Posts filed under ‘FIEBRE y RASH’

Dengue Virus 1 Outbreak in Buenos Aires, Argentina, 2016

Emerging Infectious Diseases October 2017 V.23 N.10

Estefanía Tittarelli, Silvina B. Lusso, Stephanie Goya, Gabriel L. Rojo, Mónica I. Natale, Mariana Viegas, Alicia S. Mistchenko, and Laura E. Valinotto

Hospital de Niños “Ricardo Gutiérrez” Buenos Aires, Argentina (E. Tittarelli, S.B. Lusso, S. Goya, G.L. Rojo, M.I. Natale, M. Viegas, A.S. Mistchenko, L.E. Valinotto); CONICET, Buenos Aires (E. Tittarelli, S. Goya, M. Viegas, L.E. Valinotto); Comisión de Investigaciones Científicas de la Provincia de Buenos Aires, Buenos Aires (A.S. Mistchenko).

Abstract

The largest outbreak of dengue in Buenos Aires, Argentina, occurred during 2016. Phylogenetic, phylodynamic, and phylogeographic analyses of 82 samples from dengue patients revealed co-circulation of 2 genotype V dengue virus lineages, suggesting that this virus has become endemic to the Buenos Aires metropolitan area.

PDF

https://wwwnc.cdc.gov/eid/article/23/10/pdfs/16-1718.pdf

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September 24, 2017 at 10:56 am

Association Between Cytomegalovirus Reactivation and Clinical Outcomes in Immunocompetent Critically Ill Patients: A Systematic Review and Meta-Analysis

Open Forum Infectious Diseases April 2017 V.4 N.2

Philippe Lachance; Justin Chen; Robin Featherstone; Wendy I. Sligl

Background.

The aim of our systematic review was to investigate the association between cytomegalovirus (CMV) reactivation and outcomes in immunocompetent critically ill patients.

Methods.

We searched electronic databases and gray literature for original studies and abstracts published between 1990 and October 2016. The review was limited to studies including critically ill immunocompetent patients. Cytomegalovirus reactivation was defined as positive polymerase chain reaction, pp65 antigenemia, or viral culture from blood or bronchoalveolar lavage. Selected patient-centered outcomes included mortality, duration of mechanical ventilation, need for renal replacement therapy (RRT), and nosocomial infections. Health resource utilization outcomes included intensive care unit and hospital lengths of stay.

Results.

Twenty-two studies were included. In our primary analysis, CMV reactivation was associated with increased ICU mortality (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.87–3.47), overall mortality (OR, 2.02; 95% CI, 1.60–2.56), duration of mechanical ventilation (mean difference 6.60 days; 95% CI, 3.09–10.12), nosocomial infections (OR, 3.20; 95% CI, 2.05–4.98), need for RRT (OR, 2.37; 95% CI, 1.31–4.31), and ICU length of stay (mean difference 8.18 days; 95% CI, 6.14–10.22). In addition, numerous sensitivity analyses were performed.

Conclusions.

In this meta-analysis, CMV reactivation was associated with worse clinical outcomes and greater health resource utilization in critically ill patients. However, it remains unclear whether CMV reactivation plays a causal role or if it is a surrogate for more severe illness.

PDF

https://watermark.silverchair.com/api/watermark?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAdcwggHTBgkqhkiG9w0BBwagggHEMIIBwAIBADCCAbkGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMgS29QRsi_OI3SkaMAgEQgIIBigRs9nl2ylsVhYS_sYzV1Exhw5kNEVc_CDMHi9al85en5nmbiM0fSguSAPaX7eVjsRODgkAPeEpkpHFXtT5ee2umJp97CEvGaAbkiVReIdzG4W2RNfMvE2sN1dsphR2nXEn42SJyigJqE4fzz8cIaXZ_D-EACpZzDmIRmUo86ZcUsycSI2PzFbJFj19cTvvoID75bRPJGugrZ8SAfBf6V6-1IrrVl8xG1P7LAmi8eED3QPkcOjtAWOyzyW8WPYJ_5JOJPPAUzlNTmWAKP_9QjSg3NBavgOdzFrhwpzWnF7DYh5qVYp2bg2jrG3iXICmUVNPuC32npr3L2qEWvfmA4-_gQfRgRLvm8G42pCbdO1bBp5NGgHoMFnGHIlF3s-z4Xx7as7oIryKBJsd-MG9CE5kkL9d_x6nJLEr-WqRPZF6rmWl_0VWYfbOyAIn7u3OJrtX9NrLBsFWsmCxKa7Ghsvbvfkk9jpoerEn8x48ljyevLRq7bimX0gm-Vgo3GtltcVdajTLQ5-rUsEQ

September 3, 2017 at 6:43 pm

Editor’s Choice: Coinfection With Zika and Dengue-2 Viruses in a Traveler Returning From Haiti, 2016: Clinical Presentation and Genetic Analysis

Clinical Infectious Diseases January 1, 2017 V.64 N.1 P.72-75

BRIEF REPORTS

Nicole M. Iovine, John Lednicky, Kartikeya Cherabuddi, Hannah Crooke, Sarah K. White, Julia C. Loeb, Eleonora Cella, Massimo Ciccozzi, Marco Salemi, and J. Glenn Morris, Jr

1Division of Infectious Diseases, Department of Medicine, College of Medicine

2Emerging Pathogens Institute

3Department of Environmental and Global Health, College of Public Health and Health Professions

4Department of Epidemiology, College of Public Health and Health Professions

5Department of Pathology, Immunology and Laboratory Sciences, College of Medicine, University of Florida, Gainesville

6Department of Infectious Parasitic and Immunomediated Diseases, Reference Centre on Phylogeny, Molecular Epidemiology and Microbial Evolution/Epidemiology Unit, Istituto Superiore di Sanita, Rome, Italy

Zika virus and dengue virus serotype 2 were isolated from a patient with travel to Haiti who developed fever, rash, arthralgias, and conjunctivitis. The infecting Zika virus was related to Venezuelan and Brazilian strains but evolved along a lineage originating from strains isolated in 2014 in the same region of Haiti.

PDF

https://cid.oxfordjournals.org/content/64/1/72.full.pdf+html

August 19, 2017 at 10:26 am

Interim Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure — United States (Including U.S. Territories), July 2017

MMWR July 28, 2017 V.66 N.29 P.781-793

Update

Titilope Oduyebo, MD1; Kara D. Polen, MPH1; Henry T. Walke, MD1; Sarah Reagan-Steiner, MD1; Eva Lathrop, MD1; Ingrid B. Rabe, MBChB1; Wendi L. Kuhnert-Tallman, PhD1; Stacey W. Martin, MSc1; Allison T. Walker, PhD1; Christopher J. Gregory, MD1; Edwin W. Ades, PhD1; Darin S. Carroll, PhD1; Maria Rivera, MPH1; Janice Perez-Padilla, MPH1; Carolyn Gould, MD1; Jeffrey B. Nemhauser, MD1; C. Ben Beard, PhD1; Jennifer L. Harcourt, PhD1; Laura Viens, MD1; Michael Johansson, PhD1; Sascha R. Ellington, MSPH1; Emily Petersen, MD1; Laura A. Smith, MA1; Jessica Reichard, MPA1; Jorge Munoz-Jordan, PhD1; Michael J. Beach, PhD1; Dale A. Rose, PhD1; Ezra Barzilay, MD1; Michelle Noonan-Smith1; Denise J. Jamieson, MD1; Sherif R. Zaki, MD1; Lyle R. Petersen, MD1; Margaret A. Honein, PhD1; Dana Meaney-Delman, MD1

CDC has updated the interim guidance for U.S. health care providers caring for pregnant women with possible Zika virus exposure in response to 1) declining prevalence of Zika virus disease in the World Health Organization’s Region of the Americas (Americas) and 2) emerging evidence indicating prolonged detection of Zika virus immunoglobulin M (IgM) antibodies.

Zika virus cases were first reported in the Americas during 2015–2016; however, the incidence of Zika virus disease has since declined.

As the prevalence of Zika virus disease declines, the likelihood of false-positive test results increases. In addition, emerging epidemiologic and laboratory data indicate that, as is the case with other flaviviruses, Zika virus IgM antibodies can persist beyond 12 weeks after infection.

Therefore, IgM test results cannot always reliably distinguish between an infection that occurred during the current pregnancy and one that occurred before the current pregnancy, particularly for women with possible Zika virus exposure before the current pregnancy.

These limitations should be considered when counseling pregnant women about the risks and benefits of testing for Zika virus infection during pregnancy.

This updated guidance emphasizes a shared decision-making model for testing and screening pregnant women, one in which patients and providers work together to make decisions about testing and care plans based on patient preferences and values, clinical judgment, and a balanced assessment of risks and expected outcomes…..

PDF

https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6629e1.pdf

July 28, 2017 at 5:17 pm

High risk for invasive meningococcal disease among patients receiving eculizumab (Soliris) despite receipt of meningococcal vaccine

Morbidity and Mortalality Weekly Report July 14,  2017 V.66 N.27 P.734-737.

Lucy A. McNamara, PhD1; Nadav Topaz, MSc1; Xin Wang, PhD1; Susan Hariri, PhD1; LeAnne Fox, MD1; Jessica R. MacNeil, MPH1

Use of eculizumab (Soliris, Alexion Pharmaceuticals), a terminal complement inhibitor, is associated with a 1,000-fold to 2,000-fold increased incidence of meningococcal disease (1). Administration of meningococcal vaccines is recommended for patients receiving eculizumab before beginning treatment (2,3).

Sixteen cases of meningococcal disease were identified in eculizumab recipients in the United States during 2008–2016; among these, 11 were caused by nongroupable Neisseria meningitidis.

Fourteen patients had documentation of receipt of at least 1 dose of meningococcal vaccine before disease onset.

Because eculizumab recipients remain at risk for meningococcal disease even after receipt of meningococcal vaccines, some health care providers in the United States as well as public health agencies in other countries recommend antimicrobial prophylaxis for the duration of eculizumab treatment; a lifelong course of treatment is expected for many patients.

Heightened awareness, early care seeking, and rapid treatment of any symptoms consistent with meningococcal disease are essential for all patients receiving eculizumab treatment, regardless of meningococcal vaccination or antimicrobial prophylaxis status….

PDF

https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6627e1.pdf

July 27, 2017 at 8:12 am

Measles Outbreak – Minnesota April-May 2017.

MMWR Morb Mortal Wkly Rep. 2017 Jul 14;66(27):713-717.

Hall V, Banerjee E, Kenyon C, Strain A, Griffith J, Como-Sabetti K, Heath J, Bahta L, Martin K, McMahon M, Johnson D, Roddy M, Dunn D, Ehresmann K.

Abstract

On April 10, 2017, the Minnesota Department of Health (MDH) was notified about a suspected measles case. The patient was a hospitalized child aged 25 months who was evaluated for fever and rash, with onset on April 8.

The child had no history of receipt of measles-mumps-rubella (MMR) vaccine and no travel history or known exposure to measles. On April 11, MDH received a report of a second hospitalized, unvaccinated child, aged 34 months, with an acute febrile rash illness with onset on April 10.

The second patient’s sibling, aged 19 months, who had also not received MMR vaccine, had similar symptoms, with rash onset on March 30.

Real-time reverse transcription-polymerase chain reaction (rRT-PCR) testing of nasopharyngeal swab or throat specimens performed at MDH confirmed measles in the first two patients on April 11, and in the third patient on April 13; subsequent genotyping identified genotype B3 virus in all three patients, who attended the same child care center.

MDH instituted outbreak investigation and response activities in collaboration with local health departments, health care facilities, child care facilities, and schools in affected settings.

Because the outbreak occurred in a community with low MMR vaccination coverage, measles spread rapidly, resulting in thousands of exposures in child care centers, schools, and health care facilities.

By May 31, 2017, a total of 65 confirmed measles cases had been reported to MDH (Figure 1); transmission is ongoing.

PDF

https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6627a1.pdf

July 27, 2017 at 8:11 am

Practices of Lyme disease diagnosis and treatment by general practitioners in Quebec, 2008-2015.

BMC Fam Pract. 2017 May 22;18(1):65.

Gasmi S1,2, Ogden NH3,4, Leighton PA5, Adam-Poupart A6, Milord F6, Lindsay LR7, Barkati S8, Thivierge K9.

Author information

1 Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, 20045, chemin Sainte-Marie, Sainte-Anne-de-Bellevue, H9X 3R5, Canada.

2 Policy Integration and Zoonoses Division, Centre for Food-borne, Environmental & Zoonotic Infectious Diseases, Public Health Agency of Canada, 3200 Sicotte, Saint-Hyacinthe, J2S 7C6, Canada.

3 Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, 3200 Sicotte, Saint-Hyacinthe, J2S 7C6, Canada.

4 Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique (GREZOSP), 3200 Sicotte, Saint-Hyacinthe, J2S 7C6, Canada.

5 Faculty of Veterinary Medicine, University of Montreal, 3200 Sicotte, Saint-Hyacinthe, J2S 7C6, Canada.

6 Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, 190, boulevard Crémazie Est, Montréal, H2P 1E2, Canada.

7 Zoonotic Diseases & Special Pathogens Division, National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street, Winnipeg, R3E 3R2, Canada.

8 Department of Microbiology and Immunology, Faculty of Medicine, University of Montreal, 2900, boul. Édouard-Montpetit, Montréal, H3T 1J4, Canada.

9 Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, 20045, chemin Sainte-Marie, Sainte-Anne-de-Bellevue, H9X 3R5, Canada. karine.thivierge@inspq.qc.ca

Abstract

BACKGROUND:

Lyme disease (LD), a multisystem infection caused by the spirochete Borrelia burgdorferi sensu stricto (B. burgdorferi), is the most reported vector-borne disease in North America, and by 2020, 80% of the population in central and eastern Canada could live in LD risk areas. Among the key factors for minimising the impact of LD are the accurate diagnosis and appropriate management of patients bitten by ticks. In this study, the practices of Quebec general practitioners (GPs) on LD diagnosis and management of patients bitten by infected ticks are described.

METHODS:

Eight years (2008 to 2015) of retrospective demographic and clinical data on patients bitten by infected Ixodes scapularis (I. scapularis) ticks and on the management of suspected and confirmed LD cases by Quebec GPs were analysed.

RESULTS:

Among 50 patients, all the antimicrobial treatments of LD clinical cases were appropriate according to current guidelines. However, more than half (62.8%) of erythema migrans (EM) were possibly misdiagnosed, 55.6%, (n = 27) of requested serologic tests were possibly unnecessary and the majority (96.5%, n = 57) of prophylactic antimicrobial treatments were not justified according to current guidelines.

CONCLUSIONS:

These observations underline the importance for public health to enhance the knowledge of GPs where LD is emerging, to minimise the impact of the disease on patients and the financial burden on the health system

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5441092/pdf/12875_2017_Article_636.pdf

July 15, 2017 at 2:12 pm

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