Archive for December 23, 2016

Pneumococcal urinary antigen test use in diagnosis and treatment of pneumonia in seven Utah hospitals

ERJ Open Research October 1, 2016 V.2 N.4

Devin M. West, Lindsay M. McCauley, Jeffrey S. Sorensen, Al R. Jephson, Nathan C. Dean

Abstract

The pneumocococcal urine antigen test increases specific microbiological diagnosis over conventional culture methods in pneumonia patients. Data are limited regarding its yield and effect on antibiotic prescribing among patients with community-onset pneumonia in clinical practice.

We performed a secondary analysis of 2837 emergency department patients admitted to seven Utah hospitals over 2 years with international diagnostic codes version 9 codes and radiographic evidence of pneumonia.

Mean age was 64.2 years, 47.2% were male and all-cause 30-day mortality was 9.6%. Urinary antigen testing was performed in 1110 (39%) patients yielding 134 (12%) positives. Intensive care unit patients were more likely to undergo testing, and have a positive result (15% versus 8.8% for ward patients; p<0.01). Patients with risk factors for healthcare-associated pneumonia had fewer urinary antigen tests performed, but 8.4% were positive. Physicians changed to targeted antibiotic therapy in 20 (15%) patients, de-escalated antibiotic therapy in 76 patients (57%). In 38 (28%) patients, antibiotics were not changed. Only one patient changed to targeted therapy suffered clinical relapse. Length of stay and mortality were lower in patients receiving targeted therapy.

Pneumococcal urinary antigen testing is an inexpensive, noninvasive test that favourably influenced antibiotic prescribing in a “real world”, multi-hospital observational study.

FULL TEXT

http://openres.ersjournals.com/content/2/4/00011-2016?etoc

PDF

http://openres.ersjournals.com/content/erjor/2/4/00011-2016.full.pdf

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December 23, 2016 at 3:00 pm

Neumonía por Mycoplasma pneumoniae: presentación de un caso y breve revisión bibliográfica

Med Int Mex 2012;28(1):81-88

Gustavo Armando Gómez Meléndez,*

José Raymundo Durán Guzmán,**

Diana Arlette Berny Chávez,***

Mario I. Salcedo Roldán****

* Residente de cuarto año de Medicina interna.

** Médico adscrito al área de Medicina interna, profesor adjunto del curso de especialización en Medicina interna.

*** Médico general.

**** Jefe de servicio del área de Medicina interna, profesor titular del curso de especialización en Medicina interna.

Hospital General de Cuautitlán José Vicente Villada, ISEM.

Servicio de Medicina Interna, Hospital General de Cuautitlán, Estado de México

Mycoplasma pneumoniae se reconoce, en todo el mundo, como una causa primaria de neumonía atípica.

Además de las infecciones en las vías respiratorias, este organismo también es responsable de un amplio espectro de manifestaciones extrapulmonares, incluidas las enfermedades neurológicas, hepáticas y cardiacas, anemia hemolítica, poliartritis y eritema multiforme.

Esta revisión incluye algunos de los aspectos más recientes del conocimiento de este patógeno, características clínicas de la infección, causa de la enfermedad, radiología y diversas herramientas para el diagnóstico, diagnóstico diferencial y tratamiento.

PDF

http://www.medigraphic.com/pdfs/medintmex/mim-2012/mim121n.pdf

December 23, 2016 at 8:21 am

Birth Defects Among Fetuses and Infants of US Women With Evidence of Possible Zika Virus Infection During Pregnancy

The Journal of the American Medical Association Dec 16, 2016

Margaret A. Honein, PhD1; April L. Dawson, MPH1; Emily E. Petersen, MD1; et al

1Centers for Disease Control and Prevention, Atlanta, Georgia

2New York City Department of Health and Mental Hygiene, Queens, New York

3Massachusetts Department of Public Health, Boston

4New York State Department of Health, Albany

5Virginia Department of Health, Richmond

6Texas Department of State Health Services, Austin

7Florida Department of Health, Tallahassee

Key Points

Question 

What proportion of fetuses and infants of women in the United States with laboratory evidence of possible Zika virus infection during pregnancy have birth defects?

Findings 

Based on preliminary data from the US Zika Pregnancy Registry, among 442 completed pregnancies, 6% overall had a fetus or infant with evidence of a Zika virus–related birth defect, primarily microcephaly with brain abnormalities, whereas among women with possible Zika virus infection during the first trimester, 11% had a fetus or infant with a birth defect.

Meaning 

These findings support the importance of screening pregnant women for Zika virus exposure.

Abstract

Importance 

Understanding the risk of birth defects associated with Zika virus infection during pregnancy may help guide communication, prevention, and planning efforts. In the absence of Zika virus, microcephaly occurs in approximately 7 per 10 000 live births.

Objective 

To estimate the preliminary proportion of fetuses or infants with birth defects after maternal Zika virus infection by trimester of infection and maternal symptoms.

Design, Setting, and Participants 

Completed pregnancies with maternal, fetal, or infant laboratory evidence of possible recent Zika virus infection and outcomes reported in the continental United States and Hawaii from January 15 to September 22, 2016, in the US Zika Pregnancy Registry, a collaboration between the CDC and state and local health departments.

Exposures 

Laboratory evidence of possible recent Zika virus infection in a maternal, placental, fetal, or infant sample.

Main Outcomes and Measures 

Birth defects potentially Zika associated: brain abnormalities with or without microcephaly, neural tube defects and other early brain malformations, eye abnormalities, and other central nervous system consequences.

Results 

Among 442 completed pregnancies in women (median age, 28 years; range, 15-50 years) with laboratory evidence of possible recent Zika virus infection, birth defects potentially related to Zika virus were identified in 26 (6%; 95% CI, 4%-8%) fetuses or infants. There were 21 infants with birth defects among 395 live births and 5 fetuses with birth defects among 47 pregnancy losses. Birth defects were reported for 16 of 271 (6%; 95% CI, 4%-9%) pregnant asymptomatic women and 10 of 167 (6%; 95% CI, 3%-11%) symptomatic pregnant women. Of the 26 affected fetuses or infants, 4 had microcephaly and no reported neuroimaging, 14 had microcephaly and brain abnormalities, and 4 had brain abnormalities without microcephaly; reported brain abnormalities included intracranial calcifications, corpus callosum abnormalities, abnormal cortical formation, cerebral atrophy, ventriculomegaly, hydrocephaly, and cerebellar abnormalities. Infants with microcephaly (18/442) represent 4% of completed pregnancies. Birth defects were reported in 9 of 85 (11%; 95% CI, 6%-19%) completed pregnancies with maternal symptoms or exposure exclusively in the first trimester (or first trimester and periconceptional period), with no reports of birth defects among fetuses or infants with prenatal exposure to Zika virus infection only in the second or third trimesters.

Conclusions and Relevance 

Among pregnant women in the United States with completed pregnancies and laboratory evidence of possible recent Zika infection, 6% of fetuses or infants had evidence of Zika-associated birth defects, primarily brain abnormalities and microcephaly, whereas among women with first-trimester Zika infection, 11% of fetuses or infants had evidence of Zika-associated birth defects. These findings support the importance of screening pregnant women for Zika virus exposure.

FULL TEXT

http://jamanetwork.com/journals/jama/fullarticle/2593702

PDF (CLIC in DOWNLOAD PDF)

December 23, 2016 at 8:10 am


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