Neisseria gonorrhoeae — Rising Infection Rates, Dwindling Treatment Options

N Engl J Med November 8, 2018 V.379 P.1795

Blank and D.C. Daskalakis

Gnorrhea infection is the second most commonly reported notifiable condition in the United States, and case rates have been increasing since 2009. In 2017, a total of 555,608 cases of gonorrhea were reported nationally, the largest number since 1991 and an 18.6% increase over 2016 (see graph).1

In 2015, the Obama administration deemed Clostridium difficile, carbapenem-resistant Enterobacteriaceae, and Neisseria gonorrhoeae the most urgent infectious public health threats to national security, given the accelerating emergence of antibiotic resistance in these organisms.2 Though gonorrhea ranked third on this list, the number of cases of gonorrhea dwarfs those of the other two infections. Worldwide, gonorrhea cases have persistently affected young adults. Without a concerted global effort to mitigate antibiotic resistance, infected persons (primarily, sexually active young adults, who tend to be otherwise healthy) may require extended hospital stays and additional follow-up visits for an infection that can currently be managed on an outpatient basis. Such a shift could impose a serious burden on health care systems and societal productivity internationally. In the United States, this concern is compounded by the fact that for decades, gonorrhea infections have disproportionately affected black Americans, American Indians and Alaska Natives, Native Hawaiians and other Pacific Islanders, and Hispanic Americans….



December 4, 2018 at 7:00 pm

Recent advances in understanding Epstein-Barr virus.

F1000Res. 2017 Mar 29;6:386.

Stanfield BA1, Luftig MA1.

Author information

1 Department of Molecular Genetics and Microbiology, Duke Center for Virology, Duke University Medical Center, Durham, NC, USA.


Epstein-Barr virus (EBV) is a common human herpes virus known to infect the majority of the world population.

Infection with EBV is often asymptomatic but can manifest in a range of pathologies from infectious mononucleosis to severe cancers of epithelial and lymphocytic origin. Indeed, in the past decade, EBV has been linked to nearly 10% of all gastric cancers.

Furthermore, recent advances in high-throughput next-generation sequencing and the development of humanized mice, which effectively model EBV pathogenesis, have led to a wealth of knowledge pertaining to strain variation and host-pathogen interaction.

This review highlights some recent advances in our understanding of EBV biology, focusing on new findings on the early events of infection, the role EBV plays in gastric cancer, new strain variation, and humanized mouse models of EBV infection.


July 25, 2017 at 7:50 pm

Infectious Mononucleosis.

Curr Top Microbiol Immunol. 2015;390(Pt 1):211-40.

Dunmire SK1, Hogquist KA2, Balfour HH3.

Author information

1 Center for Immunology, University of Minnesota, Minneapolis, MN, 55455, USA.

2 Center for Immunology, University of Minnesota, Minneapolis, MN, 55455, USA.

3 Department of Laboratory Medicine and Pathology, Department of Pediatrics, University of Minnesota, University of Minnesota Medical School, Minneapolis, MN, 55455, USA.


Infectious mononucleosis is a clinical entity characterized by sore throat, cervical lymph node enlargement, fatigue, and fever most often seen in adolescents and young adults and lasting several weeks.

It can be caused by a number of pathogens, but this chapter only discusses infectious mononucleosis due to primary Epstein-Barr virus (EBV) infection. EBV is a γ-herpesvirus that infects at least 90% of the population worldwide.

The virus is spread by intimate oral contact among teenagers and young adults. How preadolescents acquire the virus is not known.

A typical clinical picture with a positive heterophile test is usually sufficient to make the diagnosis, but heterophile antibodies are not specific and do not develop in some patients. EBV-specific antibody profiles are the best choice for staging EBV infection.

In addition to causing acute illness, there can also be long-term consequences as the result of acquisition of the virus.

Several EBV-related illnesses occur including certain cancers and autoimmune diseases, as well as complications of primary immunodeficiency in persons with the certain genetic mutations.

A major obstacle to understanding these sequelae has been the lack of an efficient animal model for EBV infection, although progress in primate and mouse models has recently been made. Key future challenges are to develop protective vaccines and effective treatment regimens.


July 25, 2017 at 7:48 pm

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

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

Management of Adult Syphilis

Clinical Infectious Diseases Dec.2011 V.53 N.12 Suppl.3  S110-S128

Khalil G. Ghanem1 and Kimberly A. Workowski2,3

1Johns Hopkins University School of Medicine, Baltimore, Maryland

2National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention

3Emory University, Atlanta, Georgia

There are several important unanswered key questions in the management of adult syphilis. A systematic literature review was conducted and tables of evidence were constructed to answer these important questions. A single dose of 2.4 million units of benzathine penicillin G remains the drug of choice for managing early syphilis. Enhanced antibiotic therapy has not been shown to improve treatment outcomes, regardless of human immunodeficiency virus (HIV) status. Although additional data on the efficacy of azithromycin in treating early syphilis have emerged, reported increases in the prevalence of a mutation associated with azithromycin resistance precludes a recommendation for its routine use. Cerebrospinal fluid (CSF) examination should be performed in all persons with serologic evidence of syphilis infection and neurologic symptoms. In those persons with early syphilis who do not achieve a ≥4-fold serologic decline in their rapid plasma reagin (RPR) titers 6–12 months after adequate therapy and those with late latent infection who do not achieve a similar decline within 12–24 months, CSF examination should be considered. Among HIV-infected persons, CSF examination among all those with asymptomatic late latent syphilis is not recommended owing to lack of evidence that demonstrates clinical benefit. HIV-infected persons with syphilis of any stages whose RPR titers are ≥1:32 and/or whose CD4 cell counts are <350 cells/mm3 may be at increased risk for asymptomatic neurosyphilis. If CSF pleocytosis is evident at initial CSF examination, these examinations should be repeated every 6 months until the cell count is normal. Several important questions regarding the management of syphilis remain unanswered and should be a priority for future research.


June 29, 2016 at 9:05 am

Cat-scratch disease: a wide spectrum of clinical pictures.

Postepy Dermatol Alergol. 2015 Jun;32(3):216-20.

Mazur-Melewska K1, Mania A1, Kemnitz P1, Figlerowicz M1, Służewski W1.

Author information

1Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, Poznan, Poland. Head of the Department: Prof. Wojciech Służewski MD, PhD.


The aim of this review is to present an emerging zoonotic disease caused by Bartonella henselae.

The wide spectrum of diseases connected with these bacteria varies from asymptomatic cases, to skin inflammation, fever of unknown origin, lymphadenopathy, eye disorders, encephalitis and endocarditis.

The reservoirs of B. henselae are domestic animals like cats, guinea pigs, rabbits and occasionally dogs. Diagnosis is most often based on a history of exposure to cats and a serologic test with high titres of the immunoglobulin G antibody to B. henselae.

Most cases of cat-scratch disease are self-limited and do not require antibiotic treatment. If an antibiotic is chosen, however, azithromycin has been shown to speed recovery.


August 16, 2015 at 10:53 am

Cat-scratch Disease.

Am Fam Physician. 2011 Jan 15;83(2):152-5.

Klotz SA1, Ianas V, Elliott SP.

Author information

1University of Arizona, Tucson, 85724, USA.


Cat-scratch disease is a common infection that usually presents as tender lymphadenopathy. It should be included in the differential diagnosis of fever of unknown origin and any lymphadenopathy syndrome.

Asymptomatic, bacteremic cats with Bartonella henselae in their saliva serve as vectors by biting and clawing the skin. Cat fleas are responsible for horizontal transmission of the disease from cat to cat, and on occasion, arthropod vectors (fleas or ticks) may transmit the disease to humans.

Cat-scratch disease is commonly diagnosed in children, but adults can present with it as well. The causative microorganism, B. henselae, is difficult to culture.

Diagnosis is most often arrived at by obtaining a history of exposure to cats and a serologic test with high titers (greater than 1:256) of immunoglobulin G antibody to B. henselae. Most cases of cat-scratch disease are self-limited and do not require antibiotic treatment.

If an antibiotic is chosen, azithromycin has been shown in one small study to speed recovery.

Infrequently, cat-scratch disease may present in a more disseminated form with hepatosplenomegaly or meningoencephalitis, or with bacillary angiomatosis in patients with AIDS.


August 16, 2015 at 10:51 am

Tuberculosis ganglionar cervical. ¿Pensamos en ella, o nos sorprende?

Rev. Otorrinolaringol. Cir. Cabeza Cuello ABRIL 2012 V.72  N.1

Miguel Alberto Rodríguez-Pérez1, Fernando Aguirre-García2.

1 Unidad de Gestión Clínica de Otorrinolaringología, Hospital Universitario de Puerto Real (Cádiz, España).

2 Servicio de Otorrinolaringología, Hospital “Virgen del Puerto”, Plasencia, Cáceres, España.

Revisamos las características clínicas, diagnóstico y manejo de la tuberculosis (TB) cervical, así como resaltamos su importancia por su carácter epidémico.

Presentamos dos pacientes afectados por tumoraciones laterocervicales subagudas, escasa sintomatología y excelente evolución tras su diagnóstico de TB ganglionar cervical y tratamiento antibiótico.

La TB es una enfermedad que en la actual sociedad globalizada, puede encontrarse prácticamente cualquier especialista, por lo que debemos mantener un alto nivel de alerta y conocerla con detalle, para poder orientar su diagnóstico y facilitar su tratamiento precoz.


February 7, 2015 at 11:10 am

Older Posts


August 2020

Posts by Month

Posts by Category