Barr virus (EBV) encephalitis is rare in children but can have severe neurological complications and sometimes fatal.

It can manifest with varied neurological presentations like meningoencephalitis, brain stem encephalitis, GBS etc.

This can appear alone or with clinical picture of infectious mononucleosis. Establishing a diagnosis of EBV encephalitis is difficult and consequently molecular, serological and imaging techniques should be used when investigating a child with encephalitis.

To highlight this entity we report two fatal cases of EBV meningoencephalitis presenting with sole neurological manifestations.


June 20, 2014 at 4:11 pm

Laboratory assays for Epstein-Barr virus-related disease.

J Mol Diagn. 2008 Jul;10(4):279-92.

Gulley ML, Tang W.


Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC 27599-7525, USA.


Epstein-Barr virus (EBV) infects various cell types in a wide spectrum of benign and malignant diseases.

Laboratory tests for EBV have improved and are increasingly used in diagnosis, prognosis, prediction, and prevention of diseases ranging from infectious mononucleosis to selected subtypes of lymphoma, sarcoma, and carcinoma.

Indeed, the presence of EBV is among the most effective tumor markers supporting clinical management of cancer patients. In biopsies, localization of EBER transcripts by in situ hybridization remains the gold standard for identifying latent infection.

Other RNA- and protein-based assays detect lytic viral replication and can distinguish carcinoma-derived from lymphocyte-derived EBV in saliva or nasopharyngeal brushings.

Analysis of blood using EBV viral load and serology reflects disease status and risk of progression.

This review summarizes prior research in the context of basic virologic principles to provide a rational strategy for applying and interpreting EBV tests in various clinical settings.

Such assays have been incorporated into standard clinical practice in selected settings such as diagnosis of primary infection and management of patients with immune dysfunction or nasopharyngeal carcinoma.

As novel therapies are developed that target virus-infected cells or overcome the adverse effects of infection, laboratory testing becomes even more critical for determining when intervention is appropriate and the extent to which it has succeeded.


June 20, 2014 at 4:09 pm

Once-weekly dalbavancin versus daily conventional therapy for skin infection.

N Engl J Med. 2014 Jun 5;370(23):2169-79.

Boucher HW1, Wilcox M, Talbot GH, Puttagunta S, Das AF, Dunne MW.

Author information

1From the Division of Infectious Diseases and Geographic Medicine, Tufts Medical Center and Tufts University School of Medicine, Boston (H.W.B.); the Department of Microbiology, Leeds Teaching Hospital and University of Leeds, Old Medical School, Leeds, United Kingdom (M.W.); Talbot Advisors, Anna Maria, FL (G.H.T.); Durata Therapeutics, Branford, CT (S.P., M.W.D.); and InClin, San Mateo, CA (A.F.D.).



Dalbavancin, a lipoglycopeptide antibiotic agent that is active against gram-positive pathogens, has a long plasma half-life, allowing for once-weekly dosing. DISCOVER 1 and DISCOVER 2 were identically designed noninferiority trials of dalbavancin for the treatment of acute bacterial skin and skin-structure infection.


We randomly assigned patients to receive dalbavancin intravenously on days 1 and 8 or vancomycin intravenously for at least 3 days with the option to switch to oral linezolid to complete 10 to 14 days of therapy. The primary end point, early clinical response, required the cessation of spread of infection-related erythema and the absence of fever at 48 to 72 hours. Secondary end points at the end of therapy included clinical status and investigator’s assessment of outcome.


Analysis of the primary end point showed noninferiority of dalbavancin in both DISCOVER 1 and DISCOVER 2. In the pooled analysis, 525 of 659 patients (79.7%) in the dalbavancin group and 521 of 653 (79.8%) in the vancomycin-linezolid group had an early clinical response indicating treatment success (weighted difference, -0.1 percentage point; 95% confidence interval, -4.5 to 4.2). The outcomes were similar in the analyses by study and the pooled analyses of clinical status at the end of therapy and the investigator’s assessment of outcome. For patients infected with Staphylococcus aureus, including methicillin-resistant S. aureus, clinical success was seen in 90.6% of the patients treated with dalbavancin and 93.8% of those treated with vancomycin-linezolid. Adverse events and study days with an adverse event were less frequent in the dalbavancin group than in the vancomycin-linezolid group. The most common treatment-related adverse events in either group were nausea, diarrhea, and pruritus.


Once-weekly intravenous dalbavancin was not inferior to twice-daily intravenous vancomycin followed by oral linezolid for the treatment of acute bacterial skin and skin-structure infection.

(Funded by Durata Therapeutics; DISCOVER 1 and DISCOVER 2 numbers, NCT01339091 and NCT01431339.).



June 20, 2014 at 4:03 pm


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