Archive for February, 2017

Chikungunya virus-associated long-term arthralgia: a 36-month prospective longitudinal study.

PLoS Negl Trop Dis. 2013;7(3):e2137.

Schilte C1, Staikowsky F, Couderc T, Madec Y, Carpentier F, Kassab S, Albert ML, Lecuit M, Michault A.

Author information

1Unité Immunobiologie des Cellules Dendritiques, Department of Immunology, Institut Pasteur, Paris, France.

Erratum in

PLoS Negl Trop Dis. 2013 Mar;7(3). doi:10.1371/annotation/850ee20f-2641-46ac-b0c6-ef4ae79b6de6. Staikovsky, Frédérik [corrected to Staikowsky, Frederik].

Abstract

BACKGROUND:

Arthritogenic alphaviruses, including Chikungunya virus (CHIKV), are responsible for acute fever and arthralgia, but can also lead to chronic symptoms. In 2006, a Chikungunya outbreak occurred in La Réunion Island, during which we constituted a prospective cohort of viremic patients (n = 180) and defined the clinical and biological features of acute infection. Individuals were followed as part of a longitudinal study to investigate in details the long-term outcome of Chikungunya.

METHODOLOGY/PRINCIPAL FINDINGS:

Patients were submitted to clinical investigations 4, 6, 14 and 36 months after presentation with acute CHIKV infection. At 36 months, 22 patients with arthralgia and 20 patients without arthralgia were randomly selected from the cohort and consented for blood sampling. During the 3 years following acute infection, 60% of patients had experienced symptoms of arthralgia, with most reporting episodic relapse and recovery periods. Long-term arthralgias were typically polyarthralgia (70%), that were usually symmetrical (90%) and highly incapacitating (77%). They were often associated with local swelling (63%), asthenia (77%) or depression (56%). The age over 35 years and the presence of arthralgia 4 months after the disease onset are risk factors of long-term arthralgia. Patients with long-term arthralgia did not display biological markers typically found in autoimmune or rheumatoid diseases. These data helped define the features of CHIKV-associated chronic arthralgia and permitted an estimation of the economic burden associated with arthralgia.

CONCLUSIONS/SIGNIFICANCE:

This study demonstrates that chronic arthralgia is a frequent complication of acute Chikungunya disease and suggests that it results from a local rather than systemic inflammation.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3605278/pdf/pntd.0002137.pdf

February 28, 2017 at 7:01 pm

Specific management of post-chikungunya rheumatic disorders: a retrospective study of 159 cases in Reunion Island from 2006-2012.

PLoS Negl Trop Dis. 2015 Mar 11;9(3):e0003603. 

Javelle E1, Ribera A2, Degasne I3, Gaüzère BA4, Marimoutou C5, Simon F1.

Author information

1Department of Tropical and Infectious Diseases, Laveran Military Teaching Hospital, Marseille, France.

2Private Rheumatology Office, Saint Denis, La Réunion, France.

3Department of Rheumatology, Centre Hospitalier Universitaire de La Réunion, Hôpital Felix Guyon, Saint Denis, La Réunion, France.

4Intensive Care Unit, Centre Hospitalier Universitaire de La Réunion, Hôpital Felix Guyon, Saint Denis, La Réunion, France.

5French Army Centre for Epidemiology and Public Health (“IRBA”), Marseille, France.

Abstract

BACKGROUND:

Since 2003, the tropical arthritogenic chikungunya (CHIK) virus has become an increasingly medical and economic burden in affected areas as it can often result in long-term disabilities. The clinical spectrum of post-CHIK (pCHIK) rheumatic disorders is wide. Evidence-based recommendations are needed to help physicians manage the treatment of afflicted patients.

PATIENTS AND METHODS:

We conducted a 6-year case series retrospective study in Reunion Island of patients referred to a rheumatologist due to continuous rheumatic or musculoskeletal pains that persisted following CHIK infection. These various disorders were documented in terms of their clinical and therapeutic courses. Post-CHIK de novo chronic inflammatory rheumatisms (CIRs) were identified according to validated criteria.

RESULTS:

We reviewed 159 patient medical files. Ninety-four patients (59%) who were free of any articular disorder prior to CHIK met the CIR criteria: rheumatoid arthritis (n=40), spondyloarthritis (n=33), undifferentiated polyarthritis (n=21). Bone lesions detectable by radiography occurred in half of the patients (median time: 3.5 years pCHIK). A positive therapeutic response was achieved in 54 out of the 72 patients (75%) who were treated with methotrexate (MTX). Twelve out of the 92 patients (13%) received immunomodulatory biologic agents due to failure of contra-indication of MTX treatment. Other patients mainly presented with mechanical shoulder or knee disorders, bilateral distal polyarthralgia that was frequently associated with oedema at the extremities and tunnel syndromes. These pCHIK musculoskeletal disorders (MSDs) were managed with pain-killers, local and/or general anti-inflammatory drugs, and physiotherapy.

CONCLUSION:

Rheumatologists in Reunion Island managed CHIK rheumatic disorders in a pragmatic manner following the outbreak in 2006. This retrospective study describes the common mechanical and inflammatory pCHIK disorders. We provide a diagnostic and therapeutic algorithm to help physicians deal with chronic patients, and to limit both functional and economic impacts. The therapeutic indication of MTX in pCHIK CIR could be approved in future efficacy trials.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356515/pdf/pntd.0003603.pdf

February 28, 2017 at 6:59 pm

Predictors of Chikungunya rheumatism: a prognostic survey ancillary to the TELECHIK cohort study.

Arthritis Res Ther. 2013 Jan 9;15(1):R9.

Gérardin P, Fianu A, Michault A, Mussard C, Boussaïd K, Rollot O, Grivard P, Kassab S, Bouquillard E, Borgherini G, Gaüzère BA, Malvy D, Bréart G, Favier F.

Abstract

INTRODUCTION:

Long-lasting relapsing or lingering rheumatic musculoskeletal pain (RMSP) is the hallmark of Chikungunya virus (CHIKV) rheumatism (CHIK-R). Little is known on their prognostic factors. The aim of this prognostic study was to search the determinants of lingering or relapsing RMSP indicative of CHIK-R.

METHODS:

Three hundred and forty-six infected adults (age≥15 years) having declared RMSP at disease onset were extracted from the TELECHIK cohort study, Reunion island, and analyzed using a multinomial logistic regression model. We also searched for the predictors of CHIKV-specific IgG titres, assessed at the time of a serosurvey, using multiple linear regression analysis.

RESULTS:

Of these, 111 (32.1%) reported relapsing RMSP, 150 (43.3%) lingering RMSP, and 85 (24.6%) had fully recovered (reference group) on average two years after acute infection. In the final model controlling for gender, the determinants of relapsing RMSP were the age 45-59 years (adjusted OR: 2.9, 95% CI: 1.0, 8.6) or greater or equal than 60 years (adjusted OR: 10.4, 95% CI: 3.5, 31.1), severe rheumatic involvement (fever, at least six joints plus four other symptoms) at presentation (adjusted OR: 3.6, 95% CI: 1.5, 8.2), and CHIKV-specific IgG titres (adjusted OR: 3.2, 95% CI: 1.8, 5.5, per one unit increase). Prognostic factors for lingering RMSP were age 45-59 years (adjusted OR: 6.4, 95% CI: 1.8, 22.1) or greater or equal than 60 years (adjusted OR: 22.3, 95% CI: 6.3, 78.1), severe initial rheumatic involvement (adjusted OR: 5.5, 95% CI: 2.2, 13.8) and CHIKV-specific IgG titres (adjusted OR: 6.2, 95% CI: 2.8, 13.2, per one unit increase). CHIKV specific IgG titres were positively correlated with age, female gender and the severity of initial rheumatic symptoms.

CONCLUSIONS:

Our data support the roles of age, severity at presentation and CHIKV specific IgG titres for predicting CHIK-R. By identifying the prognostic value of the humoral immune response of the host, this work also suggest a significant contribution of the adaptive immune response to the physiopathology of CHIK-R and should help to reconsider the paradigm of this chronic infection primarily shifted towards the involvement of the innate immune response.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3672753/pdf/ar4137.pdf

February 28, 2017 at 6:57 pm

Editorial – Overuse of Antibiotics in Treatment of Community-Acquired Pneumonia Requiring Hospitalization

Infectious Diseases in Clinical Practice March 2017 V.25 N.2 P.55-56

Mandell, Lionel A. – McMaster University, Hamilton, ON, Canada.

Community-acquired pneumonia (CAP) continues to be a significant cause of morbidity and mortality with a major impact upon health care costs.

It is the third most common cause of death on a global basis and is the eighth most common cause of death in the United States.1,2

The mortality rates among outpatients is usually less than 5%, whereas among those hospitalized for CAP treatment, the rate can range from 12% to 40% depending on the site of care in the hospital (eg, non–intensive care unit vs intensive care unit).

PDF (CLIC on PDF)

February 28, 2017 at 5:07 pm

Mycobacterium goodii: A Case Report and Review of the Literature

Infectious Diseases in Clinical Practice March 2017 V.25 N.2 P.62-65

Salas, Natalie Mariam; Klein, Nicole

Mycobacterium goodii, a rapidly growing nontuberculous mycobacterium, is an emerging pathogen in nosocomial infections.

Its inherent resistance patterns make it a challenging organism to treat, and delays in identification can lead to poor outcomes.

We present a case of cardiac device pocket infection with M. goodii, complicated by both antibiotic resistance and drug reactions that highlight the challenges faced by clinicians trying to eradicate these infections.

We also present a brief review of the English literature surrounding this disease, including a table of all reported cases of M. goodii infections and their outcomes to act as guide for clinicians formulating treatment plans for these infections.

A clear understanding of diagnostic methods and treatment caveats is essential to curing infections caused by these organisms.

PDF (CLIC on PDF)

 

February 28, 2017 at 5:05 pm

Diagnosis and Management of CAP in Adults.

Am Fam Physician. 2011 Jun 1;83(11):1299-1306.

RICHARD R. WATKINS, MD, MS, Akron General Medical Center, Akron, Ohio

TRACY L. LEMONOVICH, MD, University Hospitals Case Medical Center, Cleveland, Ohio

Community-acquired pneumonia (CAP) is diagnosed by clinical features (e.g., cough, fever, pleuritic chest pain) and by lung imaging, usually an infiltrate seen on chest radiography. Initial evaluation should determine the need for hospitalization versus outpatient management using validated mortality or severity prediction scores. Selected diagnostic laboratory testing, such as sputum and blood cultures, is indicated for inpatients with severe illness but is rarely useful for outpatients. Initial outpatient therapy should include a macrolide or doxycycline. For outpatients with comorbidities or who have used antibiotics within the previous three months, a respiratory fluoroquinolone (levofloxacin, gemifloxacin, or moxifloxacin), or an oral beta-lactam antibiotic plus a macrolide should be used. Inpatients not admitted to an intensive care unit should receive a respiratory fluoroquinolone, or a beta-lactam antibiotic plus a macrolide.

Patients with severe community-acquired pneumonia or who are admitted to the intensive care unit should be treated with a beta-lactam antibiotic, plus azithromycin or a respiratory fluoroquinolone. Those with risk factors for Pseudomonas should be treated with a beta-lactam antibiotic (piperacillin/tazobactam, imipenem/cilastatin, meropenem, doripenem, or cefepime), plus an aminoglycoside and azithromycin or an antipseudomonal fluoroquinolone (levofloxacin or ciprofloxacin). Those with risk factors for methicillin-resistant Staphylococcus aureus should be given vancomycin or linezolid. Hospitalized patients may be switched from intravenous to oral antibiotics after they have clinical improvement and are able to tolerate oral medications, typically in the first three days. Adherence to the Infectious Diseases Society of America/American Thoracic Society guidelines for the management of community-acquired pneumonia has been shown to improve patient outcomes. Physicians should promote pneumococcal and influenza vaccination as a means to prevent community-acquired pneumonia and pneumococcal bacteremia.

PDF

http://www.aafp.org/afp/2011/0601/p1299.pdf

 

February 28, 2017 at 9:09 am

Specific management of post-chikungunya rheumatic disorders: a retrospective study of 159 cases in Reunion Island from 2006-2012.

PLoS Negl Trop Dis. 2015 Mar 11;9(3):e0003603.

Javelle E1, Ribera A2, Degasne I3, Gaüzère BA4, Marimoutou C5, Simon F1.

Author information

1Department of Tropical and Infectious Diseases, Laveran Military Teaching Hospital, Marseille, France.

2Private Rheumatology Office, Saint Denis, La Réunion, France.

3Department of Rheumatology, Centre Hospitalier Universitaire de La Réunion, Hôpital Felix Guyon, Saint Denis, La Réunion, France.

4Intensive Care Unit, Centre Hospitalier Universitaire de La Réunion, Hôpital Felix Guyon, Saint Denis, La Réunion, France.

5French Army Centre for Epidemiology and Public Health (“IRBA”), Marseille, France.

Abstract

BACKGROUND:

Since 2003, the tropical arthritogenic chikungunya (CHIK) virus has become an increasingly medical and economic burden in affected areas as it can often result in long-term disabilities. The clinical spectrum of post-CHIK (pCHIK) rheumatic disorders is wide. Evidence-based recommendations are needed to help physicians manage the treatment of afflicted patients.

PATIENTS AND METHODS:

We conducted a 6-year case series retrospective study in Reunion Island of patients referred to a rheumatologist due to continuous rheumatic or musculoskeletal pains that persisted following CHIK infection. These various disorders were documented in terms of their clinical and therapeutic courses. Post-CHIK de novo chronic inflammatory rheumatisms (CIRs) were identified according to validated criteria.

RESULTS:

We reviewed 159 patient medical files. Ninety-four patients (59%) who were free of any articular disorder prior to CHIK met the CIR criteria: rheumatoid arthritis (n=40), spondyloarthritis (n=33), undifferentiated polyarthritis (n=21). Bone lesions detectable by radiography occurred in half of the patients (median time: 3.5 years pCHIK). A positive therapeutic response was achieved in 54 out of the 72 patients (75%) who were treated with methotrexate (MTX). Twelve out of the 92 patients (13%) received immunomodulatory biologic agents due to failure of contra-indication of MTX treatment. Other patients mainly presented with mechanical shoulder or knee disorders, bilateral distal polyarthralgia that was frequently associated with oedema at the extremities and tunnel syndromes. These pCHIK musculoskeletal disorders (MSDs) were managed with pain-killers, local and/or general anti-inflammatory drugs, and physiotherapy.

CONCLUSION:

Rheumatologists in Reunion Island managed CHIK rheumatic disorders in a pragmatic manner following the outbreak in 2006. This retrospective study describes the common mechanical and inflammatory pCHIK disorders. We provide a diagnostic and therapeutic algorithm to help physicians deal with chronic patients, and to limit both functional and economic impacts. The therapeutic indication of MTX in pCHIK CIR could be approved in future efficacy trials.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356515/pdf/pntd.0003603.pdf

February 28, 2017 at 9:06 am

Destructive arthritis in a patient with chikungunya virus infection with persistent specific IgM antibodies.

BMC Infect Dis. 2009 Dec 10;9:200.

Malvy D1, Ezzedine K, Mamani-Matsuda M, Autran B, Tolou H, Receveur MC, Pistone T, Rambert J, Moynet D, Mossalayi D.

Author information

1Travel Clinics and Tropical Disease Unit, Department of Internal Medicine, Infectious Diseases and Tropical Medicine, University Hospital Center, Bordeaux, F-33075 France. denis.malvy@chu-bordeaux.fr

Abstract

BACKGROUND:

Chikungunya fever is an emerging arboviral disease characterized by an algo-eruptive syndrome, inflammatory polyarthralgias, or tenosynovitis that can last for months to years. Up to now, the pathophysiology of the chronic stage is poorly understood.

CASE PRESENTATION:

We report the first case of CHIKV infection with chronic associated rheumatism in a patient who developed progressive erosive arthritis with expression of inflammatory mediators and persistence of specific IgM antibodies over 24 months following infection.

CONCLUSIONS:

Understanding the specific features of chikungunya virus as well as how the virus interacts with its host are essential for the prevention, treatment or cure of chikungunya disease.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2803790/pdf/1471-2334-9-200.pdf

February 28, 2017 at 9:03 am

Severe Community-Acquired Pneumonia Caused by Human Adenovirus in Immunocompetent Adults: A Multicenter Case Series.

PLoS One. 2016 Mar 11;11(3):e0151199.

Tan D1, Zhu H1, Fu Y1, Tong F2, Yao D2, Walline J3, Xu J1, Yu X1.

Author information

1Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical sciences, Beijing, China.

2Department of Emergency, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei province, China.

3Division of Emergency Medicine, Department of Surgery, Saint Louis University Hospital, Saint Louis, Missouri, United States of America.

Abstract

BACKGROUND:

Severe community-acquired pneumonia (CAP) caused by human adenovirus (HAdV), especially HAdV type 55 (HAdV-55) in immunocompetent adults has raised increasing concerns. Clinical knowledge of severe CAP and acute respiratory distress syndrome induced by HAdV-55 is still limited, though the pathogen has been fully characterized by whole-genome sequencing.

METHODS:

We conducted a multicentre retrospective review of all consecutive patients with severe CAP caused by HAdV in immunocompetent adults admitted to the Emergency Department Intensive Care Unit of two hospitals in Northern China between February 2012 and April 2014. Clinical, laboratory, radiological characteristics, treatments and outcomes of these patients were collected and analyzed.

RESULTS:

A total of 15 consecutive severe CAP patients with laboratory-confirmed adenovirus infections were included. The median age was 30 years and all cases were identified during the winter and spring seasons. HAdV-55 was the most frequently (11/15) detected HAdV type. Persistent high fever, cough and rapid progression of dyspnea were typically reported in these patients. Significantly increased pneumonia severity index (PSI), respiratory rate, and lower PaO2/FiO2, hypersensitive CRP were reported in non-survivors compared to survivors (P = 0.013, 0.022, 0.019 and 0.026, respectively). The rapid development of bilateral consolidations within 10 days after illness onset were the most common radiographic finding, usually accompanied by adjacent ground glass opacities and pleural effusions. Total mortality was 26.7% in this study. Corticosteroids were prescribed to 14 patients in this report, but the utilization rate between survivors and non-survivors was not significant.

CONCLUSIONS:

HAdV and the HAdV-55 sub-type play an important role among viral pneumonia pathogens in hospitalized immunocompetent adults in Northern China. HAdV should be tested in severe CAP patients with negative bacterial cultures and a lack of response to antibiotic treatment, even if radiologic imaging and clinical presentation initially suggest bacterial pneumonia

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4788423/pdf/pone.0151199.pdf

February 25, 2017 at 1:27 pm

Streptococcus pyogenes Pneumonia in Adults: Clinical Presentation and Molecular Characterization of Isolates 2006-2015.

PLoS One. 2016 Mar 30;11(3):e0152640.

Tamayo E1, Montes M1,2, Vicente D1,2, Pérez-Trallero E1,2,3.

Author information

1Biomedical Research Center Network for Respiratory Diseases (CIBERES), San Sebastián, Spain.

2Microbiology Department, Hospital Universitario Donostia-Instituto Biodonostia, San Sebastián, Spain.

3Medicine Faculty, University of the Basque Country, UPV/EHU, San Sebastián, Spain.

Abstract

INTRODUCTION:

In the preantibiotic era Streptococcus pyogenes was a common cause of severe pneumonia but currently, except for postinfluenza complications, it is not considered a common cause of community-acquired pneumonia in adults.

AIM AND MATERIAL AND METHODS:

This study aimed to identify current clinical episodes of S. pyogenes pneumonia, its relationship with influenza virus circulation and the genotypes of the involved isolates during a decade in a Southern European region (Gipuzkoa, northern Spain). Molecular analysis of isolates included emm, multilocus-sequence typing, and superantigen profile determination.

RESULTS:

Forty episodes were detected (annual incidence 1.1 x 100,000 inhabitants, range 0.29-2.29). Thirty-seven episodes were community-acquired, 21 involved an invasive infection and 10 developed STSS. The associated mortality rate was 20%, with half of the patients dying within 24 hours after admission. Influenza coinfection was confirmed in four patients and suspected in another. The 52.5% of episodes occurred outside the influenza seasonal epidemic. The 67.5% of affected persons were elderly individuals and adults with severe comorbidities, although 13 patients had no comorbidities, 2 of them had a fatal outcome. Eleven clones were identified, the most prevalent being emm1/ST28 (43.6%) causing the most severe cases.

CONCLUSIONS:

  1. pyogenes pneumonia had a continuous presence frequently unrelated to influenza infection, being rapidly fatal even in previously healthy individuals.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4814053/pdf/pone.0152640.pdf

February 25, 2017 at 1:26 pm

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