Archive for July 28, 2018

Impact of postherpetic neuralgia: A six year population-based analysis on people aged 50 years or older

Journal of Infection August 2018 V.76 N.8 P.131–136

Cintia Muñoz-Quiles, Mónica López-Lacort, Alejandro Orrico-Sánchez, Javier Díez-Domingo

Highlights

  • This population-based study shows that 15.7% of HZ cases develop PHN.
  • Incidence rate of PHN was 1.19/1000 persons (≥50)-year and it was double in women.
  • The adjusted risk of developing PHN increased sharply with age and comorbidities.
  • About 32% of people will develop a HZ between ages 50–90 years.
  • About 7% of people will develop PHN between ages 50–90 years.

Objectives

To estimate the incidence and burden of postherpetic neuralgia (PHN) and to investigate risk factors for PHN in the Valencia Region of Spain.

Methods

Data were extracted from population and healthcare databases from the Valencia Region (2009–2014). Herpes zoster (HZ) and PHN were defined using ICD-9 codes and drug prescriptions in people aged ≥50 years. The risk of HZ patients for developing PHN and potential risk factors (diabetes mellitus, COPD and heart failure) were investigated. A survival analysis was developed to estimate the cumulative hazard of developing HZ and PHN between ages 50–90 years.

Results

From a total of 2,289,485 subjects, 87,086 cases of HZ were registered, 13,658 (15.7%) of whom developed PHN. PHN risk was higher in women and increased sharply with age and comorbidities as diabetes mellitus, COPD and heart failure. The cumulative risk of developing HZ between ages 50–90 years was 31.7% (95% CI: 31.3-32.1) and 6.9 (95% CI: 6.7–7.1) for PHN.

Conclusions

PHN risk was higher in women and increased with age and comorbidities. At least 32% and 7% of people will develop HZ and PHN, respectively, between ages 50–90 years. These results should be considered for vaccine policy implementation.

FULL TEXT

https://www.journalofinfection.com/article/S0163-4453(18)30107-5/fulltext

PDF

https://www.journalofinfection.com/article/S0163-4453(18)30107-5/pdf

July 28, 2018 at 7:32 pm

Biomarker guided triage can reduce hospitalization rate in community acquired febrile urinary tract infection

Journal of Infection July 2018 V.76 N.7 P.18–24

Janneke Evelyne Stalenhoef, Cees van Nieuwkoop, Darius Cameron Wilson, Willize Elizabeth van der Starre, Nathalie Manon Delfos, Eliane Madeleine Sophie Leyten, Ted Koster, Hans Christiaan Ablij, Johannes(Jan) Willem van’t Wout, Jaap Tamino van Dissel

Highlights

  • Biomarkers are assessed to predict disease severity in febrile urinary tract infection.
  • MRproADM has a higher predictive value for a complicated course than PCT or CRP.
  • MRproADM and PCT were significantly higher in patients directly hospitalized.
  • Outpatients requiring subsequent hospitalization had higher MRproADM concentrations.
  • MRproADM guided triage may decrease hospitalization rate without compromising safety.

Objectives

Febrile urinary tract infections (fUTI) can often be treated safely with oral antimicrobials in an outpatient setting. However, a minority of patients develop complications that may progress into septic shock. An accurate assessment of disease severity upon emergency department (ED) presentation is therefore crucial in order to guide the most appropriate triage and treatment decisions.

Methods

Consecutive patients were enrolled with presumptive fUTI across 7 EDs in the Netherlands. The biomarkers mid-regional proadrenomedullin (MR-proADM), procalcitonin (PCT), C-reactive protein (CRP), and a clinical score (PRACTICE), were compared in their ability to predict a clinically severe course of fUTI, initial hospital admission and subsequent readmission using area under the receiver operating characteristic (AUROC) curves.

Results

Biomarker concentrations were measured in 313 patients, with 259 (83%) hospitalized upon ED presentation, and 54 (17%) treated as outpatients. Of these outpatients, 12 (22%) were later hospitalized. MR-proADM had the highest diagnostic accuracy for predicting a complicated fUTI (AUROC [95% CI]: 0.86 [0.79–0.92]), followed by PCT (AUROC [95% CI]: 0.69 [0.58–0.80]). MR-proADM concentrations were unique in being significantly elevated in patients directly admitted and in outpatients requiring subsequent hospitalization, compared to those completing treatment at home. A virtual triage algorithm with an MR-proADM cut-off of 0.80  nmol/L resulted in a hospitalization rate of 66%, with only 2% secondary admissions.

Conclusion

MR-proADM could accurately predict a severe course in patients with fUTI, and identify greater patient numbers who could be safely managed as outpatients. An initial assessment on ED presentation may focus resources to patients with highest disease severities.

FULL TEXT

https://www.journalofinfection.com/article/S0163-4453(18)30159-2/fulltext

PDF

https://www.journalofinfection.com/article/S0163-4453(18)30159-2/pdf

July 28, 2018 at 7:31 pm

Neisseria gonorrhoeae molecular typing for understanding sexual networks and antimicrobial resistance transmission: A systematic review

Journal of Infection June 2018 V.76 N.6 P.507–514

Katy Town, Hikaru Bolt, Sara Croxford, Michelle Cole, Simon Harris, Nigel Field, Gwenda Hughes

Highlights

  • Combined molecular and epidemiological data can describe the spread of gonorrhoea.
  • Sexual networks can be inferred from molecular clusters of infection.
  • Gender and sexual orientation are commonly used to characterise these networks.
  • Application of these data within gonorrhoea control interventions is limited.
  • Future studies should focus on evaluating molecular typing data in practice.

Objectives

Neisseria gonorrhoeae (NG) is a significant global public health concern due to rising diagnoses rates and antimicrobial resistance. Molecular combined with epidemiological data have been used to understand the distribution and spread of NG, as well as relationships between cases in sexual networks, but the public health value gained from these studies is unclear. We conducted a systematic review to examine how molecular epidemiological studies have informed understanding of sexual networks and NG transmission, and subsequent public health interventions.

Methods

Five research databases were systematically searched up to 31st March 2017 for studies that used sequence-based DNA typing methods, including whole genome sequencing, and linked molecular data to patient-level epidemiological data. Data were extracted and summarised to identify common themes.

Results

Of the 49 studies included, 82% used NG Multi-antigen Sequence Typing. Gender and sexual orientation were commonly used to characterise sexual networks that were inferred using molecular clusters; clusters predominantly of one patient group often contained a small number of isolates from other patient groups. Suggested public health applications included using these data to target interventions at specific populations, confirm outbreaks, and inform partner management, but these were mainly untested.

Conclusions

Combining molecular and epidemiological data has provided insight into sexual mixing patterns, and dissemination of NG, but few studies have applied these findings to design or evaluate public health interventions. Future studies should focus on the application of molecular epidemiology in public health practice to provide evidence for how to prevent and control NG.

FULL TEXT

https://www.journalofinfection.com/article/S0163-4453(18)30085-9/fulltext

PDF

https://www.journalofinfection.com/article/S0163-4453(18)30085-9/pdf

July 28, 2018 at 7:29 pm

Incidence and costs of herpes zoster and postherpetic neuralgia in German adults aged ≥50 years: A prospective study

Journal of Infection May 2018 V.76 N.5 P.475–482

Ruprecht Schmidt-Ott, Ulf Schutter, Jörg Simon, Barbara Poulsen Nautrup, Alfred von Krempelhuber, Kusuma Gopala, Anastassia Anastassopoulou, Adrienne Guignard, Desmond Curran, Sean Matthews, Emmanuelle Espié

Objectives

Herpes zoster (HZ) mainly affects elderly people and immunocompromised individuals. HZ is usually characterized by a unilateral painful skin rash. Its most common complication, postherpetic neuralgia (PHN), may cause chronic debilitating pain. This study aimed to estimate the HZ incidence in individuals aged ≥50 years in Germany, the proportion of PHN and the economic burden.

Methods

From 2010 to 2014, HZ patients were recruited when consulting physicians in physician networks covering about 157,000 persons aged ≥50 years. PHN was defined as “worst pain” rated ≥3 on the zoster brief pain inventory persisting or appearing over 90 days after rash onset. Costs were calculated based on medical resource utilization and lost working time.

Results

HZ incidence was estimated as 6.7/1000 person-years, increasing with age to 9.4/1000 in ≥80 year-olds. Among 513 HZ patients enrolled, the proportion of PHN was 11.9%, rising with age to 14.3% in HZ patients ≥80 years. Estimated total cost per HZ patient was €156 from the healthcare system perspective and €311 from the societal perspective.

Conclusions

The study confirmed previous findings that HZ causes a substantial clinical and economic burden in older German adults. It also confirmed the age-related increasing risk of HZ and PHN.

FULL TEXT

https://www.journalofinfection.com/article/S0163-4453(18)30053-7/fulltext

PDF

https://www.journalofinfection.com/article/S0163-4453(18)30053-7/pdf

July 28, 2018 at 7:27 pm

Meningococcal disease and control in China: Findings and updates from the Global Meningococcal Initiative (GMI)

Journal of Infection May 2018 V.76 N.5 P.429–437

Reviews

Junhong Li, Zhujun Shao, Gang Liu, Xilian Bai, Ray Borrow, Min Chen, Qinglan Guo, Yue Han, Yixing Li, Muhamed-Kheir Taha, Xihai Xu, Xin Xu, Huizhen Zheng

Highlights

  • MD epidemiology is changing in China with the decline of MenA and rise of MenB, MenC and MenW.
  • MD prevention strategies in China include sentinel surveillance and immunization.
  • Conjugate vaccines reduce carriage rates and impart herd protection.
  • Improvements in disease surveillance and laboratory techniques are needed across China.
  • Universal SOPs for outbreak management should be defined and implemented globally.

Abstract

The Global Meningococcal Initiative (GMI) is a global expert group, including scientists, clinicians and public health officials from a wide range of specialities. The goal of the GMI is to prevent meningococcal disease worldwide through education, research, and co-operation. The Chinese GMI roundtable meeting was held in June 2017. The GMI met with local experts to gain insight into the meningococcal disease burden in China and current prevention and vaccination strategies in place. China experienced five epidemics of serogroup A meningococcal disease (MenA) between 1938 and 1977, with peak incidence of 403/100,000 recorded in 1967. MenA incidence rates have significantly declined following the universal introduction of the MenA polysaccharide vaccine in China in the 1980s. Further, surveillance data indicates changing meningococcal epidemiology in China with the emergence of new clones of serogroup B from serogroup C clonal complex (cc) 4821 due to capsular switching, and the international spread of serogroup W cc11. The importance of carriage and herd protection for controlling meningococcal disease was highlighted with the view to introduce conjugate vaccines and serogroup B vaccines into the national immunization schedule. Improved disease surveillance and standardized laboratory techniques across and within provinces will ensure optimal epidemiological monitoring.

FULL TEXT

https://www.journalofinfection.com/article/S0163-4453(18)30027-6/fulltext

PDF

https://www.journalofinfection.com/article/S0163-4453(18)30027-6/pdf

July 28, 2018 at 7:26 pm

Utility of a Stressed Single Nucleotide Polymorphism (SNP) Real-Time PCR Assay for Rapid Identification of Measles Vaccine Strains in Patient Samples

Journal of Clinical Microbiology  August 2018 V.56 N.8

Thomas Tran, Renata Kostecki, Michael Catton and Julian Druce

Rapid differentiation of wild-type measles virus from measles vaccine strains is crucial during a measles outbreak and in a measles elimination setting.

A real-time reverse transcription-PCR (rRT-PCR) for the rapid detection of measles vaccine strains was developed with high specificity and sensitivity equivalent to that of traditional measles genotyping methods.

The “stressed” minor groove binder-TaqMan probe design approach achieves specificity to vaccine strains only, without compromising sensitivity.

This assay, without requiring sequence genotyping, has proved to be extremely useful in outbreak settings for over 4 years at the Regional Measles Reference Laboratory for the Western Pacific Region.

FULL TEXT

http://jcm.asm.org/content/56/8/e00360-18.abstract?etoc

PDF

http://jcm.asm.org/content/56/8/e00360-18.full.pdf+html

July 28, 2018 at 6:34 pm

Shotgun Metagenomic Detection of Pathogens: a Micro-Comic Strip

Journal of Clinical Microbiology  August 2018 V.56 N.8

Editorial

Alexander J. McAdam

Next-generation sequencing has made shotgun metagenomic testing of primary clinical specimens for detection of pathogens feasible (1).

These technologies can routinely detect a range of pathogens (bacterial, viral, fungal, and eukaryotic parasites), allowing for hypothesis-free testing, in which test selection does not depend on knowing what pathogens are likely to be present.

Such testing has been applied for detecting infections or colonization of the nervous system (2–4), gastrointestinal tract (5, 6), prosthetic joints (7, 8), and blood or serum (9, 10).

Shotgun metagenomic testing for pathogens is now available for patient testing at a small number of academic and commercial laboratories, and it is expensive compared to other microbiology tests.

Where do the cost of and diversity of pathogens detected by shotgun metagenomic testing fit into the range of available microbiology tests?

FULL TEXT

http://jcm.asm.org/content/56/8/e00799-18?etoc

PDF

http://jcm.asm.org/content/56/8/e00799-18.full.pdf+html

July 28, 2018 at 6:32 pm

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