Archive for January, 2015

Update: Ebola Virus Disease Epidemic — West Africa, January 2015

MMWR January 30, 2015 V.64 P.1-2

Incident Management System Ebola Epidemiology Team, CDC; Guinea Interministerial Committee for Response Against the Ebola Virus; World Health Organization; CDC Guinea Response Team; Liberia Ministry of Health and Social Welfare; CDC Liberia Response Team; Sierra Leone Ministry of Health and Sanitation; CDC Sierra Leone Response Team; Viral Special Pathogens Branch, National Center for Emerging and Zoonotic Infectious Diseases, CDC

CDC is assisting ministries of health and working with other organizations to end the ongoing epidemic of Ebola virus disease (Ebola) in West Africa (1). The updated data in this report were compiled from situation reports from the Guinea Interministerial Committee for Response Against the Ebola Virus, the Liberia Ministry of Health and Social Welfare, the Sierra Leone Ministry of Health and Sanitation, and the World Health Organization…

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http://www.cdc.gov/mmwr/pdf/wk/mm64e0130.pdf

January 30, 2015 at 7:47 pm

Delayed HIV diagnosis common in Sweden, 2003–2010

Scandinavian Journal of Infectious Diseases Dec 2014

Katarina Widgren, Helena Skar, Torsten Berglund, Anna-Maria Kling, Anders Tegnell, and Jan Albert

From the 1Department for Monitoring and Evaluation, Public Health Agency of Sweden, Solna, Sweden*

2Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden

3Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden

4Theoretical Biology and Biophysics, T-6, Los Alamos National Laboratory, NM, USA

5Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden

6Department of Science and Technology, Linköping University, Linköping, Sweden

*Previously the Department for Analysis and Prevention, Swedish Institute for Communicable Disease Control, Solna, Sweden.

Correspondence: Katarina Widgren, Folkhälsomyndigheten, 171 82 Solna, Sweden. E-mail: Widgren.katarina@gmail.com

Background

Early diagnosis of HIV is important for the prognosis of individual patients, because antiretroviral treatment can be started at the appropriate time, and for public health, because transmission can be prevented.

Methods

Data were collected from 767 HIV patients who were diagnosed in Sweden during 2003–2010 and were infected in Sweden or born in Sweden and infected abroad. A recent infection testing algorithm (RITA) was applied to BED-EIA test results (OD-n < 0.8), CD4 counts (≥ 200 cells/μl), and clinical information. A recent infection classification was used as indicator for early diagnosis. Time trends in early diagnosis were investigated to detect population changes in HIV testing behavior. Patients with early diagnosis were compared to patients with delayed diagnosis with respect to age, gender, transmission route, and country of infection (Sweden or abroad).

Results

Early diagnosis was observed in 271 patients (35%). There was no statistically significant time trend in the yearly percentage of patients with early diagnosis in the entire study group (p = 0.836) or in subgroups. Early diagnosis was significantly more common in men who have sex men (MSM) (45%) than in heterosexuals (21%) and injecting drug users (27%) (p < 0.001 and p = 0.001, respectively) in both univariate and multivariable analyses. The only other factor that remained associated with early diagnosis in multivariable analysis was young age group.

Conclusion

Approximately one-third of the study patients were diagnosed early with no significant change over time. Delayed HIV diagnosis is a considerable problem in Sweden, which does not appear to diminish.

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http://informahealthcare.com/doi/pdfplus/10.3109/00365548.2014.953575

January 29, 2015 at 8:41 am

Risk of HIV transmission from patients on antiretroviral therapy: A position statement from the Public Health Agency of Sweden and the Swedish Reference Group for Antiviral Therapy

Scandinavian Journal of Infectious Diseases OCT 2014 V.46 N.10

Jan Albert , Torsten Berglund , Magnus Gisslén , Peter Gröön , Anders Sönnerborg , Anders Tegnell , Anders Alexandersson , Ingela Berggren , Anders Blaxhult , Maria Brytting , Christina Carlander , Johan Carlson , Leo Flamholc , Per Follin , Axana Haggar , Frida Hansdotter , Filip Josephson , Olle Karlström , Fredrik Liljeros , Lars Navér , Karin Pettersson , Veronica Svedhem Johansson , Bo Svennerholm , Petra Tunbäck , Katarina Widgren

From the 1Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm

2Department of Clinical Microbiology, Karolinska University Hospital, Stockholm

3The Swedish Reference Group for Antiviral Therapy, Solna

4The Public Health Agency of Sweden, Solna

5Department of Infectious Diseases, University of Gothenburg, Gothenburg

6Department of Communicable Diseases Control and Prevention, Stockholm County Council, Stockholm

7Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, Stockholm

8Department of Infectious Diseases, Karolinska University Hospital, Stockholm

9National Board of Health and Welfare, Stockholm

10Venhälsan/Infektion, Södersjukhuset, Stockholm

11Clinic of Infectious Diseases, County Hospital of Västmanland, Västerås

12Department of Infectious Diseases, University of Lund, Skåne University Hospital, Malmö

13Department of Communicable Disease Control and Prevention, Region Västra Götaland, Gothenburg

14Swedish Medical Products Agency, Uppsala

15Department of Sociology, Stockholm University, Stockholm

16Department of Paediatrics, Karolinska University Hospital, Stockholm

17Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm

18Department of Obstetrics, Karolinska University Hospital, Huddinge, Stockholm

19Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm

20Department of Clinical Virology, Sahlgrenska Academy, University of Gothenburg, Gothenburg

21Department of Dermatovenereology, University of Gothenburg, Gothenburg, Sweden

Correspondence: J. Albert, Department of Clinical Microbiology L2:02, Karolinska University Hospital Solna, S-171 76 Stockholm, Sweden. Tel: + 46 8 5177 9471. E-mail: jan.albert@ki.se

The modern medical treatment of HIV with antiretroviral therapy (ART) has drastically reduced the morbidity and mortality in patients infected with this virus. ART has also been shown to reduce the transmission risk from individual patients as well as the spread of the infection at the population level. This position statement from the Public Health Agency of Sweden and the Swedish Reference Group for Antiviral Therapy is based on a workshop organized in the fall of 2012. It summarizes the latest research and knowledge on the risk of HIV transmission from patients on ART, with a focus on the risk of sexual transmission. The risk of transmission via shared injection equipment among intravenous drug users is also examined, as is the risk of mother-to-child transmission. Based on current knowledge, the risk of transmission through vaginal or anal intercourse involving the use of a condom has been judged to be minimal, provided that the person infected with HIV fulfils the criteria for effective ART. This probably also applies to unprotected intercourse, provided that no other sexually transmitted infections are present, although it is not currently possible to fully support this conclusion with direct scientific evidence. ART is judged to markedly reduce the risk of blood-borne transmission between people who share injection equipment. Finally, the risk of transmission from mother to child is very low, provided that ART is started well in advance of delivery.

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http://informahealthcare.com/doi/pdfplus/10.3109/00365548.2014.926565

January 29, 2015 at 8:40 am

Nonfoodborne Vibrio infections: an important cause of morbidity and mortality in the United States, 1997-2006.

Clinical Infectious Diseases April 1, 2008 V.46 N.7 P.970-6

Dechet AM, Yu PA, Koram N, Painter J

1AIDS Education and Training Center, San Francisco General Hospital, San Francisco, California

2Enteric Diseases Epidemiology Branch, Division of Foodborne, Bacterial and Mycotic Diseases, National Center for Zoonotic, Vectorborne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

Reprints or correspondence: Dr. John Painter, Centers for Disease Control and Prevention, 1600 Clifton Rd., Mailstop E-03, Atlanta, GA 30333 (jpainter@cdc.gov).

BACKGROUND

Infections due to Vibrio species cause an estimated 8000 illnesses annually, often through consumption of undercooked seafood. Like foodborne Vibrio infections, nonfoodborne Vibrio infections (NFVI) also result in serious illness, but awareness of these infections is limited.

METHODS

We analyzed illnesses occuring during the period 1997-2006 that were reported to the Centers for Disease Control and Prevention’s Cholera and Other Vibrio Illness Surveillance system. The diagnosis of NFVI required isolation of Vibrio species from a patient with contact with seawater.

RESULTS

Of 4754 Vibrio infections reported, 1210 (25%) were NFVIs. Vibrio vulnificus infections were the most common (accounting for 35% of NFVIs), with 72% of V. vulnificus infections reported from residents of Gulf Coast states. Infections due to V. vulnificus resulted in fever (72% of cases), cellulitis (85%), amputation (10%), and death (17%). V. vulnificus caused 62 NFVI-associated deaths (78%). Recreational activities accounted for 70% of exposures for patients with NFVIs associated with all species. Patients with liver disease were significantly more likely to die as a result of infection (odds ratio, 7.8; 95% confidence interval, 2.8-21.9). Regardless of pre-existing conditions, patients were more likely to die when hospitalization occurred >2 days after symptom onset (odds ratio, 2.9; 95% confidence interval, 1.8-4.8).

CONCLUSION

NFVIs, especially those due to V. vulnificus, demonstrate high morbidity and mortality. Persons with liver disease should be advised of the risks associated with seawater exposure if a wound is already present or is likely to occur. Clinicians should consider Vibrio species as an etiologic agent in infections occurring in persons with recent seawater exposure, even if the individual was only exposed during recreational marine activities. Immediate antibiotic treatment with aggressive monitoring is advised in suspected cases.

PDF

http://cid.oxfordjournals.org/content/46/7/970.full.pdf+html

January 27, 2015 at 8:51 am

Increasing rates of vibriosis in the United States, 1996-2010: review of surveillance data from 2 systems.

Clinical Infectious Diseases June 2012 V.54 Suppl 5 P.S391-5

Newton A, Kendall M, Vugia DJ, Henao OL, Mahon BE

1Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta

2Atlanta Research and Education Foundation, Inc, Decatur, Georgia

3Infectious Diseases Branch, California Department of Public Health, Richmond

Correspondence: Anna E. Newton, MPH, Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA 30033 (aenewton@cdc.gov).

BACKGROUND

The Centers for Disease Control and Prevention monitors vibriosis through 2 surveillance systems: the nationwide Cholera and Other Vibrio Illness Surveillance (COVIS) system and the 10-state Foodborne Diseases Active Surveillance Network (FoodNet). COVIS conducts passive surveillance and FoodNet conducts active surveillance for laboratory-confirmed Vibrio infections.

METHODS

We summarized Vibrio infections (excluding toxigenic V. cholerae O1 and O139) reported to COVIS and FoodNet from 1996 through 2010. For each system, we calculated incidence rates using US Census Bureau population estimates for the surveillance area.

RESULTS

From 1996 to 2010, 7700 cases of vibriosis were reported to COVIS and 1519 to FoodNet. Annual incidence of reported vibriosis per 100,000 population increased from 1996 to 2010 in both systems, from 0.09 to 0.28 in COVIS and from 0.15 to 0.42 in FoodNet. The 3 commonly reported Vibrio species were V. parahaemolyticus, V. vulnificus, and V. alginolyticus; both surveillance systems showed that the incidence of each increased. In both systems, most hospitalizations and deaths were caused by V. vulnificus infection, and most patients were white men. The number of cases peaked in the summer months.

CONCLUSIONS

Surveillance data from both COVIS and FoodNet indicate that the incidence of vibriosis increased from 1996 to 2010 overall and for each of the 3 most commonly reported species. Epidemiologic patterns were similar in both systems. Current prevention efforts have failed to prevent increasing rates of vibriosis; more effective efforts will be needed to decrease rates.

PDF

http://cid.oxfordjournals.org/content/54/suppl_5/S391.full.pdf+html

January 27, 2015 at 8:48 am

Optimizing Research Methods Used for the Evaluation of Antimicrobial Stewardship Programs

Clinical Infectious Diseases OCT 15, 2014 V.59 Suppl.3 S185-S192

Jessina C. McGregor and Jon P. Furuno

Department of Pharmacy Practice, Oregon State University/Oregon Health and Science University College of Pharmacy, Portland

Correspondence: Jessina C. McGregor, PhD, Department of Pharmacy Practice, OSU/OHSU College of Pharmacy, 2730 SW Moody Ave, CL5CP, Portland, OR 97201 (mcgregoj@ohsu.edu).

Antimicrobial stewardship programs (ASPs) are an increasingly common intervention for optimizing antimicrobial therapy in healthcare settings.

These programs aim to improve patient care and limit the emergence and spread of multidrug-resistant organisms by supporting prudent antimicrobial use. However, pressure from the current reimbursement climate necessitates that ASPs operate as cost-cutting programs rather than focus on patient outcomes.

This has forced the research that is evaluating ASP interventions to concentrate heavily on economic outcomes. As the science of antimicrobial stewardship advances, it is essential that well-conducted evaluations, focused on patient and microbial outcomes, serve as the evidence base that directs optimal ASP intervention design and implementation.

In this review, we provide guidance and recommendations for the design of studies to evaluate the impact of ASP interventions on patient and microbial outcomes….

PDF

http://cid.oxfordjournals.org/content/59/suppl_3/S185.full.pdf+html

January 26, 2015 at 8:29 am

Demonstrating the Value of Antimicrobial Stewardship Programs to Hospital Administrators

Clinical Infectious Diseases OCT 15, 2014 V.59 Suppl.3 S146-S153 

Jerod L. Nagel1, James G. Stevenson1, Edward H. Eiland III2,a, and Keith S. Kaye3

1University of Michigan Hospitals and Health System, Ann Arbor

2Department of Pharmacy, Huntsville Hospital, Alabama

3Division of Infectious Diseases, Wayne State University School of Medicine, Detroit, Michigan

Correspondence: Keith S. Kaye, MD, MPH, Division of Infectious Diseases, Wayne State University School of Medicine, 4201 Saint Antoine, Ste 2B, Box 331, Detroit, MI 48201 (kkaye@dmc.org).

The movement away from fee-for-service models to those that emphasize quality of care and patient outcomes affords a unique opportunity for antimicrobial stewardship programs to expand their value for hospital administration.

Antimicrobial stewardship participants must collaborate with administrators and key stakeholders to position themselves to improve economic, process, and outcomes measures.

This will allow the establishment of antimicrobial stewardship programs as essential components of the present and future healthcare quality journey….

PDF

http://cid.oxfordjournals.org/content/59/suppl_3/S146.full.pdf+html

January 26, 2015 at 8:27 am

EBOLA – Recomendaciones para la atención de pacientes en áreas críticas (33 págs)

Medicina Intensiva OCT 2014 V.31 N.4 Supl.

Sociedad Argentina de Terapia Intensiva (SATI)

Agradecemos al Comité de Infectología Crítica de la Sociedad Argentina de Terapia Intensiva por compartir su trabajo poniéndolo a disposición de los colegas de todos los países de habla hispana. El artículo fue publicado en la revista “Medicina Intensiva”.

El propóstio de este documento es proporcionar un enfoque práctico a los intensivistas ante la enfermedad por virus del Ébola, con especial énfasis en el diagnóstico y el tratamiento oportunos, como así también en la prevención de su diseminación a otros pacientes o al personal sanitario.

El documento se redactó sobre la base de las recomendaciones de los organismos internacionales y del Ministerio de Salud de la Nación, adaptándolas a la realidad local.

Documento imprescindible fundado en la mejor evidencia científica y con aplicaciones prácticas elaborado por el Comité de Infectología Crítica de la SATI.

 

INDICE

  1. Objetivos
  2. Aspectos epidemiológicos y transmisión del virus del Ébola
  3. Sistema de notificación
  4. Toma y derivación de muestras para diagnósticos por laboratorio específicos y de rutina
  5. Infraestructura y manejo de pacientes en áreas críticas
  6. Medidas de prevención y control de infecciones
  7. Atención del paciente en áreas críticas
  8. Anexos
  9. Bibliografía

 

PDF

http://www.intramed.net/userfiles/2015/file/Ebola_SATI.pdf

 

January 22, 2015 at 4:06 pm

HIV protease inhibitor use during pregnancy is associated with decreased progesterone levels, suggesting a potential mechanism contributing to fetal growth restriction. 

J Infect Dis 2015 Jan 1 V. 211 N.1 P.10-18.

Eszter Papp1, Hakimeh Mohammadi1, Mona R. Loutfy2,3, Mark H. Yudin3,4, Kellie E. Murphy3,5, Sharon L. Walmsley1,3, Rajiv Shah4, Jay MacGillivray4, Michael Silverman3,6 and Lena Serghides1,2

1Toronto General Research Institute, University Health Network

2Women’s College Research Institute, Women’s College Hospital

3University of Toronto

4St. Michael’s Hospital

5Mount Sinai Hospital, Toronto

6Lakeridge Health, Rouge Valley Hospital, Ajax, Canada

Correspondence: Lena Serghides, 101 College St, 10-359, Toronto, ON, Canada M5G 1L7 (lena.serghides@utoronto.ca).

Background

Protease inhibitor (PI)–based combination antiretroviral therapy (cART) is administered during pregnancy to prevent perinatal human immunodeficiency virus (HIV) transmission. However, PI use has been associated with adverse birth outcomes, including preterm delivery and small-for-gestational-age (SGA) births. The mechanisms underlying these outcomes are unknown. We hypothesized that PIs contribute to these adverse events by altering progesterone levels.

Methods

PI effects on trophoblast progesterone production were assessed in vitro. A mouse pregnancy model was used to assess the impact of PI-based cART on pregnancy outcomes and progesterone levels in vivo. Progesterone levels were assessed in plasma specimens from 27 HIV-infected and 17 HIV-uninfected pregnant women.

Results

PIs (ritonavir, lopinavir, and atazanavir) but not nucleoside reverse transcriptase inhibitors (NRTIs) or nonnucleoside reverse transcriptase inhibitors reduced trophoblast progesterone production in vitro. In pregnant mice, PI-based cART but not dual-NRTI therapy was associated with significantly lower progesterone levels that directly correlated with fetal weight. Progesterone supplementation resulted in a significant improvement in fetal weight. We observed lower progesterone levels and smaller infants in HIV-infected women receiving PI-based cART, compared with the control group. In HIV-infected women, progesterone levels correlated significantly with birth weight percentile.

Conclusions

Our data suggest that PI use in pregnancy may lead to lower progesterone levels that could contribute to adverse birth outcomes.

 

PDF

http://jid.oxfordjournals.org/content/211/1/10.full.pdf+html

 

J Infect Dis 2015 Jan 1; 211:4.

EDITORIAL COMMENTARY

Protease inhibitors and adverse birth outcomes: Is progesterone the missing piece to the puzzle? 

Kathleen M. Powis1,2 and Roger L. Shapiro2,3

1Departments of Internal Medicine and Pediatrics, Massachusetts General Hospital

2Department of Immunology and Infectious Diseases, Harvard School of Public Health

3Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts

Correspondence: Kathleen M. Powis, MD, Massachusetts General Hospital, 100 Cambridge St, 15th Fl, Boston, MA 02114 (kpowis@mgh.harvard.edu).

The ability to prevent mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) with combination antiretroviral (ARV) treatment or prophylaxis represents one of the greatest success stories of the HIV epidemic [1–6]. Virtually all national and international guidelines now call for maternal combination ARV prophylaxis or antiretroviral treatment (ART) during pregnancy [7–10], and MTCT has been nearly eliminated in regions of the world where women have access to ART in pregnancy. But has this success come with a cost? In addition to our ongoing efforts to treat women and protect children, we need to understand the consequences of using 3 potent medications throughout pregnancy and to explore mechanisms for making ART use in pregnancy safer for women and children….

PDF

http://jid.oxfordjournals.org/content/211/1/4.full.pdf+html

January 19, 2015 at 8:47 am

Diagnóstico de infección en la artroplastia total de rodilla

Rev Asoc Arg de Ortopedia y Traumatología abr-Jun 2009 V.74 N.2 P.167-175

ACTUALIZACIÓN

Horacio F. Rivarola Etcheto, Marcos Galli Serra y Carlos María Autorino – Hospital Universitario Austral

Correspondencia: Dr. Horacio F. Rivarola Etcheto hrivarol@cas.austral.edu.ar

Introducción

La infección de una artroplastia total de rodilla (ATR) es una complicación mayor, que tiene un alto impacto económico y gran repercusión en la relación médico-paciente.

En los Estados Unidos se realizan alrededor de 400.000 artroplastias anuales de rodilla, cifra que sin duda se duplicará en los próximos años si se tienen en cuenta diversos factores estudiados epidemiológicamente:

  1. a) La prolongación de la vida media de la población.
  2. b) El incremento de la población femenina (en la cual su indicación es prevalente).
  3. c) La obesidad, que representa un factor de riesgo significativo de aparición de osteoartritis de la rodilla. A partir de las evidencias estadísticas aportadas por los estudios demográficos, según las cuales dos tercios de la población tienen sobrepeso o son obesos, puede decirse que el paciente de “peso o dimensión normal” se ha convertido en una suerte de excepción a la prevalencia del morfotipo en relación con la cirugía artroplástica.
  4. d) Los niveles más exigentes de actividad en edades más avanzadas.

Asimismo, se ha documentado el incremento de las revisiones protésicas y se han realizado proyecciones de expectativa de su incidencia futura. Dado que el costo promedio de unaATR infectada se estima en 15.000 dólares, cifra que llega hasta triplicar o cuadriplicar la de la ATR primaria no complicada, sus consecuencias en la economía sanitaria son muy preocupantes…

PDF

http://www.scielo.org.ar/pdf/raaot/v74n2/v74n2a10.pdf

January 17, 2015 at 5:28 pm

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