Archive for November, 2014

Clinical and Laboratory Findings of the First Imported Case of Middle East Respiratory Syndrome Coronavirus to the United States

Clinical Infectious Diseases December 1, 2014 V.59 N.11 P.1511-1518

Minal Kapoor1, Kimberly Pringle4, Alan Kumar2, Stephanie Dearth3, Lixia Liu3, Judith Lovchik3, Omar Perez3, Pam Pontones3, Shawn Richards3, Jaime Yeadon-Fagbohun3, Lucy Breakwell4, Nora Chea4, Nicole J. Cohen5, Eileen Schneider6, Dean Erdman6, Lia Haynes6, Mark Pallansch6, Ying Tao6, Suxiang Tong6, Susan Gerber6, David Swerdlow7, and Daniel R. Feikin6

1Division of Infectious Diseases

2Department of Emergency Medicine, Community Hospital, Munster

3Indiana State Department of Health, Indianapolis, Indiana

4Epidemic Intelligence Service, Division of Scientific Education and Professional Development

5Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases

6Division of Viral Diseases

7National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

Correspondence: Daniel R. Feikin, MD, MSPH, Division of Viral Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS-A34, Atlanta, GA 30030 (


The Middle East respiratory syndrome coronavirus (MERS-CoV) was discovered September 2012 in the Kingdom of Saudi Arabia (KSA). The first US case of MERS-CoV was confirmed on 2 May 2014.


We summarize the clinical symptoms and signs, laboratory and radiologic findings, and MERS-CoV–specific tests.


The patient is a 65-year-old physician who worked in a hospital in KSA where MERS-CoV patients were treated. His illness onset included malaise, myalgias, and low-grade fever. He flew to the United States on day of illness (DOI) 7. His first respiratory symptom, a dry cough, developed on DOI 10. On DOI 11, he presented to an Indiana hospital as dyspneic, hypoxic, and with a right lower lobe infiltrate on chest radiography. On DOI 12, his serum tested positive by real-time reverse transcription polymerase chain reaction (rRT-PCR) for MERS-CoV and showed high MERS-CoV antibody titers, whereas his nasopharyngeal swab was rRT-PCR negative. Expectorated sputum was rRT-PCR positive the following day, with a high viral load (5.31 × 106 copies/mL). He was treated with antibiotics, intravenous immunoglobulin, and oxygen by nasal cannula. He was discharged on DOI 22. The genome sequence was similar (>99%) to other known MERS-CoV sequences, clustering with those from KSA from June to July 2013.


This patient had a prolonged nonspecific prodromal illness before developing respiratory symptoms. Both sera and sputum were rRT-PCR positive when nasopharyngeal specimens were negative. US clinicians must be vigilant for MERS-CoV in patients with febrile and/or respiratory illness with recent travel to the Arabian Peninsula, especially among healthcare workers.


November 30, 2014 at 8:13 pm

Update on Acinetobacter Species: Mechanisms of Antimicrobial Resistance and Contemporary In Vitro Activity of Minocycline and Other Treatment Options

Clinical Infectious Diseases December 1, 2014 V.59 suppl 6  S367-S373

Mariana Castanheira, Rodrigo E. Mendes, and Ronald N. Jones

JMI Laboratories, North Liberty, Iowa

Correspondence: Mariana Castanheira, PhD, 345 Beaver Kreek Centre, Ste A, North Liberty, IA 52317 (

Among Acinetobacter species, A. baumannii and other closely related species are commonly implicated in nosocomial infections. These organisms are usually multidrug resistant (MDR), and therapeutic options to treat A. baumannii infections are very limited.

Clinicians have been resorting to older antimicrobial agents to treat infections caused by MDR A. baumannii, and some of these agents have documented toxicity and/or are not optimized for the infection type to be treated.

Recent clinical experience supported by antimicrobial susceptibility data suggests that minocycline has greater activity than other tetracyclines and glycylcyclines against various MDR pathogens that have limited therapeutic options available, including Acinetobacter species.

An intravenous formulation of minocycline has recently become available for clinical use, and in contrast to most older tetracyclines, minocycline has high activity against Acinetobacter species.

In this report, we summarized some of the characteristics of the tetracycline class, and quantified the minocycline activity against contemporary (2007–2011) isolates and its potential therapeutic role against a collection of 5477 A. baumannii and other relevant gram-negative organisms when compared directly with tetracycline, doxycycline, and other broad-spectrum antimicrobial agents.

Acinetobacter baumannii strains were highly resistant to all agents tested, with the exception of minocycline (79.1% susceptible) and colistin (98.8% susceptible).

Minocycline (minimum inhibitory concentration that inhibits 50% and 90% of the isolates [MIC50/90]: 1/8 µg/mL) displayed greater activity than doxycycline (MIC50/90: 2/>8 µg/mL) and tetracycline hydrochloride (HCL) (only 30.2% susceptible) against A. baumannii isolates, and was significantly more active than other tetracyclines against Burkholderia cepacia, Escherichia coli, Serratia marcescens, and Stenotrophomonas maltophilia isolates.

In vitro susceptibility testing using tetracycline HCL as a surrogate for the susceptibility other tetracyclines fails to detect minocycline-susceptible isolates and the potential utility of minocycline for the treatment of many MDR A. baumannii infections and other difficult-to-treat species, where there are often limited choices of antimicrobials.


November 30, 2014 at 8:10 pm

Minocycline: An Old Drug for a New Bug: Multidrug-Resistant Acinetobacter baumannii

Clinical Infectious Diseases December 1, 2014 V.59 suppl 6  S365-S366

Debra A. Goff1 and Keith S. Kaye2,3

1Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus

2Department of Medicine, Division of Infectious Diseases, Detroit Medical Center

3Wayne State University School of Medicine, Detroit, Michigan

Correspondence: Debra A. Goff, PharmD, FCCP, The Ohio State University Wexner Medical Center, Department of Pharmacy, 410 W 10th Ave, Rm 368 Doan Hall, Columbus, OH 43210 (

Acinetobacter baumannii is listed in the Centers for Disease Control and Prevention’s (CDC) report “Antibiotic Resistance Threats in the United States, 2013” as 1 of 18 microorganisms whose threat level is “urgent,” “serious,” or “concerning” according to their current and projected health and economic impacts [1].

The A. baumannii threat level is ranked as “serious” and carries a warning that this organism requires prompt and sustained action by healthcare providers to ensure that this problem pathogen does not continue to become more resistant to antimicrobials and spread.

The CDC estimates that nearly 7000 of 12 000 (63%) healthcare-associated Acinetobacter infections are multidrug resistant (MDR), defined as resistance to ≥3 different classes of antimicrobials.

Hospitals around the world are witnessing the loss of antibiotics for the treatment of MDR A. baumannii (MDR-AB) infections [2].

The lack of clinically effective antimicrobials to treat A. baumannii infections has led clinicians to reevaluate other “older” agents for the treatment of MDR-AB…..


November 30, 2014 at 8:07 pm

Are antibiotics indicated for the treatment of aspiration pneumonia?

Cleve Clin J Med 1 September 2010 V.77 N.9 p.573-576


Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, Cleveland Clinic


Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, Cleveland Clinic

Antibiotics are indicated for primary bacterial aspiration pneumonia and secondary bacterial infection of aspiration (chemical) pneumonitis, but not for uncomplicated chemical pneumonitis.



November 21, 2014 at 8:50 am

Interferon-gamma-release assays: Better than tuberculin skin testing?

Cleve Clin J Med 1 September 2010 V.77 N.9 p.606-611


Department of Infectious Disease, Medicine Institute, Cleveland Clinic


Head, Section of Granulomatous Infections, Department of Infectious Disease, Medicine Institute, Cleveland Clinic


Chairman, Department of Infectious Disease, Medicine Institute, Cleveland Clinic


Although the tuberculin skin test has long been the standard for detecting latent tuberculosis infection, it has many limitations.

Interferon-gamma-release assays are gaining acceptance as an alternative.

In this paper we present cases to illustrate how these new tests can be used and how to interpret the results.



November 21, 2014 at 8:49 am

Hepatitis C virus: Prevention, screening, and interpretation of assays

Cleve Clin J Med 1 September 2010 V.77 N.9 p.616-626


Department of Internal Medicine, Cleveland Clinic


Department of Internal Medicine, Cleveland Clinic


Transplant Center and Digestive Disease Institute, Cleveland Clinic; Director, Center for Continuing Education; Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University


Patients at risk of hepatitis C virus (HCV) infection should be screened for it so that they can be treated and potentially cured, or can at least avoid transmitting the disease to others.

The authors describe why and how to screen for HCV and how to interpret the test results.



November 21, 2014 at 8:47 am

The Burden of Illness in International Travelers

N. Engl. J of Med Jan.12, 2006 V.354 N.2 P.115-117

David R. Hill, M.D., D.T.M.&H.

In 2004, 763 million people crossed international borders, reflecting an increase of 73 percent over the course of 15 years.1 International travel has rebounded since the attacks of September 11, 2001, and is steadily increasing despite a variety of global health crises, the threat of terrorism, and the war in Iraq.

Nearly 55 percent of travelers are vacationing, and about 15 percent are conducting business, but a growing number are visiting friends and relatives.

Typically, such travelers were born in a resource-poor country, now live in a resource-rich country, and are returning to their country of birth to visit.

Moreover, though most people travel voluntarily, thousands of uncounted travelers cross borders to flee war or persecution or to seek better opportunities.

During the past 25 years, a new specialty of travel medicine has evolved to address the health of these international travelers — particularly those who visit resource-poor regions.

Travel to these regions carries health risks and requires preventive measures that may be unfamiliar to many physicians……



November 21, 2014 at 8:46 am

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