Archive for October, 2016

Zika virus in Brazil and the danger of infestation by Aedes (Stegomyia) mosquitoes.

Rev Soc Bras Med Trop. 2016 Feb;49(1):4-10.

Marcondes CB1, Ximenes Mde F2.

Author information

1Departamento de Microbiologia, Imunologia e Parasitologia, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.

2Departamento de Microbiologia e Parasitologia, Centro de Biociências, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.


Zika virus, already widely distributed in Africa and Asia, was recently reported in two Northeastern Brazilian: State of Bahia and State of Rio Grande do Norte, and one Southeastern: State of São Paulo.

This finding adds a potentially noxious virus to a list of several other viruses that are widely transmitted by Aedes (Stegomyia) aegypti and Aedes (Stegomyia) albopictus in Brazil.

The pathology and epidemiology, including the distribution and vectors associated with Zika virus, are reviewed.

This review is focused on viruses transmitted by Aedes (Stegomyia) mosquitoes, including dengue, Chikungunya, Zika, Mayaro, and yellow fever virus, to emphasize the risks of occurrence for these arboviruses in Brazil and neighboring countries.

Other species of Aedes (Stegomyia) are discussed, emphasizing their involvement in arbovirus transmission and the possibility of adaptation to environments modified by human activities and introduction in Brazil.


October 30, 2016 at 12:45 pm

Global emergence of Alphaviruses that cause arthritis in humans.

Infect Ecol Epidemiol. 2015 Dec 18;5:29853.

Lwande OW1, Obanda V2, Bucht G3, Mosomtai G4, Otieno V5, Ahlm C6, Evander M7.

Author information

1Department of Clinical Microbiology, Virology, Umeå University, Umeå, Sweden;;

2Veterinary Services Department, Kenya Wildlife Service, Nairobi, Kenya.

3Swedish Defence Research Agency, CBRN Defence and Security, Umeå, Sweden.

4Earth Observation Unit, International Centre of Insect Physiology and Ecology, Nairobi, Kenya.

5IGAD Climate Prediction and Application Centre (ICPAC), Nairobi, Kenya.

6Department of Clinical Microbiology, Infectious Diseases, Umeå University, Umeå, Sweden.

7Department of Clinical Microbiology, Virology, Umeå University, Umeå, Sweden.


Arthropod-borne viruses (arboviruses) may cause severe emerging and re-emerging infectious diseases, which pose a significant threat to human and animal health in the world today.

These infectious diseases range from mild febrile illnesses, arthritis, and encephalitis to haemorrhagic fevers. It is postulated that certain environmental factors, vector competence, and host susceptibility have a major impact on the ecology of arboviral diseases.

Presently, there is a great interest in the emergence of Alphaviruses because these viruses, including Chikungunya virus, O’nyong’nyong virus, Sindbis virus, Ross River virus, and Mayaro virus, have caused outbreaks in Africa, Asia, Australia, Europe, and America. Some of these viruses are more common in the tropics, whereas others are also found in temperate regions, but the actual factors driving Alphavirus emergence and re-emergence remain unresolved.

Furthermore, little is known about the transmission dynamics, pathophysiology, genetic diversity, and evolution of circulating viral strains.

In addition, the clinical presentation of Alphaviruses may be similar to other diseases such as dengue, malaria, and typhoid, hence leading to misdiagnosis.

However, the typical presence of arthritis may distinguish between Alphaviruses and other differential diagnoses.

The absence of validated diagnostic kits for Alphaviruses makes even routine surveillance less feasible. For that purpose, this review describes the occurrence, genetic diversity, clinical characteristics, and the mechanisms involving Alphaviruses causing arthritis in humans.

This information may serve as a basis for better awareness and detection of Alphavirus-caused diseases during outbreaks and in establishing appropriate prevention and control measures.


October 30, 2016 at 12:43 pm

Emerging alphaviruses in the Americas: Chikungunya and Mayaro.

Rev Soc Bras Med Trop. 2014 Nov-Dec;47(6):677-83.

Figueiredo ML1, Figueiredo LT2.

Author information

1Instituto Evandro Chagas, Belém, PA, Brazil.

2Centro de Pesquisa em Virologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.


Chikungunya virus (CHIKV) and Mayaro virus (MAYV) are emergent arthropod-borne viruses that produce outbreaks of acute febrile illness with arthropathy.

Despite their different continental origins, CHIKV and MAYV are closely related and are components of the Semliki Forest Complex of the Alphavirus (Togaviridae). MAYV and, more recently, CHIKV, which are both transmitted by Aedes mosquitoes, have resulted in severe public health problems in the Americas, including Brazil.

In this review, we present aspects of the pathogenesis, clinical presentation and treatment of febrile illnesses produced by CHIKV and MAYV. We also discuss the epidemiological aspects and effects related to the prophylaxis of infections by both viruses.


October 30, 2016 at 12:41 pm

Insights into Newer Antimicrobial Agents Against Gram-negative Bacteria

Microbiol Insights. 2016 Mar 20;9:9-19.

Taneja N1, Kaur H1.

Author information

1Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.


Currently, drug resistance, especially against cephalosporins and carbapenems, among gram-negative bacteria is an important challenge, which is further enhanced by the limited availability of drugs against these bugs.

There are certain antibiotics (colistin, fosfomycin, temocillin, and rifampicin) that have been revived from the past to tackle the menace of superbugs, including members of Enterobacteriaceae, Acinetobacter species, and Pseudomonas species. Very few newer antibiotics have been added to the pool of existing drugs.

There are still many antibiotics that are passing through various phases of clinical trials. The initiative of Infectious Disease Society of America to develop 10 novel antibiotics against gram-negative bacilli by 2020 is a step to fill the gap of limited availability of drugs.

This review aims to provide insights into the current and newer drugs in pipeline for the treatment of gram-negative bacteria and also discusses the major challenging issues for their management.


October 30, 2016 at 12:11 pm

Guidelines for management of community-acquired pneumonia in adults.

Medicina (B Aires). 2015;75(4):245-57.

[Article in Spanish]

Lopardo G1, Basombrío A, Clara L, Desse J, De Vedia L, Di Libero E, Gañete M, López Furst MJ, Mykietiuk A, Nemirovsky C, Osuna C, Pensotti C, Scapellato P.

Author information

1Sociedad Argentina de Infectología, Buenos Aires, Argentina. E-mail:


Community-acquired pneumonia in adults is a common cause of morbidity and mortality particularly in the elderly and in patients with comorbidities. Most episodes are of bacterial origin, Streptococcus pneumoniae is the most frequently isolated pathogen. Epidemiological surveillance provides information about changes in microorganisms and their susceptibility. In recent years there has been an increase in cases caused by community-acquired meticillin resistant Staphylococcus aureus and Legionella sp. The chest radiograph is essential as a diagnostic tool. CURB-65 score and pulse oximetry allow stratifying patients into those who require outpatient care, general hospital room or admission to intensive care unit. Diagnostic studies and empirical antimicrobial therapy are also based on this stratification. The use of biomarkers such as procalcitonin or C-reactive protein is not part of the initial evaluation because its use has not been shown to modify the initial approach. We recommend treatment with amoxicillin for outpatients under 65 year old and without comorbidities, for patients 65 years or more or with comorbidities amoxicillin-clavulanic/sulbactam, for patients hospitalized in general ward ampicillin-sulbactam with or without the addition of clarithromycin, and for patients admitted to intensive care unit ampicillin-sulbactam plus clarithromycin. Suggested treatment duration is 5 to 7 days for outpatients and 7 to 10 for those who are hospitalized. During the influenza season addition of oseltamivir for hospitalized patients and for those with comorbidities is suggested.


October 30, 2016 at 12:08 pm

Laboratory Diagnosis of Congenital Toxoplasmosis

Journal of Clinical Microbiology October 2016 V.54 N.10 P.2448-2454

Christelle Pomares and Jose G. Montoya

aPalo Alto Medical Foundation Toxoplasma Serology Laboratory, National Reference Center for the Study and Diagnosis of Toxoplasmosis, Palo Alto, California, USA

bStanford University, Division of Infectious Diseases, Stanford, California, USA

cINSERM U1065, Centre Méditerranéen de Médecine Moléculaire, Toxines Microbiennes dans la Relation Hôte-Pathogènes, Nice, France

dService de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Nice, Nice, France

Recent studies have demonstrated that screening and treatment for toxoplasmosis during gestation result in a decrease of vertical transmission and clinical sequelae. Early treatment was associated with improved outcomes.

Thus, laboratory methods should aim for early identification of infants with congenital toxoplasmosis (CT). Diagnostic approaches should include, at least, detection of Toxoplasma IgG, IgM, and IgA and a comprehensive review of maternal history, including the gestational age at which the mother was infected and treatment.

Here, we review laboratory methods for the diagnosis of CT, with emphasis on serological tools. A diagnostic algorithm that takes into account maternal history is presented


October 30, 2016 at 12:04 pm

Síndrome de mononucleosis infecciosa en pacientes adolescentes y adultos

Rev Chil Infect 2003; 20 (4): 235-242


Sección de Infectología, Departamento de Medicina, Hospital Clínico Universidad de Chile

Exudates, cervical adenopathies and atypical lymphocytosis is associated in most cases to Epstein-Barr virus (EBV) infection. Other potential causes for this syndrome are acute cytomegalovirus (CMV), Human Immunodeficiency Virus, Toxoplasma gondii or Human Herpes virus 6 infection. These alternative etiologies evolve with a modified clinical picture that includes sometimes leukopenia or rash. Diagnosis of EBV is easily accomplished by atypical lymphocytosis (> 10%), positive heterophil antibodies and IgM antibodies directed against the EB viral capsid antigen (VCA). The latter is needed for cases without positive heterophil antibodies. Acute CMV infection is the second most important cause and can be diagnosed by CMV antigen detection, PCR or shell vial culture of blood samples, although experience with these tests among immunocompetent patients in primary care settings is sparse. Acute primary HIV infection is an important cause for this syndrome and should not be neglected when other causes are discarded. Third or fourth generation HIV ELISA tests, p24 antigen or HIV-PCR detection in blood samples allow recognition of this agent from the second or third week of inoculation. T. gondii and human herpes virus 6 infection can be diagnosed by serological methods. Evolution of EBV or CMV infection is favorable with infrequent complications…


October 30, 2016 at 12:01 pm

Concomitant Multiple Joint Arthroplasty Infections: Report on 16 Cases

Journal of Arthroplasty November 2016 V.31 N.11 P.2564-2568

Valérie Zeller, Delphine Dedome, Luc Lhotellier, Wilfrid Graff, Nicole Desplaces, Simon Marmor


Concomitant infections of several prostheses are very rare, serious events that pose particular medical and surgical therapeutic challenges. This study was undertaken to describe epidemiologic, clinical, and microbiological characteristics of concomitant multiple joint arthroplasty infections, their treatments, and outcomes.


Retrospective (January 2000 and January 2014), single-center, cohort study in a referral center for bone and joint infections. All patients with at least 2 concomitant, microbiologically documented, prosthetic joint infections, that is, during the same septic episode, were included.


Sixteen patients were included. Median (range) age was 78 years (46-93 years), gender ratio was 1, and median (range) body mass index was 27 (21-42). Multiple joint arthroplasties (bilateral hip in 8 patients; bilateral knee in 3 patients; hip and knee in 1 patient; and 2 knees and 1 hip in 1 patient) were contaminated hematogenously in all patients, 2 after early postoperative infections. Eight Staphylococcus aureus, 1 Staphylococcus epidermidis, 6 Streptococcus, and 1 Escherichia coli strains were isolated. A curative strategy was applied to 11 patients: 3 underwent bilateral synovectomies, 6 had successive 1-stage exchange arthroplasties, and 2 were treated with other strategies. After 37 months (range, 24-132 months) of follow-up, reinfection occurred in 1 patient. The 5 other patients received prolonged suppressive antibiotic therapy.


These complex infections occur during staphylococcal or streptococcal bacteremia. Treatment strategies should be discussed by a multidisciplinary team on a case-by-case basis.



October 29, 2016 at 10:30 am

Incidence of Infection and Inhospital Mortality in Patients With Chronic Renal Failure After Total Joint Arthroplasty

Journal of Arthroplasty November 2016 V.31 N.11 P.2473-2441

Omer F. Erkocak, Joanne Y. Yoo, Camilo Restrepo, Mitchell G. Maltenfort, Javad Parvizi

Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania


Patients with chronic renal failure (CRF) may require total joint arthroplasty (TJA) to treat degenerative joint disease, fractures, osteonecrosis, or amyloid arthropathy. There have been conflicting results, however, regarding outcomes of TJA in patients with chronic renal disease. The aim of this case-controlled study was to determine the outcome of TJA in patients with CRF, with particular interest in the incidence of infections and inhospital mortality.


We queried our electronic database to determine which patients among the 29,389 TJAs performed at our institution between January 2000 and June 2012 had a diagnosis of CRF. A total of 359 CRF patients were identified and matched for procedure, gender, age (±4 years), date of surgery (±2 years), and body mass index (±5 kg/m2) in a 2:1 ratio to 718 control patients.


The incidence of infection and inhospital mortality was not significantly different between the nondialysis CRF patients and controls, whereas it was significantly higher in dialysis-dependent end-stage renal failure patients compared to controls. Of the 50 CRF patients receiving hemodialysis, 10 (20%) developed surgical site infection, of which 4 (8%) were periprosthetic joint infection, and 4 (8%) died during hospital stay. The odds ratio for infection in the dialysis group was 7.54 (95% confidence interval: 2.83-20.12) and 10.46 (95% confidence interval: 1.67-65.34) for the inhospital mortality.


We conclude that end-stage renal failure patients receiving hemodialysis have higher postoperative infection and inhospital mortality rates after an elective TJA procedure, whereas nondialysis CRF patients have similar outcomes compared with the general TJA population.


October 29, 2016 at 10:27 am

Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America

Clinical Infectious Diseases May 15, 2016 V.62 N.10 P e51-e77

Tamar F. Barlam1,a, Sara E. Cosgrove2,a, Lilian M. Abbo3, Conan MacDougall4, Audrey N. Schuetz5, Edward J. Septimus6, Arjun Srinivasan7, Timothy H. Dellit8, Yngve T. Falck-Ytter9, Neil O. Fishman10, Cindy W. Hamilton11, Timothy C. Jenkins12, Pamela A. Lipsett13, Preeti N. Malani14, Larissa S. May15, Gregory J. Moran16, Melinda M. Neuhauser17, Jason G. Newland18, Christopher A. Ohl19, Matthew H. Samore20, Susan K. Seo21, and Kavita K. Trivedi22

Evidence-based guidelines for implementation and measurement of antibiotic stewardship interventions in inpatient populations including long-term care were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America.

The panel included clinicians and investigators representing internal medicine, emergency medicine, microbiology, critical care, surgery, epidemiology, pharmacy, and adult and pediatric infectious diseases specialties.

These recommendations address the best approaches for antibiotic stewardship programs to influence the optimal use of antibiotics…


October 28, 2016 at 3:43 pm

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