Archive for February, 2016

Neuroinvasive West Nile Infection Elicits Elevated and Atypically Polarized T Cell Responses That Promote a Pathogenic Outcome

Public Library of Science Pathogens February 21, 2016

Eddie A. James, Theresa J. Gates, Rebecca E. LaFond, Shinobu Yamamoto, Chester Ni, Duy Mai, Vivian H. Gersuk, Kimberly O’Brien, Quynh-Anh Nguyen, Brad Zeitner, Marion C. Lanteri, Philip J. Norris, Damien Chaussabel, Uma Malhotra, William W. Kwok

Eddie A. James, Theresa J. Gates, Rebecca E. LaFond, Shinobu Yamamoto, Chester Ni, Duy Mai, Vivian H. Gersuk, Kimberly O’Brien, Quynh-Anh Nguyen, Brad Zeitner, Damien Chaussabel, William W. Kwok

Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America

Marion C. Lanteri, Philip J. Norris

Blood Systems Research Institute, San Francisco, California, United States of America

Philip J. Norris

Departments of Laboratory Medicine and Medicine, University of California, San Francisco, San Francisco, California, United States of America

Uma Malhotra

Virginia Mason Medical Center, Seattle, Washington, United States of America

Uma Malhotra, William W. Kwok

Department of Medicine, University of Washington, Seattle, Washington, United States of America

Most West Nile virus (WNV) infections are asymptomatic, but some lead to neuroinvasive disease with symptoms ranging from disorientation to paralysis and death. Evidence from animal models suggests that neuroinvasive infections may arise as a consequence of impaired immune protection. However, other data suggest that neurologic symptoms may arise as a consequence of immune mediated damage. We demonstrate that elevated immune responses are present in neuroinvasive disease by directly characterizing WNV-specific T cells in subjects with laboratory documented infections using human histocompatibility leukocyte antigen (HLA) class II tetramers. Subjects with neuroinvasive infections had higher overall numbers of WNV-specific T cells than those with asymptomatic infections. Independent of this, we also observed age related increases in WNV-specific T cell responses. Further analysis revealed that WNV-specific T cell responses included a population of atypically polarized CXCR3+CCR4+CCR6- T cells, whose presence was highly correlated with neuroinvasive disease. Moreover, a higher proportion of WNV-specific T cells in these subjects co-produced interferon-γ and interleukin 4 than those from asymptomatic subjects. More globally, subjects with neuroinvasive infections had reduced numbers of CD4+FoxP3+ Tregs that were CTLA4 positive and exhibited a distinct upregulated transcript profile that was absent in subjects with asymptomatic infections. Thus, subjects with neuroinvasive WNV infections exhibited elevated, dysregulated, and atypically polarized responses, suggesting that immune mediated damage may indeed contribute to pathogenic outcomes.




February 28, 2016 at 12:36 pm

Surveillance of device-associated infection rates and mortality in 3 Greek intensive care units.

Am J Crit Care. 2013 May;22(3):e12-20.

Apostolopoulou E1, Raftopoulos V, Filntisis G, Kithreotis P, Stefanidis E, Galanis P, Veldekis D.

Author information

1Nursing Department, National and Kapodistrian University of Athens, Greece.



Several studies suggest that device-associated, health care-associated infections (DA-HAIs) affect the quality of care in intensive care units, increasing patients’ morbidity and mortality and the costs of patient care.


To assess the DA-HAIs rates, microbiological profile, antimicrobial resistance, and crude excess mortality in 3 intensive care units in Athens, Greece.


A prospective cohort, active DA-HAI surveillance study was conducted in 3 Greek intensive care units from July 2009 to June 2010. The rates of mechanical ventilator-associated pneumonia (VAP), central catheter-associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI) were calculated along with microbiological profile, antimicrobial resistance, and crude excess mortality.


During 6004 days in intensive care, 152 of 294 patients acquired 205 DA-HAIs, an overall rate of 51.7% of patients or 34.1 DA-HAIs per 1000 days (95% CI, 29.3-38.6). The VAP rate was 20 (95% CI, 16.3-23.7) per 1000 ventilator-days, the CLABSI rate was 11.8 (95% CI: 9.2-14.8) per 1000 catheter-days, and the CAUTI rate was 4.2 (95% CI, 2.5-5.9) per 1000 catheter-days. The most frequently isolated pathogen was Acinetobacter baumannii among patients with CLABSI (37.8%) and Candida species among patients with CAUTI (66.7%). Excess mortality was 20.3% for VAP and CLABSI and 32.2% for carbapenem-resistant A baumannii CLABSI.


High rates of DA-HAIs, device utilization, and antimicrobial resistance emphasize the need for antimicrobial stewardship, the establishment of an active surveillance program of DA-HAIs, and the implementation of evidence-based preventive strategies.


February 28, 2016 at 12:35 pm

Nosocomial infections associated to invasive devices in the intensive care units of a national hospital of Lima, Peru.

Rev Peru Med Exp Salud Publica. 2013 Oct-Dec;30(4):616-20.

[Article in Spanish]

Chincha O, Cornelio E, Valverde V, Acevedo M.


In order to describe the incidence of nosocomial infections associated to invasive devices in intensive care units (UCI) of the National Hospital Cayetano Heredia, a retrospective observational study was conducted using the data from the Office of Epidemiology and Environmental Health from 2010 to 2012.

A total number of 222 nosocomial infections were reported; the general medicine UCI reported the highest incidence of pneumonia cases associated to a mechanical ventilator in 1000 days of use of the device (28.6); infection of the blood stream associated to central venous catheter (11.9), and infection of the urinary tract associated to a catheter (8,1).

The main infectious agents isolated were Pseudomonas sp. (32.3%) in the emergency UCI, negative Staphylococcus coagulasa (36%) in the general medicine UCI and Candida sp (69.2%) in the Surgery UCI.

The rates of infections associated to invasive devices were high as in other national hospitals with limited resources and infrastructure.


February 28, 2016 at 12:33 pm

Zika Virus Infection Among U.S. Pregnant Travelers — August 2015–February 2016

MMWR Early Release February 26, 2016 Vol. 65, Early Release

Dana Meaney-Delman, MD; Susan L. Hills, MBBS; Charnetta Williams, MD; et al.

On January 19, 2016, CDC released interim guidelines recommending pregnant women who had traveled to areas with ongoing local transmission of Zika virus and who had symptoms consistent with Zika virus disease be tested for Zika virus infection. These guidelines were updated and expanded on February 5 to offer Zika virus testing to all pregnant women with Zika virus exposure, regardless of presence of symptoms. As of February 17, 2016, nine pregnant travelers with Zika virus infection from the United States had been identified. No Zika virus–related hospitalizations or deaths were reported among pregnant women. Pregnancy outcomes among the nine confirmed cases included two early pregnancy losses, two elective terminations, and three live births (two apparently healthy infants and one infant with severe microcephaly); two pregnancies (18 weeks’ and 34 weeks’ gestation) are continuing without known complications.


February 26, 2016 at 9:44 pm

Transmission of Zika Virus Through Sexual Contact with Travelers to Areas of Ongoing Transmission — Continental United States, 2016

MMWR Early Release February 26, 2016 Vol. 65, Early Release

Susan L. Hills, MBBS; Kate Russell, MD; Morgan Hennessey, DVM; et al.

CDC released interim guidance for prevention of sexual transmission of Zika virus on February 5, 2016, and updated guidelines on February 26, 2016. This report provides information on six confirmed and probable cases of sexual transmission of Zika virus from male travelers to female nontravelers.


February 26, 2016 at 9:42 pm

Postpandemic Influenza A/H1N1pdm09 is still Causing Severe Perinatal Complications.

Mediterr J Hematol Infect Dis. 2015 Jan 1;7(1):e2015007.

Bogers H1, Bos D1, Schoenmakers S1, Duvekot JJ1.

Author information

1Erasmus MC, University Medical Centre Rotterdam, Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, University Medical Centre Rotterdam.


Although influenza A/H1N1pdm09 is not causing a pandemic anymore, we recently observed two critically ill pregnant women infected by this virus.

We present these cases to illustrate the possible severe complications of an – at that moment – seasonal influenza in pregnancy.

We discuss the epidemiological differences between the pandemic and post pandemic phase and try to explain the high virulence of influenza A/H1N1pdm09 -infections in pregnancy by discussing insights in immunology during pregnancy.

We conclude that although influenza A/H1N1pdm09 is in the post pandemic phase, infection by this influenza virus still needs to be considered in pregnant women with progressive respiratory dysfunction.


February 26, 2016 at 7:52 am

Candida urinary tract infections – epidemiology.

Clin Infect Dis. 2011 May;52 Suppl 6:S433-6.

Sobel JD1, Fisher JF, Kauffman CA, Newman CA.

Author information

1Division of Infectious Diseases, Wayne State University School of Medicine, Detroit, Michigan, USA.


Candiduria is rarely present in healthy individuals. In contrast, it is a common finding in hospitalized patients, especially those in intensive care units (ICUs) who often have multiple predisposing factors, including diabetes mellitus, indwelling urinary catheters, and exposure to antimicrobials.

Candiduria occurs much less commonly in the community setting. In a majority of episodes in adult patients in critical care facilities candiduria represents colonization, and antifungal therapy is not required.

However, the presence of yeast in the urine can be a sign of a disseminated infection. In the critically ill newborn, candiduria often reflects disseminated candidiasis and is accompanied by obstructing fungus ball formation in the urinary tract.

In ICU patients, although candiduria is a marker for increased mortality, it is only rarely attributable to Candida urinary tract infection


February 26, 2016 at 7:49 am

Catheter-associated urinary tract infections in intensive care units at a university hospital in Turkey.

Bosn J Basic Med Sci. 2014 Nov 14;14(4):227-33.

Keten D1, Aktas F, Guzel Tunccan O, Dizbay M, Kalkanci A, Biter G, Keten HS.

Author information

1Kahramanmaras Necip Fazil City Hospital, Clinic of Infectious Diseases and Clinical Microbiology, Kahramanmaraş.


In this study, urinary catheter utilization rates, the causative agents for catheter-associated urinary tract infection (CAUTI) and their antimicrobial susceptibilities in intensive care units (ICUs) in 2009 were investigated at Gazi university hospital.

We aimed to determine the causative agents and risk factors for CAUTIs, and antimicrobial susceptibilities of the pathogens; and also sensitivities of Candida spp. to antifungal agents with Microdilution and E-test.

The most common etiological agents of CAUTIs were Candida spp. (34.7%). The most frequently isolated Candida spp. was C.albicans (52.4%). All C. albicans spp. were sensitive to fluconazole. Microdilution, used as a reference method to determine the sensitivity to antifungal agents, was compared with E test. E test was found to be sufficient to analyze sensitivity to amphotericin B, caspofungin, fluconazole and voriconazole, but inappropriate for itraconazole.

E.coli and Klebsiella spp. were found to be causative agents for CAUTI in 20.6% and 9.9% of cases respectively. Pseudomonas spp. and Acinetobacter spp. were isolated in 14% and 8.2% of the cases, respectively. All E.coli and Klebsiella strains were found sensitive to carbapenems.

Carbapenem sensitivity was found in 47.1% and 30% of the cases infected with Pseudomonas and Acinetobacter strains, respectively. According to our results, fluconazole therapy seems to be an appropriate choice for the treatment of CAUTIs caused by C.albicans.

Third and fourth generation cephalosporins should not be used for empirical treatment because of the high prevalence of extended spectrum beta-lactamase production among E.coli and Klebsiella isolates.


February 26, 2016 at 7:46 am

Trends in nosocomial infections and multidrug-resistant microorganisms in Spanish pediatric intensive care units.

Enferm Infecc Microbiol Clin. 2015 Sep 10. pii: S0213-005X(15)00285-2.

Jordan Garcia I1, Esteban Torné E2, Bustinza Arriortua A3, de Carlos Vicente JC4, García Soler P5, Concha Torre JA6, Flores González JC7, Madurga Revilla P8, Palomar Martínez M9; VINCIP Study Group, from Spanish Society of Pediatric Intensive Care (SECIP).

Author information

1Unidad de Cuidados Intensivos Pediátricos, Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain. Electronic address:

2Unidad de Cuidados Intensivos Pediátricos, Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain.

3Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, Spain.

4Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Son Espases, Palma, Mallorca, Spain.

5Unidad de Cuidados Intensivos Pediátricos, Hospital Regional Universitario Carlos Haya de Málaga, Málaga, Spain.

6Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Central de Asturias, Oviedo, Spain.

7Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Puerta del Mar de Cádiz, Cádiz, Spain.

8Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Miguel Servet de Zaragoza, Zaragoza, Spain.

9Unidad de Medicina Intensiva, Hospital Universitario Arnau de Vilanova de Lleida, Spain.



Nosocomial infections (NI) are a major healthcare problem. National surveillance systems enable data to be compared and to implement new measures to improve our practice.


A multicentre, prospective, descriptive and observational study was conducted using the data from surveillance system for nosocomial infections created in 2007 for Spanish pediatric intensive care units. Data were collected for one month, between 01 and 31 March, for every study year (2008-2012). The objective was to report 5-years of NI surveillance data, as well as trends in infections by multidrug resistant organisms in Spanish pediatric intensive care units.


A total of 3667 patients were admitted to the units during the study period. There were 90 (2.45%) patients with nosocomial infections. The mean rates during the 5 years study were: central line-associated bloodstream infection, 3.8/1000 central venous catheter-days, Ventilator-associated pneumonia 7.5/1000 endotracheal tube-days, and catheter-associated urinary tract infections 4.1/1000 urinary catheter-days. The comparison between the 2008 and 2009 rates for nosocomial infections did not show statistically significant differences. All rates homogeneously decreased from 2009 to 2012: central line-associated bloodstream infection 5.83 (95% CI 2.67-11.07) to 0.49 (95% CI 0.0125-2.76), P=0.0029; ventilator-associated pneumonia 10.44 (95% CI 5.21-18.67) to 4.04 (95% CI 1.48-8.80), P=0.0525; and Catheter-associated urinary tract infections 7.10 (95% CI 3.067-13.999) to 2.56 (95% CI 0.697-6.553), P=0.0817; respectively. The microorganism analysis: 63 of the 99 isolated bacteria (63.6%) were Gram-negative bacteria (36.5% were resistant), 19 (19.2%) Gram-positive bacteria, and 17 (17.2%) were Candida spp. infections.


The local surveillance systems provide information for dealing with nosocomial infections rates.


February 26, 2016 at 7:43 am

Executive Summary: Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America

Clinical Infectious Diseases February 15, 2016 V.62 N.4 P.409-417


Peter G. Pappas, Carol A. Kauffman, David R. Andes, Cornelius J. Clancy, Kieren A. Marr, Luis Ostrosky-Zeichner, Annette C. Reboli, Mindy G. Schuster, Jose A. Vazquez, Thomas J. Walsh, Theoklis E. Zaoutis, and Jack D. Sobel

1University of Alabama at Birmingham

2Veterans Affairs Ann Arbor Healthcare System and University of Michigan Medical School, Ann Arbor

3University of Wisconsin, Madison

4University of Pittsburgh, Pennsylvania

5Johns Hopkins University School of Medicine, Baltimore, Maryland

6University of Texas Health Science Center, Houston

7Cooper Medical School of Rowan University, Camden, New Jersey

8University of Pennsylvania, Philadelphia

9Georgia Regents University, Augusta

10Weill Cornell Medical Center and Cornell University, New York, New York

11Children’s Hospital of Pennsylvania, Philadelphia

12Harper University Hospital and Wayne State University, Detroit, Michigan

It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations.

IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient’s individual circumstances.




February 25, 2016 at 7:52 am

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