Archive for March, 2017

Estimating the burden of invasive and serious fungal disease in the United Kingdom

Journal of Infection January 2017 V.74 N.1

Matthew Pegorie a, David W. Denning b,c,d, *, William Welfare a,d

a Public Health England North West Health Protection Team (Greater Manchester), UK

bNational Aspergillosis Centre, University Hospital of South Manchester, Manchester, UK

c The University of Manchester, Manchester, UK

d Manchester Academic Health Sciences Centre, University of Manchester, UK

Background: The burden of fungal disease in the UK is unknown. Only limited data are systematically collected. We have estimated the annual burden of invasive and serious fungal disease.

Methods: We used several estimation approaches. We searched and assessed published estimates of incidence, prevalence or burden of specific conditions in various high risk groups. Studies with adequate internal and external validity allowed extrapolation to estimate current UK burden. For conditions without adequate published estimates, we sought expert advice.

Results: The UK population in 2011 was 63,182,000 with 18% aged under 15 and 16% over 65. The following annual burden estimates were calculated: invasive candidiasis 5142; Candida peritonitis complicating chronic ambulatory peritoneal dialysis 88; Pneumocystis pneumonia 207e587 cases, invasive aspergillosis (IA), excluding critical care patients 2901e2912, and IA in critical care patients 387e1345 patients, <100 cryptococcal meningitis cases. We estimated 178,000 (50,000e250,000) allergic bronchopulmonary aspergillosis cases in people with asthma, and 873 adults and 278 children with cystic fibrosis. Chronic pulmonary aspergillosis is estimated to affect 3600 patients, based on burden estimates post tuberculosis and in sarcoidosis.

Conclusions: Uncertainty is intrinsic to most burden estimates due to diagnostic limitations, lack of national surveillance systems, few published studies and methodological limitations. The largest uncertainty surrounds IA in critical care patients. Further research is needed to produce a more robust estimate of total burden


March 25, 2017 at 5:40 pm

Incidence and mortality of herpes simplex encephalitis in Denmark: A nationwide registry-based cohort study

Journal of Infection January 2017 V.74 N.1

Laura Krogh Jørgensen a, *, Lars Skov Dalgaard a, Lars Jørgen Østergaard a, Mette Nørgaard b, Trine Hyrup Mogensen a,c

a Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensen Boulevard 99, 8200 Aarhus N, Denmark

b Department of Clinical Epidemiology, Aarhus University Hospital, Oluf Palmes Alle´ 43-45, 8200 Aarhus N, Denmark

cDepartment of Biomedicine, Aarhus University, Vennelyst Blvd. 4, 8000 Aarhus C, Denmark

Objectives: We aimed to investigate the incidence and mortality of herpes simplex encephalitis (HSE) in a nationwide cohort.

Methods: From the Danish National Patient Registry, we identified all adults hospitalised with a first-time diagnosis of HSE in Denmark during 2004e2014. The HSE diagnoses were verified using medical records and microbiological data. Patients were followed for mortality through the Danish Civil Registry System. We estimated age-standardised incidence rates of HSE and 30-day, 60-day, and 1-year cumulative mortality. Furthermore, we assessed whether calendar year, age, gender, level of comorbidity, virus type, and department type was associated with HSE mortality.

Results: We identified a total of 230 cases of HSE. Median age was 60.7 years (interquartile range: 49.3e71.6). The overall incidence rate was 4.64 cases per million population per year (95% confidence interval: 4.06e5.28). The cumulative mortality within 30 days, 60 days, and 1 year of the HSE admission was 8.3%, 11.3%, and 18.6%, respectively. Advanced age and presence of comorbidity were associated with increased 60-day and 1-year mortality.

Conclusions: This nationwide study of verified HSE found a higher incidence than reported in previous nationwide studies. Presence of comorbidity was identified as a novel adverse prognostic factor. Mortality rates following HSE remain high.


March 25, 2017 at 5:38 pm

Adults with suspected central nervous system infection: A prospective study of diagnostic accuracy

Journal of Infection January 2017 V.74 N.1

Ula Khatib, Diederik van de Beek, John A. Lees, Matthijs C. Brouwer

Objectives: To study the diagnostic accuracy of clinical and laboratory features in the diagnosis of central nervous system (CNS) infection and bacterial meningitis.

Methods: We included consecutive adult episodes with suspected CNS infection who underwent cerebrospinal fluid (CSF) examination. The reference standard was the diagnosis classified into five categories: 1) CNS infection; 2) CNS inflammation without infection; 3) other neurological disorder; 4) non-neurological infection; and 5) other systemic disorder.

Results: Between 2012 and 2015, 363 episodes of suspected CNS infection were included. CSF examination showed leucocyte count >5/mm3 in 47% of episodes. Overall, 89 of 363 episodes were categorized as CNS infection (25%; most commonly viral meningitis [7%], bacterial meningitis [7%], and viral encephalitis [4%]), 36 (10%) episodes as CNS inflammatory disorder, 111 (31%) as systemic infection, in 119 (33%) as other neurological disorder, and 8 (2%) as other systemic disorders. Diagnostic accuracy of individual clinical characteristics and blood tests for the diagnosis of CNS infection or bacterial meningitis was low. CSF leucocytosis differentiated best between bacterial meningitis and other diagnoses (area under the curve [AUC] 0.95) or any neurological infection versus other diagnoses (AUC 0.93).

Conclusions: Clinical characteristics fail to differentiate between neurological infections and other diagnoses, and CSF analysis is the main contributor to the final diagnosis.


March 25, 2017 at 5:36 pm

Comparison of serological and molecular test for diagnosis of infectious mononucleosis.

Adv Biomed Res. 2016 May 30;5:95.

Salehi H1, Salehi M2, Roghanian R3, Bozari M3, Taleifard S3, Salehi MM4, Salehi M4.
Author information
1 Department of Infectious Diseases, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
2 Student Research Center, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
3 Department of Biology, Faculty of Sciences, University of Isfahan, Isfahan, Iran.
4 Student Research Center, Faculty of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran.

Epstein-Bar virus (EBV) is the main etiology of infectious mononucleosis (IM) syndrome that is characterized by fever, sore throat, and lymph adenopathy. Since, this virus could be associated with a number of malignancies, some hematologic disorders, and chronic fatigue syndrome, identification of IM is very important. The aim of study was to evaluate the specificity, as well as sensitivity of the two different methods that is, serology versus molecular diagnosis that are currently used for diagnosis of IM.
In this study, during a period of 3.5 years, 100 suspected patients as case group and 100 healthy individuals as a control group were studied. Fifty samples in each group were tested by polymerase chain reaction (PCR) and all the samples including case group and control group were carried out by enzyme-linked immunosorbent assay (ELISA).
In 76% of patients and in 20% of the healthy individuals, samples were detected EBV DNA by PCR. On the other hand, 68.5% of the samples belong to the case group and 46% in the control group showed positivity by ELISA.
By comparing the two methods, since PCR is very expensive and time consuming, and the percentages of difference ranges are narrow, ELISA could be applied as a first, easiest, and preliminary diagnostic test for IM. In addition, this test could be applied in various phases of the disease with a higher sensitivity comparing to PCR. Although PCR is routinely used for diagnosis of various infectious agents, it is considered as an expensive test and merely could be used after 1-2 weeks from the onset of the illness.

March 24, 2017 at 7:31 pm

Usefulness of biomarkers to predict bacteraemia in patients with infection in the emergency department.

Rev Esp Quimioter. 2017 Mar 8. pii: julian08mar2017. [Epub ahead of print]

[Article in Spanish]

Julián-Jiménez A1, Candel FJ, González-Del Castillo J; en representación del grupo INFURG-SEMES (grupo de estudio de infecciones de la Sociedad Española de Medicina de Urgencias y Emergencias).

Author information

1 Agustín Julián-Jiménez, Servicio de Urgencias – Unidad de Docencia, Formación e Investigación. Complejo Hospitalario Universitario de Toledo, Avda. de Barber nº 30. C.P: 45.004. Toledo, Spain.


Between all patients attended in the Emergency Department (ED), 14.3% have an infectious disease diagnosis. Blood cultures (BC) are obtained in 14.6% of patients and have a profitability of 20%, whereas 1% are considered as contaminated and 1-3% of positive cultures correspond to discharge patients (“hidden bacteraemia”). The highest number of confirmed bacteraemias comes from the samples of patients with urinary tract infections, followed by community-acquired pneumonia. The suspicion and detection of bacteraemia have an important diagnostic and prognostic significance and could modify some important making-decisions (admission, BC request, administration of appropriate and early antimicrobial, etc). Therefore, finding a predictive model of bacteraemia useful and applicable in ED has become the objective of many authors that combine different clinical, epidemiological and analytical variables, including infection and inflammatory response biomarkers (IIRBM), as they significantly increase the predictive power of such models. The aim of this review is to highlight the evidence showed in recent published articles, to clarify existing controversies, and to compare the accuracy of the most important IIRBM to predict bacteremia in patients attended due to infection in the ED. Finally, to generate different recommendations that could help to define the role of IIRBM in improving the indication to obtaining BC, as well as in immediate decision-making in diagnosis and treatment (early and adequate antibiotic treatment, complementary tests, other microbiological samples, hemodynamic support measures, need for admission, etc.).


March 22, 2017 at 3:47 pm

Neumonía adquirida en la comunidad – Guía práctica elaborada por un comité intersociedades

Medicina (B. Aires) Julio/Agosto 2003 V.63 N.4

Luna C. M.1, Calmaggi A.2, Caberloto O.1, Gentile J.2, Valentín R.1, 3, Ciruzzi J.1 , Clara L.2, Rizzo O.1, Lasdica S.1, 3, Blumenfeld M.2, Benchetrit G.2, Famiglietti A.4, ApezteguIa C.1, 3, Monteverde A.1 y Grupo Argentino de Estudio de la NAC

1 Asociación Argentina de Medicina Respiratoria (AAMR),

2 Sociedad Argentina de Infectología (SADI),

3 Sociedad Argentina de Terapia Intensiva (SATI),

4 Sociedad Argentina de Bacteriología Clínica (SADEBAC), Asociación Argentina de Microbiología (AAM),

5 Sociedad Argentina de Virología (SAV),

6 Sociedad Argentina de Medicina (SAM), Buenos Aires


Las guías para neumonía adquirida en la comunidad (NAC) contribuyen a ordenar el manejo de los pacientes. La NAC presenta cambios en su etiología, epidemiología y sensibilidad a antibióticos que obligan a la revisión periódica de las guías. Un comité intersociedades elaboró esta guía dividida en tópicos y basada en guías y estudios clínicos recientes. La NAC afecta anualmente al 1% de la población; la mayoría de los pacientes requiere atención ambulatoria, en otros reviste gravedad (representa la 6ª causa de muerte en Argentina). La etiología es diferente si el paciente es ambulatorio, requiere internación en sala general o en terapia intensiva, pero no hay forma segura de predecirla clínicamente. Los predictores de mala evolución son: edad, antecedentes personales y comorbilidades y hallazgos del examen físico, del laboratorio y de la radiografía de tórax.  Entre 10 y 25% de los pacientes que se internan deben hacerlo en terapia intensiva para ventilación mecánica o soporte hemodinámico (NAC grave), tanto inicialmente como durante su evolución. Estos pacientes presentan alta mortalidad; algunos criterios ayudan a reconocerlos. Embarazo, EPOC e internación en institutos geriátricos requieren consideraciones especiales. El diagnóstico es clínico, los métodos complementarios ayudan a determinar la etiología y la gravedad: la radiografía de tórax debe practicarse en todos los pacientes; el resto de los estudios están indicados en internados. El tratamiento inicial es empírico y debe iniciarse precozmente usando antibióticos activos frente a los gérmenes blanco, evitando el uso inapropiado que induce el desarrollo de resistencias. El tratamiento no debe prolongarse innecesariamente. Hidratación, nutrición, oxígeno y el manejo de las complicaciones complementan al tratamiento antibiótico. La prevención se basa en la profilaxis antinfluenza y antineumocóccica, evitar la aspiración y medidas generales.


March 22, 2017 at 3:46 pm

Use of Proton Pump Inhibitors and the Risk of Listeriosis: A Nationwide Registry-based Case-Control Study

Clinical Infectious Diseases April 1, 2017 V.64 N. P.845-851


Anne Kvistholm Jensen; Jacob Simonsen; Steen Ethelberg

We investigated the association between proton pump inhibitors (PPIs) and risk of listeriosis in Denmark, 1994-2012, using register data. The matched comorbidity adjusted odds ratio was 2.8 (95%CI: 2.1–3.7). PPIs may increase the risk of listeriosis in vulnerable populations groups.


March 20, 2017 at 9:12 am

Management of septic arthritis – Systematic review.

Ann Rheum Dis. 2007 Apr;66(4):440-5.

Mathews CJ1, Kingsley G, Field M, Jones A, Weston VC, Phillips M, Walker D, Coakley G.

Author information

1 Queen Elizabeth Hospital, Stadium Road, Woolwich, and University Hospital Lewisham, Kings College London, UK.


OBJECTIVE: To evaluate the existing evidence on the diagnosis and management of septic arthritis in native joints.

DESIGN: Systematic review.

DATA SOURCES: Cochrane Library, Medline, Embase, National Electronic Library for Health, reference lists, national experts.

REVIEW METHODS: Systematic review of the literature with evaluation of the methodological quality of the selected papers using defined criteria set out by the Clinical Effectiveness and Evaluation Unit of the Royal College of Physicians.

RESULTS: 3291 citations were initially identified. Of these, 189 full text articles were identified for potential selection. Following review of these full text articles, 80 articles were found to fulfil the inclusion criteria and were included in the final list.

CONCLUSIONS: were drawn on the diagnosis, investigation and management of septic arthritis.

DISCUSSION: Little good quality evidence exists to guide the diagnosis and management of septic arthritis. Overall, no investigation is more reliable in the diagnosis of septic arthritis than the opinion of an experienced doctor. Aspiration and culture of synovial fluid is crucial to the diagnosis, but measurement of cell count is unhelpful. Antibiotics are clearly required for a prolonged period, but there are no data to indicate by which route or for how long. Key unanswered questions remain surrounding the medical and surgical management of the infected joint.


March 18, 2017 at 10:43 am

Prosthetic Joint Infection due to Mycobacterium avium-intracellulare in a Patient with Rheumatoid Arthritis: A Case Report and Review of the Literature.

Case Rep Infect Dis. 2017;2017:8682354. doi: 10.1155/2017/8682354. Epub 2017 Feb 9.

Ingraham NE1, Schneider B2, Alpern JD3.

Author information

1 Department of Internal Medicine, University of Minnesota, Minneapolis, MN, USA.

2 Department of Internal Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.

3 Department of Infectious Disease, University of Minnesota, Minneapolis, MN, USA.


Nontuberculous mycobacteria (NTM) are a rare cause of prosthetic joint infections (PJI). However, the prevalence of NTM infections may be increasing with the rise of newer immunosuppressive medications such as biologics. In this case report, we describe a rare complication of immunosuppressive therapies and highlight the complexity of diagnosing and treating PJI due to NTM. The patient is a 79-year-old Caucasian male with a history of severe destructive rheumatoid arthritis on several immunosuppressive agents and right hip osteoarthritis s/p total hip arthroplasty 15 years previously with several complex revisions, presenting with several weeks of worsening right hip and abdominal pain. A right hip CT scan revealed periprosthetic fluid collections. Aspiration of three fluid pockets was AFB smear-positive and grew Mycobacterium avium-intracellulare. The patient was deemed a poor surgical candidate. He underwent a limited I&D and several months of antimycobacterial therapy but clinically deteriorated and opted for hospice care. PJI caused by NTM are rare and difficult to treat. The increased use of biologics and prosthetic joint replacements over the past several decades may increase the risk of PJI due to NTM. A high index of suspicion for NTM in immunosuppressed patients with PJI is needed.


March 18, 2017 at 10:42 am

Chikungunya Virus Infection: An Update on Joint Manifestations and Management.

Rambam Maimonides Med J. 2016 Oct 31;7(4). doi: 10.5041/RMMJ.10260.

Krutikov M1, Manson J2.

Author information

1 Department of Infectious Diseases, University College London Hospital, London, UK.

2 Department of Rheumatology, University College London Hospital, London, UK.


The advent of sophisticated diagnostics has enabled the discovery of previously unknown arthropod-borne viruses like Chikungunya. This infection has become increasingly prevalent in the last 10 years across the Indian Ocean and has been brought to media attention by a recent outbreak in the Caribbean. The outbreak has been aided by a drastic rise in air travel, allowing infected individuals to transport the virus to previously unaffected regions. In addition, a recently documented viral mutation has allowed its transmission by the Aedes albopictus mosquito, therefore facilitating outbreaks in Southern Europe and the USA. The duration and extent of the arthritis seen peri- and post infection has become a topic of academic interest. Although published data are largely observational, there has been a definite increase in original research focusing on this. Symptoms can persist for years, particularly in older patients with pre-existing medical conditions. The etiology is still not fully understood, but viral persistence and immune activation within synovial fluid have been shown in mouse models. There have been no prospective clinical trials of treatment in humans; however, animal trials are in process. The mainstay of treatment remains anti-inflammatories and steroids where necessary. The clinical presentation seems to mimic common rheumatological conditions like rheumatoid arthritis; therefore recent recommendations suggest the use disease-modifying agents as a common practice for the specific syndrome. This review uses recent published data and draws on our own clinical experience to provide an overview of joint complications of Chikungunya infection.


March 18, 2017 at 10:40 am

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