Archive for February 28, 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

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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

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