Posts filed under ‘F.O.D’

Histoplasmosis-related healthcare use, diagnosis, and treatment in a commercially insured population, United States.

Clinical Infectious Diseases April 30, 2019  

Benedict K1, Beer KD1, Jackson BR1.

Abstract

BACKGROUND:

Infections with Histoplasma can range from asymptomatic to life-threatening acute pulmonary or disseminated disease. Histoplasmosis can be challenging to diagnose and is widely under-recognized. We analyzed insurance claims data to better characterize histoplasmosis testing and treatment practices and its burden on patients.

METHODS:

We used the IBM® MarketScan® Research Databases to identify patients with histoplasmosis (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 115.00-115.99) during 2012-2014. We analyzed claims in the 3 months before to the 1 year after diagnosis and examined differences between probable (hospitalized or >1 outpatient visit) and suspect (1 outpatient visit) patients.

RESULTS:

Among 1,935 patients (943 probable, 922 suspect), 54% had codes for symptoms or findings consistent with histoplasmosis and 35% had ≥2 healthcare visits in the 3 months before diagnosis. Overall, 646 (33%) had any fungal-specific laboratory test: histoplasmosis antibody test (n= 349, 18%), Histoplasma antigen test (n=349, 18%), fungal smear (n=294, 15%), or fungal culture (n=223, 12%); 464 (24%) had a biopsy. Forty-nine percent of probable patients and 10% of suspect patients were prescribed antifungal medication in the outpatient setting. Total, 19% were hospitalized. Patients’ last histoplasmosis-associated healthcare visits occurred a median of 6 months after diagnosis.

CONCLUSIONS:

Some histoplasmosis patients experienced severe disease, apparent diagnostic delays, and prolonged illness, whereas other patients lacked symptoms and were likely diagnosed incidentally (e.g., via biopsy). Low rates of histoplasmosis-specific testing also suggest incidental diagnoses and low provider suspicion, highlighting the need for improved awareness about this disease.

abstract

https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciz324/5481778

PDF (CLIC en PDF)

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May 23, 2019 at 8:16 am

Candida auris Clinical Isolates from South Korea: Identification, Antifungal Susceptibility, and Genotyping

Journal of Clinical Microbioliology March 2019 57:e01624-18

Yong Jun Kwon, Jong Hee Shin, Seung A Byun, Min Ji Choi, Eun Jeong Won, Dain Lee, Seung Yeob Lee, Sejong Chun, Jun Hyung Lee, Hyun Jung Choi, Seung Jung Kee, Soo Hyun Kim and Myung Geun Shin

Candida auris is an emerging worldwide fungal pathogen. Over the past 20 years, 61 patient isolates of C. auris (4 blood and 57 ear) have been obtained from 13 hospitals in Korea.

abstract

https://jcm.asm.org/content/57/4/e01624-18.abstract?etoc

PDF

https://jcm.asm.org/content/jcm/57/4/e01624-18.full.pdf

 

March 31, 2019 at 6:54 pm

Disminución del nivel de conciencia, fiebre y disnea en una paciente infectada con HIV.

Revista Argentina de Microbiologia 2014 V.46 N.3 P.271-272

Carta al Editor

Shock séptico con meningitis debido a la bacteriemia por Klebsiella pneumoniae y falla multiorgánica en el contexto de un síndrome de hiperinfección por Strongyloides stercoralis,

PDF

https://www.redalyc.org/pdf/2130/213032482015.pdf

March 24, 2019 at 5:31 pm

Infección por Strongyloides stercoralis: estudio epidemiológico, clínico, diagnóstico y terapéutico en 30 pacientes

Revista Chilena de Infectologia Junio 2011 V.28 N.3

Marcelo Corti, María F. Villafañe, Norberto Trione, Daniel Risso, Juan Carlos Abuín y Omar Palmieri

Hospital de Enfermedades Infecciosas Francisco J. Muñiz, Buenos Aires, Argentina

Antecedentes

Strongyloides stercoralis, parásito endémico de áreas tropicales y subtropicales del planeta, en sujetos inmunodeprimidos puede cursar con formas graves y aun mortales como el síndrome de hiperinfestación y la enfermedad diseminada.

Métodos

Análisis retrospectivo de las características epidemiológicas, manifestaciones clínicas, co-infección por virus de inmunodeficiencia humana (VIH), hallazgos microbiológicos y evolución de 30 pacientes con estrongiloidiasis, atendidos en el Hospital de Enfermedades Infecciosas F. J. Muñiz de Buenos Aires, entre enero 2004 y diciembre 2008.

Resultados

Se incluyeron en la evaluación 20 hombres y 10 mujeres con una mediana de edad de 33 años. Co-infección por VIH hubo en 21 pacientes (70%); la mediana de linfocitos T CD4+ en ellos al momento del diagnóstico de la parasitosis fue de 50 céls/mm3 (rango 7 a 355), (media de 56 céls/mm3). En los pacientes seronegativos para VIH, se comprobaron las siguientes co-morbilidades: tuberculosis (n: 3) y un caso de cada una de las siguientes afecciones: alcoholismo crónico, diabetes mellitus, reacción lepromatosa bajo corticotera-pia, y psoriasis en tratamiento inmunosupresor. Hubo dos pacientes sin aparentes enfermedades de base. Diecisiete pacientes presentaron enfermedad intestinal crónica con diarrea (57%), era asintomática y fue sospechada por la eosinofilia periférica (n: 7, 23%) y se clasificó como síndrome de hiperinfestación (n: 6, 20%) diagnosticado por la identificación de larvas en la materia fecal y secreciones broncopulmonares. Diecisiete pacientes (57%) presentaron eosinofilia periférica. El diagnóstico se efectuó por la visualización directa de las larvas en muestras de heces en fresco mediante la técnica de concentración de Baer-man (n: 20); por el examen copro-parasitológico seriado (n: 2) y por ambos métodos (n: 1); en líquido duodenal y materia fecal (n: 1) y por la identificación de larvas en materia fecal y secreciones respiratorias (n: 6). Letalidad global: 20% (6/30). Los pacientes con eosinofilia tuvieron una menor letalidad que aquellos sin esta respuesta (p < 0,001). No hubo correlación estadística entre la edad y la supervivencia. Sí fue significativa la correlación entre el recuento de CD4 y la letalidad, incluyendo 18 de los 21 pacientes seropositivos para VIH (p: 0,03). Finalmente, la correlación seropositividad para VIH y letalidad también fue significativa. Veintidós pacientes respondieron a la terapia antiparasitaria con ivermectina y evolucionaron favorablemente.

PDF

https://scielo.conicyt.cl/pdf/rci/v28n3/art03.pdf

March 24, 2019 at 5:28 pm

Antimicrobial Prophylaxis for Adult Patients With Cancer-Related Immunosuppression: ASCO and IDSA Clinical Practice Guideline Update.

J Clin Oncol. 2018 Sep 4:JCO1800374

Taplitz RA, Kennedy EB, Bow EJ, et al.

Purpose

To provide an updated joint ASCO/Infectious Diseases Society of America (IDSA) guideline on antimicrobial prophylaxis for adult patients with immunosuppression associated with cancer and its treatment.

Methods

ASCO and IDSA convened an update Expert Panel and conducted a systematic review of relevant studies from May 2011 to November 2016. The guideline recommendations were based on the review of evidence by the Expert Panel.

Results

Six new or updated meta-analyses and six new primary studies were added to the updated systematic review.

Recommendations

Antibacterial and antifungal prophylaxis is recommended for patients who are at high risk of infection, including patients who are expected to have profound, protracted neutropenia, which is defined as < 100 neutrophils/µL for > 7 days or other risk factors. Herpes simplex virus–seropositive patients undergoing allogeneic hematopoietic stem-cell transplantation or leukemia induction therapy should receive nucleoside analog-based antiviral prophylaxis, such as acyclovir. Pneumocystis jirovecii prophylaxis is recommended for patients receiving chemotherapy regimens that are associated with a > 3.5% risk for pneumonia as a result of this organism (eg, those with ≥ 20 mg prednisone equivalents daily for ≥ 1 month or on the basis of purine analog usage). Treatment with a nucleoside reverse transcription inhibitor (eg, entecavir or tenofovir) is recommended for patients at high risk of hepatitis B virus reactivation. Recommendations for vaccination and avoidance of prolonged contact with environments that have high concentrations of airborne fungal spores are also provided within the updated guideline. Additional information is available at http://www.asco.org/supportive-care-guidelines.

FULL TEXT

https://ascopubs.org/doi/full/10.1200/JCO.18.00374

PDF (CLIC en PDF)

 

March 20, 2019 at 3:44 pm

Review – Epidemiology, Diagnosis, and Antimicrobial Treatment of Acute Bacterial Meningitis.

Clinical Microbiology Review July 2010 V.23 N.3 P.467-492

Matthijs C. Brouwer, Allan R. Tunkel, Diederik van de Beek

The epidemiology of bacterial meningitis has changed as a result of the widespread use of conjugate vaccines and preventive antimicrobial treatment of pregnant women.

Given the significant morbidity and mortality associated with bacterial meningitis, accurate information is necessary regarding the important etiological agents and populations at risk to ascertain public health measures and ensure appropriate management.

In this review, we describe the changing epidemiology of bacterial meningitis in the United States and throughout the world by reviewing the global changes in etiological agents followed by specific microorganism data on the impact of the development and widespread use of conjugate vaccines.

We provide recommendations for empirical antimicrobial and adjunctive treatments for clinical subgroups and review available laboratory methods in making the etiological diagnosis of bacterial meningitis.

Finally, we summarize risk factors, clinical features, and microbiological diagnostics for the specific bacteria causing this disease.

FULL TEXT

https://cmr.asm.org/content/23/3/467

PDF

https://cmr.asm.org/content/cmr/23/3/467.full.pdf

 

March 17, 2019 at 10:17 am

Mycobacterium tuberculosis prosthetic joint infections: A case series and literature review

Journal of Infection January 2019 V.78 N.1 P.27–34

Fabrice Uhel, Gregory Corvaisier, Yves Poinsignon, Catherine Chirouze, Guillaume Beraud, Olivier Grossi, Nicolas Varache, Cédric Arvieux, Rozenn Le Berre, Pierre Tattevin, for the Groupe d’Epidémiologie et Recherche en Infectiologie Clinique Centre-Ouest (GERICCO)

Objectives

We aimed to characterize diagnosis, management, and outcome of Mycobacterium tuberculosis prosthetic joint infections (PJI).

Methods

Cases of M. tuberculosis PJI documented in 7 referral French centers were retrospectively reviewed. Data were collected from medical files on a standardized questionnaire. We performed a literature review using the keywords ‘prosthetic joint’, and ‘tuberculosis’.

Results

During years 1997–2016, 13 patients (8 males, 5 females, median age 79 years [range, 60–86]) had documented M. tuberculosis PJI, involving hip (n = 6), knee (n = 6), or shoulder (n = 1). Median time from arthroplasty to diagnosis was 9 years [0.4–20]. The diagnosis was obtained on joint aspirates (n = 9), or synovial tissue (n = 4). PCR was positive in all cases tested (5/5). Median duration of antituberculosis treatment was 14 months [6–32]). Nine patients underwent surgery: debridement (n = 4), resection arthroplasty (n = 3), and revision arthroplasty (1-stage exchange, n = 2). PJI was controlled in 12 patients. Seventeen additional cases of documented M. tuberculosis PJI have been reported, with a favorable outcome in 79% (11/14) of patients with no surgery, 85% (11/13) with debridement, 86% (19/22) with revision arthroplasty, and 81% (17/21) with resection (NS).

Conclusions

  1. tuberculosis PJI can be controlled with prolonged antituberculosis treatment in most cases, with or without surgical treatment.

FULL TEXT

https://www.journalofinfection.com/article/S0163-4453(18)30253-6/abstract

PDF

https://www.journalofinfection.com/article/S0163-4453(18)30253-6/pdf

January 12, 2019 at 10:01 am

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