Archive for May 22, 2015

Infectious mononucleosis.

Clin Transl Immunology. 2015 Feb 27;4(2):e33.

Balfour HH Jr1, Dunmire SK2, Hogquist KA2.

1Department of Laboratory Medicine and Pathology, University of Minnesota Medical School , Minneapolis, MN, USA ; Department of Pediatrics, University of Minnesota Medical School , Minneapolis, MN, USA.

2Department of Laboratory Medicine and Pathology, University of Minnesota Medical School , Minneapolis, MN, USA.

Abstract

Infectious mononucleosis is a clinical entity characterized by pharyngitis, cervical lymph node enlargement, fatigue and fever, which results most often from a primary Epstein-Barr virus (EBV) infection.

EBV, a lymphocrytovirus and a member of the γ-herpesvirus family, infects at least 90% of the population worldwide, the majority of whom have no recognizable illness.

The virus is spread by intimate oral contact among adolescents, but how preadolescents acquire the virus is not known. During the incubation period of approximately 6 weeks, viral replication first occurs in the oropharynx followed by viremia as early as 2 weeks before onset of illness.

The acute illness is marked by high viral loads in both the oral cavity and blood accompanied by the production of immunoglobulin M antibodies against EBV viral capsid antigen and an extraordinary expansion of CD8(+) T lymphocytes directed against EBV-infected B cells. During convalescence, CD8(+) T cells return to normal levels and antibodies develop against EBV nuclear antigen-1.

A typical clinical picture in an adolescent or young adult with a positive heterophile test is usually sufficient to make the diagnosis of infectious mononucleosis, but heterophile antibodies are not specific and do not develop in some patients especially young children. EBV-specific antibody profiles are the best choice for staging EBV infection. In addition to causing acute illness, long-term consequences are linked to infectious mononucleosis, especially Hodgkin lymphoma and multiple sclerosis.

There is no licensed vaccine for prevention and no specific approved treatment. Future research goals are development of an EBV vaccine, understanding the risk factors for severity of the acute illness and likelihood of developing cancer or autoimmune diseases, and discovering anti-EBV drugs to treat infectious mononucleosis and other EBV-spurred diseases.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4346501/pdf/cti20151a.pdf

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May 22, 2015 at 8:59 am

Trial of Short-Course Antimicrobial Therapy for Intraabdominal Infection

N Engl J Med 2015;372:1996-2005

R.G. Sawyer and Others

BACKGROUND

The successful treatment of intraabdominal infection requires a combination of anatomical source control and antibiotics. The appropriate duration of antimicrobial therapy remains unclear.

METHODS

We randomly assigned 518 patients with complicated intraabdominal infection and adequate source control to receive antibiotics until 2 days after the resolution of fever, leukocytosis, and ileus, with a maximum of 10 days of therapy (control group), or to receive a fixed course of antibiotics (experimental group) for 4±1 calendar days. The primary outcome was a composite of surgical-site infection, recurrent intraabdominal infection, or death within 30 days after the index source-control procedure, according to treatment group. Secondary outcomes included the duration of therapy and rates of subsequent infections.

RESULTS

Surgical-site infection, recurrent intraabdominal infection, or death occurred in 56 of 257 patients in the experimental group (21.8%), as compared with 58 of 260 patients in the control group (22.3%) (absolute difference, −0.5 percentage point; 95% confidence interval [CI], −7.0 to 8.0; P=0.92). The median duration of antibiotic therapy was 4.0 days (interquartile range, 4.0 to 5.0) in the experimental group, as compared with 8.0 days (interquartile range, 5.0 to 10.0) in the control group (absolute difference, −4.0 days; 95% CI, −4.7 to −3.3; P<0.001). No significant between-group differences were found in the individual rates of the components of the primary outcome or in other secondary outcomes.

CONCLUSIONS

In patients with intraabdominal infections who had undergone an adequate source-control procedure, the outcomes after fixed-duration antibiotic therapy (approximately 4 days) were similar to those after a longer course of antibiotics (approximately 8 days) that extended until after the resolution of physiological abnormalities. (Funded by the National Institutes of Health; STOP-IT ClinicalTrials.gov number, NCT00657566.)

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1411162

 

N Engl J Med 2015;372:2062-2063

EDITORIALS

Antibiotics for Abdominal Sepsis

R.P. Wenzel and M.B. Edmond

From the Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (R.P.W.); and the Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City (M.B.E.).

Major milestones in surgery have included safe sutures to promote tissue integrity, cautery to minimize bleeding, the use of anesthesia to avoid pain, and antisepsis to prevent operative contamination. In the antibiotic era, surgical procedures for source control in abdominal sepsis have been complemented with drugs targeting persistent organisms after luminal inflammation, obstruction, or perforation.

The appropriate duration of postsurgical antibiotic therapy has been unclear.1 However, if safe, shorter courses would be desirable to minimize drug-related adverse events, the selection of antibiotic resistance, and costs….

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMe1503936

 

2015-05 EDIT Antibiotics for Abdominal Sepsis NEJM

May 22, 2015 at 8:55 am


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