Archive for February 20, 2017

Revisiones – Diagnóstico microbiológico de las hepatitis virales

Enf Infecc & Microbiol. Clínica Noviembre 2015 V.33 N.9 e53-e62

Roberto Alonso, Antonio Aguilera, Juan Córdoba, Antonio Fuertes

a Servicio de Microbiología y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, España

b Servicio de Microbiología, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, España

c Servicio de Microbiología, Hospital Universitari i Politècnic La Fe, Valencia, España

d LABCO QualityDiagnostics, Madrid, España

La inflamación hepática o hepatitis tiene causas diversas, tanto infecciosas como no infecciosas. Entre las primeras, cabe destacar la etiología viral que es la causa de, al menos, la mitad de todas las hepatitis en el mundo.

Se han descrito distintos virus con tropismo primario por el tejido hepático. Estos microorganismos se han ido nombrando sucesivamente con las letras del abecedario: A, B, C, D, E y G.

El objetivo de este artículo es revisar este grupo heterogéneo de virus en sus aspectos más básicos, sus implicaciones clínicas, su tratamiento, las principales medidas preventivas frente a estas infecciones y, con especial interés, las aproximaciones diagnósticas, tanto serológicas como moleculares, que se utilizan para su detección, cuantificación y caracterización

PDF

http://apps.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=90443319&pident_usuario=0&pcontactid=&pident_revista=28&ty=51&accion=L&origen=zonadelectura&web=www.elsevier.es&lan=es&fichero=28v33n09a90443319pdf001.pdf

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February 20, 2017 at 3:26 pm

CD4 Decline Is Associated With Increased Risk of Cardiovascular Disease, Cancer, and Death in Virally Suppressed Patients With HIV

Clinical Infectious Diseases July 15, 2013 V.57 N.2 P.314-321

Marie Helleberg, Gitte Kronborg, Carsten S. Larsen, Gitte Pedersen, Court Pedersen, Niels Obel, and Jan Gerstoft

1Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet

2Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre

3Department. of Infectious Diseases, Aarhus University Hospital, Skejby

4Department of Infectious Diseases, Aalborg University Hospital

5Deptartment of Infectious Diseases, Odense University Hospital, Denmark

Background

The clinical implications of a considerable CD4 decline despite antiretroviral treatment and viral suppression are unknown. We aimed to test the hypothesis that a major CD4 decline could be a marker of cardiovascular disease or undiagnosed cancer.

Methods

Patients with human immunodeficiency virus (HIV) were followed in the Danish nationwide, population-based cohort study in the period 1995–2010 with quarterly CD4 measurements. Associations between a CD4 decline of ≥30% and cardiovascular disease, cancer, and death were analyzed using Poisson regression with date of CD4 decline as a time-updated variable.

Results

We followed 2584 virally suppressed HIV patients for 13 369 person-years (PY; median observation time, 4.7 years). Fifty-six patients developed CD4 decline (incidence rate, 4.2/1000 PY [95% confidence interval {CI}, 3.2–5.4]). CD4 counts dropped from a median of 492 cells/µL to 240 cells/µL. CD8, CD3, and total lymphocyte counts dropped concomitantly. No HIV-related factors, apart from treatment with didanosine, were associated with CD4 decline. The risk of cardiovascular disease, cancer, and death increased markedly ≤6 months after CD4 decline (incidence rate ratio, 11.7 [95% CI, 3.6–37.4] and 13.7 [95% CI, 4.3–43.6], respectively, and mortality rate ratio 4.3 [95% CI, 1.1–17.6]).

Conclusion

A major decline in CD4 count is associated with a marked increased risk of cardiovascular disease, cancer, and death among virally suppressed HIV patients. We studied the clinical implications of CD4 decline among virally suppressed human immunodeficiency virus patients and found that the risk of cardiovascular disease, cancer, and death was substantially increased within 6 months after a major CD4 decline and moderately increased thereafter.

PDF

http://cid.oxfordjournals.org/content/57/2/314.full.pdf

February 20, 2017 at 3:23 pm

Infectious Complications Following Transrectal Ultrasound–Guided Prostate Biopsy: New Challenges in the Era of Multidrug-Resistant Escherichia coli

Clinical Infectious Diseases July 15, 2013 V.57 N.2 P.267-274

CLINICAL PRACTICE

Deborah A. Williamson, Lucinda K. Barrett, Benjamin A. Rogers, Joshua T. Freeman, Paul Hadway, and David L. Paterson

1Faculty of Medical and Health Sciences, University of Auckland

2Department of Clinical Microbiology, Auckland District Health Board, New Zealand

3The University of Queensland, UQ Centre for Clinical Research, Brisbane

4Department of Urology, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia

Transrectal ultrasound (TRUS)–guided prostate biopsy is currently considered the standard technique for obtaining tissue to make a histological diagnosis of prostatic carcinoma. Infectious complications following TRUS-guided prostate biopsy are well described, and are reportedly increasing in incidence.

The role of antibiotic prophylaxis in reducing post–TRUS biopsy infections is now established, and many guidelines suggest that fluoroquinolone antimicrobials are the prophylactic agents of choice.

Of note, however, recent reports suggest an emerging association between TRUS biopsy and subsequent infection with fluoroquinolone-resistant Escherichia coli.

Against this background, we provide an overview of the epidemiology, prevention, and treatment of infectious complications following TRUS biopsy, in the wider context of increasing global antimicrobial resistance.

 

We provide an overview of the published literature relating to the epidemiology, prevention, and treatment of infections following transrectal ultrasound–guided prostate biopsy in the wider context of increasing antimicrobial resistance.

PDF

http://cid.oxfordjournals.org/content/57/2/267.full.pdf

February 20, 2017 at 3:21 pm


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