Archive for June, 2017

The role of biomarkers in the diagnosis of periprosthetic joint infection.

EFORT Open Rev. 2017 Mar 13;1(7):275-278.

Shahi A1, Parvizi J1.

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1 The Rothman Institute at Thomas Jefferson University, Philadelphia, USA.


The role of serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) as the first line for evaluating a patient with periprosthetic joint infection (PJI) has been debunked.We are living in the era of biomarkers for the diagnosis of PJI, and to that effect, several biomarkers have been introduced such as synovial fluid alpha defensin and leukocyte esterase.The synovial fluid leukocyte esterase test has a low cost, is accessible, and has provided promising results for diagnosing PJI.There is an urgent need for an accurate and reliable serum biomarker for diagnosing patients with PJI. Cite this article: Shahi A, Parvizi J. The role of biomarkers in the diagnosis of periprosthetic joint infection.


June 30, 2017 at 12:01 pm

Management of Resistant, Atypical and Culture-negative Periprosthetic Joint Infections after Hip and Knee Arthroplasty.

Open Orthop J. 2016 Nov 30;10:615-632.

McLawhorn AS1, Nawabi DH1, Ranawat AS1.

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1 Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70 Street, New York, NY 10021, USA.



Periprosthetic joint infection (PJI) is a devastating complication following lower extremity total joint arthroplasty (TJA). It is a leading cause of morbidity and revision following TJA. As such, PJI is a significant driver of healthcare costs. The prevalence of PJI related to resistant and atypical organisms is increasing, and approximately 10-30% of PJIs are culture-negative. The purpose of this review is to summarize the current epidemiology, diagnostics, and management of PJI associated with resistant and atypical pathogens and of culture-negative PJIs.


The published literature related to the epidemiology, diagnosis, and management of atypical, drug-resistant, and culture-negative PJI is reviewed.


The clinical diagnosis of PJI is often challenging, particularly when pathogens are fastidious or when antibiotics have been administered empirically. Molecular diagnostic studies, such as synovial α-defensin, may provide rapid, accurate identification of PJI, even in the setting of concurrent antibiotics administration or systemic inflammatory disease. Once PJI is diagnosed, two-stage exchange arthroplasty remains the gold standard for treating PJI with resistant microorganisms, since there is a high rate of treatment failure with irrigation and debridement and with one-stage exchange arthroplasty.


Additional research is needed to define the optimal treatment of PJIs associated with rare pathogens, such as fungi and mycobacteria. There is a need for inexpensive, reliable tests that rapidly detect specific microbial species and antimicrobial susceptibilities. Additional research is also required to define the specific organisms, clinical scenarios, surgical techniques, and antimicrobial regimens that allow for reproducible treatment success with prosthetic retention strategies.


June 30, 2017 at 11:59 am

Efficacy of Antibiotic Suppressive Therapy in Patients with a Prosthetic Joint Infection.

J Bone Jt Infect. 2017 Jan 15;2(2):77-83.

Wouthuyzen-Bakker M1, Nijman JM1, Kampinga GA2, van Assen S1, Jutte PC3.

Author information

1 Department of Internal Medicine/Infectious diseases.

2 Department of Medical Microbiology.

3 Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, the Netherlands.


Introduction: For chronic prosthetic joint infections (PJI), complete removal of the infected prosthesis is necessary in order to cure the infection. Unfortunately, a subgroup of patients is not able to undergo a revision surgery due to high surgical risk. Alternatively, these patients can be treated with antibiotic suppressive therapy (AST) to suppress the infection. Aim: To evaluate the efficacy and tolerability of AST. Methods: We retrospectively collected data (period 2009-2015) from patients with a PJI (of hip, knee or shoulder) who were treated with AST at the University Medical Center Groningen, the Netherlands. AST was defined as antibiotic treatment for PJI that was started after the usual 3 months of antibiotic treatment. The time of follow-up was defined from the time point AST was started. Treatment was considered as failed, when the patient still experienced joint pain, when surgical intervention (debridement, removal, arthrodesis or amputation) was needed to control the infection and/or when death occurred due to the infection. Results: We included 21 patients with a median age of 67 years (range 21 – 88) and with a median follow-up of 21 months (range 3 – 81). Coagulase negative staphylococci (CNS) (n=6), S. aureus (n=6) and polymicrobial flora (n=4) were the most frequently found causative pathogens. Most patients with CNS and S. aureus were treated with minocycline (67%) and clindamycin (83%) as AST, respectively. Overall, treatment was successful in 67% of patients. Failure was due to persistent joint pain (n=1), surgical intervention because of an uncontrolled infection (n=3), and death due the infection (n=3). We observed a treatment success of 90% in patients with a ‘standard’ prosthesis (n=11), compared to only 50% in patients with a tumor-prosthesis (n=10). Also, treatment was successful in 83% of patients with a CNS as causative microorganism for the infection, compared to 50% in patients with a S. aureus. Patients who failed on AST had a higher ESR in comparison to patients with a successful treatment (mean 73 ± 25SD versus 32 ± 19SD mm/hour (p = 0.007), respectively. 43% of patients experienced side effects and led to a switch of antibiotic treatment or a dose adjustment in almost all of these patients. Conclusions: Removal of the implant remains first choice in patients with chronic PJI. However, AST is a reasonable alternative treatment option in a subgroup of patients with a PJI who are no candidate for revision surgery, in particular in patients with a ‘standard’ prosthesis and/or CNS as the causative micro-organism.



June 30, 2017 at 11:55 am

Epidemiology of human plague in the United States, 1900-2012.

Emerg Infect Dis. 2015 Jan;21(1):16-22.

Kugeler KJ, Staples JE, Hinckley AF, Gage KL, Mead PS.


We summarize the characteristics of 1,006 cases of human plague occurring in the United States over 113 years, beginning with the first documented case in 1900.

Three distinct eras can be identified on the basis of the frequency, nature, and geographic distribution of cases. During 1900-1925, outbreaks were common but were restricted to populous port cities.

During 1926-1964, the geographic range of disease expanded rapidly, while the total number of reported cases fell. During 1965-2012, sporadic cases occurred annually, primarily in the rural Southwest.

Clinical and demographic features of human illness have shifted over time as the disease has moved from crowded cities to the rural West.

These shifts reflect changes in the populations at risk, the advent of antibiotics, and improved detection of more clinically indistinct forms of infection.

Overall, the emergence of human plague in the United States parallels observed patterns of introduction of exotic plants and animals.


June 29, 2017 at 8:17 am

Gentamicin and tetracyclines for the treatment of human plague: review of 75 cases in new Mexico, 1985-1999.

Clin Infect Dis. MARCH 2004 Mar 1;38(5):663-9.

Boulanger LL1, Ettestad P, Fogarty JD, Dennis DT, Romig D, Mertz G.

Author information

1 Department of Internal Medicine, Division of Infectious Diseases, University of New Mexico, Albuquerque, NM, USA.


Streptomycin, an antimicrobial with limited availability, is the treatment of choice for plague, a fulminating and potentially epidemic disease that poses a bioterrorism concern. We evaluated the efficacy of gentamicin and tetracyclines for treating human plague. A medical record review was conducted on all 75 patients with plague who were reported in New Mexico during 1985-1999. Fifty patients were included in an analysis that compared streptomycin-treated patients (n=14) with those treated with gentamicin and/or a tetracycline (n=36). The mean numbers of fever days, hospital days, and complications and the number of deaths did not differ between patients treated with streptomycin and those treated with gentamicin. One patient who received tetracycline alone experienced a serious complication. Gentamicin alone or in combination with a tetracycline was as efficacious as streptomycin for treating human plague. The efficacy of a tetracycline alone could not be determined from the study.


June 29, 2017 at 8:15 am

European consensus-based (S2k) Guideline on the Management of Herpes Zoster – guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV), Part 2: TREATMENT.

J Eur Acad Dermatol Venereol. January 2017 V.31 N.1 P.20-29.                        

Werner RN1, Nikkels AF2, Marinović B3, Schäfer M4, Czarnecka-Operacz M5, Agius AM6, Bata-Csörgő Z7, Breuer J8, Girolomoni G9, Gross GE10, Langan S11, Lapid-Gortzak R12, Lesser TH13, Pleyer U14, Sellner J15, Verjans GM16, Wutzler P17, Dressler C1, Erdmann R1, Rosumeck S1, Nast A1.

Author information

1 Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine in Dermatology (dEBM), Charité – Universitätsmedizin Berlin, Berlin, Germany.

2 Department of Dermatology, University Medical Center of Liège, Liège, Belgium.

3 Department of Dermatology and Venereology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia.

4 Department of Anesthesiology, Charité – Universitätsmedizin Berlin, Berlin, Germany.

5 Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland.

6 Department of Otorhinolaryngology, The Medical School, University of Malta, Msida, Malta.

7 Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary.

8 Division of Infection and Immunity, University College London, London, United Kingdom.

9 Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy.

10 Department of Dermatology and Venerology, Universitätsklinik Rostock, Rostock, Germany.

11 Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.

12 Department of Ophthalmology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

13 Department of Otolaryngology, University Hospital Aintree NHS Foundation Trust, Liverpool, UK.

14 Department of Ophthalmology, Charité – Universitätsmedizin Berlin, Berlin, Germany.

15 Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.

16 Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands.

17 Department of Virology and Antiviral Therapy, Jena University Hospital, Jena, Germany.


Herpes zoster (HZ, shingles) is a frequent medical condition which may severely impact the quality of life of affected patients. Different therapeutic approaches to treat acute HZ are available.

The aim of this European project was the elaboration of a consensus-based guideline on the management of patients who present with HZ, considering different patient populations and different localizations.

This interdisciplinary guideline aims at an improvement of the outcomes of the acute HZ management concerning disease duration, acute pain and quality of life of the affected patients and at a reduction in the incidence of postherpetic neuralgia (PHN) and other complications.

The guideline development followed a structured and pre-defined process, considering the quality criteria for guidelines development as suggested by the AGREE II instrument.

The steering group was responsible for the planning and the organization of the guideline development process (Division of Evidence-Based Medicine, dEBM).

The expert panel was nominated by virtue of clinical expertise and/or scientific experience and included experts from the fields of dermatology, virology/infectiology, ophthalmology, otolaryngology, neurology and anaesthesiology.

Recommendations for clinical practice were formally consented during the consensus conference, explicitly considering different relevant aspects.

The guideline was approved by the commissioning societies after an extensive internal and external review process. In this second part of the guideline, therapeutic interventions have been evaluated.

The expert panel formally consented recommendations for the treatment of patients with HZ (antiviral medication, pain management, local therapy), considering various clinical situations.

Users of the guideline must carefully check whether the recommendations are appropriate for the context of intended application.

In the setting of an international guideline, it is generally important to consider different national approaches and legal circumstances with regard to the regulatory approval, availability and reimbursement of diagnostic and therapeutic interventions.



June 28, 2017 at 8:53 am

2016-11 European consensus – Guideline on the Management of H Zoster – guided by the EDF in cooperation with the EADV, Part 1: DIAGNOSIS


R.N. Werner, A.F. Nikkels, B. Marinović, M. Schäfer, M. Czarnecka-Operacz, A.M. Agius, Z. Bata-Csörgő, J. Breuer, G. Girolomoni, G.E. Gross, S. Langan, R. Lapid-Gortzak, T.H. Lesser, U. Pleyer, J. Sellner, G.M. Verjans, P. Wutzler, C. Dressler, R. Erdmann, S. Rosumeck, A. Nast


June 28, 2017 at 8:51 am

Risk Factors for Legionella longbeachae Legionnaires’ Disease, New Zealand

Emerging Infectious Diseases July 2017 V.23 N.7

Emma Kenagy1, Patricia C. Priest1Comments to Author , Claire M. Cameron, Debbie Smith, Pippa Scott, Vicki Cho, Peter Mitchell, and David R. Murdoch

Author affiliations: University of Otago, Christchurch, New Zealand (E. Kenagy, P. Scott, V. Cho, D.R. Murdoch); Canterbury District Health Board, Christchurch (E. Kenagy, D. Smith, P. Mitchell); University of Otago, Dunedin, New Zealand (P. Priest, C.M. Cameron)

Legionella longbeachae, found in soil and compost-derived products, is a globally underdiagnosed cause of Legionnaires’ disease.

We conducted a case–control study of L. longbeachae Legionnaires’ disease in Canterbury, New Zealand. Case-patients were persons hospitalized with L. longbeachae pneumonia, and controls were persons randomly sampled from the electoral roll for the area served by the participating hospital.

Among 31 cases and 172 controls, risk factors for Legionnaires’ disease were chronic obstructive pulmonary disease, history of smoking >10 years, and exposure to compost or potting mix.

Gardening behaviors associated with L. longbeachae disease included having unwashed hands near the face after exposure to or tipping and troweling compost or potting mix. Mask or glove use was not protective among persons exposed to compost-derived products.

Precautions against inhaling compost and attention to hand hygiene might effectively prevent L. longbeachae disease. Long-term smokers and those with chronic obstructive pulmonary disease should be particularly careful….


June 28, 2017 at 7:49 am

Modelling the effects of global climate change on Chikungunya transmission in the 21st century

Scientific Reports 7, Article number: 3813 (2017)

Nils B. Tjaden, Jonathan E. Suk, Dominik Fischer, Stephanie M. Thomas, Carl Beierkuhnlein & Jan C. Semenza

The arrival and rapid spread of the mosquito-borne viral disease Chikungunya across the Americas is one of the most significant public health developments of recent years, preceding and mirroring the subsequent spread of Zika.

Globalization in trade and travel can lead to the importation of these viruses, but climatic conditions strongly affect the efficiency of transmission in local settings.

In order to direct preparedness for future outbreaks, it is necessary to anticipate global regions that could become suitable for Chikungunya transmission.

Here, we present global correlative niche models for autochthonous Chikungunya transmission. These models were used as the basis for projections under the representative concentration pathway (RCP) 4.5 and 8.5 climate change scenarios. In a further step, hazard maps, which account for population densities, were produced. The baseline models successfully delineate current areas of active Chikungunya transmission.

Projections under the RCP 4.5 and 8.5 scenarios suggest the likelihood of expansion of transmission-suitable areas in many parts of the world, including China, sub-Saharan Africa, South America, the United States and continental Europe.

The models presented here can be used to inform public health preparedness planning in a highly interconnected world…..


June 28, 2017 at 7:48 am

Ongoing Transmission of Candida auris in Health Care Facilities – United States, June 2016-May 2017.

Morbidity and Mortality Weekly Report. May 19, 2017 V.66 N.19 P.514-515

Notes from the Field

Tsay S, Welsh RM, Adams EH, Chow NA, Gade L, Berkow EL, Poirot E, Lutterloh E, Quinn M, Chaturvedi S, Kerins J, Black SR, Kemble SK, Barrett PM; MSD, Barton K, Shannon DJ, Bradley K, Lockhart SR, Litvintseva AP, Moulton-Meissner H, Shugart A, Kallen A, Vallabhaneni S, Chiller TM, Jackson BR.

In June 2016, CDC released a clinical alert about the emerging, and often multidrug-resistant, fungus Candida auris and later reported the first seven U.S. cases of infection through August 2016 (1).

Six of these cases occurred before the clinical alert and were retrospectively identified.

As of May 12, 2017, a total of 77 U.S. clinical cases of C. auris had been reported to CDC from seven states: New York (53 cases), New Jersey (16), Illinois (four), Indiana (one), Maryland (one), Massachusetts (one), and Oklahoma (one) (Figure). All of these cases were identified through cultures taken as part of routine patient care (clinical cases).

Screening of close contacts of these patients, primarily of patients on the same ward in health care facilities, identified an additional 45 patients with C. auris isolated from one or more body sites (screening cases), resulting in a total of 122 patients from whom C. auris has been isolated…..


June 28, 2017 at 5:53 am

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