Posts filed under ‘F.O.D’

Multistate infestation with the exotic disease–vector tick Haemaphysalis longicornis — United States, August 2017–September 2018.

MMWR Morb Mortal Wkly Rep November 30, 2018 V.67 N.47 P.1310-1313.

Beard CB et al

Haemaphysalis longicornis is a tick indigenous to eastern Asia and an important vector of human and animal disease agents, resulting in such outcomes as human hemorrhagic fever and reduction of production in dairy cattle by 25%.

H. longicornis was discovered on a sheep in New Jersey in August 2017 (1).

This was the first detection in the United States outside of quarantine.

In the spring of 2018, the tick was again detected at the index site, and later, in other counties in New Jersey, in seven other states in the eastern United States, and in Arkansas.

The hosts included six species of domestic animals, six species of wildlife, and humans.

To forestall adverse consequences in humans, pets, livestock, and wildlife, several critical actions are indicated, including expanded surveillance to determine the evolving distribution of H. longicornis, detection of pathogens that H. longicornis currently harbors, determination of the capacity of H. longicornis to serve as a vector for a range of potential pathogens, and evaluation of effective agents and methods for the control of H. longicornis ….

PDF

https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6747a3-H.pdf

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December 6, 2018 at 8:00 am

Radiological characteristics of pulmonary cryptococcosis in HIV-infected patients.

PLoS One. March 16, 2017 V.12 N.3 P.:e0173858.

Hu Z1, Chen J2, Wang J3, Xiong Q1, Zhong Y1, Yang Y1, Xu C4, Wei H1.

Abstract

BACKGROUND:

Current understanding of human immunodeficiency virus (HIV)-associated pulmonary cryptococcosis (PC) is largely based on studies performed about 2 decades ago which reported that the most common findings on chest radiograph were diffuse interstitial infiltrates. Few studies are available regarding the computed tomography (CT) findings. The aim of this study was to characterize chest CT features of HIV-associated PC.

METHODS:

HIV patients with cryptococccal infection and pulmonary abnormalities on Chest CT between September 2010 and May 2016 in the Second Affiliated Hospital of the Southeast University were retrospectively analyzed. Confirmed cases of tumors, mycobacterial infections and other fungal infections were excluded from the analysis.

RESULTS:

60 cases were identified. The median CD4 T-cell counts were 20 cells/μL (range, 0-205 cells/μL). Chest CT scans demonstrated nodular lesions in 93.3% of the studied patients. Those nodular lesions were usually cavitated and solitary nodule was the most common form. Pleural effusions and pneumonic infiltrates occurred in 11.6% and 31.7% of the cases respectively. Those lesions were usually had co-existing nodular lesions. Etiological analysis suggested that 76.8% of the nodular lesions could have a relationship with PC that 12.5% of the nodular lesions were “laboratory-confirmed” cases, 48.2% were “clinically confirmed” cases and 16.1% were “clinically probable” cases. 85.7% of the pleural effusions could be “clinically confirmed” cases of PC. At least, 38.5% of the diffuse pneumonic infiltrates may be clinically attributed to pneumocystis pneumonia.

CONCLUSIONS:

This study suggested that pulmonary nodules but not diffuse pneumonia are the most common radiological characteristics of HIV-associated PC. HIV-infected patients with pulmonary nodules on Chest CT should particularly be screened for cryptococcal infection

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5354418/pdf/pone.0173858.pdf

November 25, 2018 at 9:40 am

Pulmonary Cryptococcosis – Localized and Disseminated Infections in 27 Patients with AIDS.

Clinical Infectious Diseases September 1995 V.21 N.3 P.628–633

Marie-Caroline Meyohas; Patricia Roux; Diane Bollens; Christos Chouaid; Willy Rozenbaum …

We reviewed the records of 85 patients infected with both human immunodeficiency virus and Cryptococcus neoformans.

Twenty-seven patients (32%) had pulmonary cryptococcosis.

C. neoformans was cultured from bronchoalveolar lavage (BAL) or pleural fluid in 25 cases; the remaining two patients had cryptococcal antigen (CA) detected in BAL fluid and C. neoformans cultured from other sites.

All but one of the 27 patients had detectable CA in serum.

The CD4+ lymphocyte count was low in all cases (median, 24/mm3). Clinical manifestations of pulmonary cryptococcosis included fever (94%), cough (71%), dyspnea (7%), expectoration (4%), chest pain (2%), and hemoptysis (1%).

Diffuse interstitial opacities (70.5%), focal interstitial abnormalities, alveolar opacities, adenopathies, cavitary lesions, and pleural effusions were evident.

Outcome was poor (mean survival time, 23 weeks) despite treatment.

Patients with localized pulmonary cryptococcosis appeared to have a higher CD4+ lymphocyte count, an earlier diagnosis, lower serum CA titers, fewer previous or concomitant infections, and a better prognosis than patients with disseminated cryptococcosis.

abstract

https://academic.oup.com/cid/article-abstract/21/3/628/362645?redirectedFrom=fulltext

PDF

https://doi.org/10.1093/clinids/21.3.628

 

November 24, 2018 at 8:03 pm

Cryptococcus neoformans Pulmonary Infection in HIV-1-Infected Patients

Journal of Acquired Immune Deficiency Syndrome May 1990 V.3  N.5 P.480-484

Clark, Rebecca A.; Greer, Donald L.; Valainis, Gregory T…..

Cryptococcus neoformans (Cn) is a frequent pathogen in patients infected with the human immunodeficiency virus (HIV-1).

We review the initial presentation and clinical course of 18 HIV-1-infected (HIV +) patients with a Cn pulmonary infection. Simultaneous positive cerebrospinal fluid (CSF) cultures were found in 10 (63%) of 16 examined.

The most frequent presenting symptoms were fever (87%) and pulmonary complaints (60%).

Although the most common chest radiographic finding was bilateral diffuse interstitial infiltrates, nodules and cavitary lesions were also seen. Nine (50%) of the 18 patients died within 6 weeks of diagnosis.

Of six patients with an isolated Cn pulmonary infection, five have subsequently died.

Three of these five patients did not receive maintenance therapy and had confirmed or probable relapse.

Patients initially presenting with an isolated Cn pulmonary infection may later show disseminated disease, suggesting that such patients should receive both acute and maintenance therapy.

abstract

https://journals.lww.com/jaids/Abstract/1990/05000/Cryptococcus_neoformans_Pulmonary_Infection_in.3.aspx

PDF (CLIC en PDF)

November 24, 2018 at 8:01 pm

Infective endocarditis due to Streptococcus dysgalactiae: clinical presentation and microbiological features

European Journal of Clinical Microbiology & Infectious Diseases December 2018 V.37 N.12 P.2261–2272

Anna Bläckberg, Nilson, Volkan Özenci, Lars Olaison, Magnus Rasmussen

Knowledge of infective endocarditis (IE) caused by Streptococcus dysgalactiae (SD) is limited.

This study aimed to identify the clinical and microbiological features of SD-caused IE and to investigate any possible synergy between penicillin and gentamicin on SD isolates.

Cases of IE 2008–2016 due to SD reported to the Swedish Registry of Infective Endocarditis (SRIE) were identified. Isolates were emm typed and synergy between antibiotics was determined in time-kill experiments. Medical records were reviewed and SD-cases were compared to cases of IE due to other pathogens reported to the SRIE.

Fifty cases of SD-caused IE were confirmed. emm types stC74a, stG62647, and stG643 were most commonly encountered.

The patients had a median age of 74 years (range 38–93) and were significantly older compared to patients with Staphylococcus aureus-caused IE, (65 years (p = 0.003)).

The median time to diagnosis from symptom onset was 1 day for patients with SD-caused IE which was less compared to patients with IE due to the other pathogens (2–15 days). Embolization was seen in 46% and the in-hospital mortality was 8%.

Etest-based methods did not indicate any synergy between penicillin and gentamicin whereas synergy was noted for four out of nine isolates applying time-kill assays.

This is the largest study of SD-caused IE, a condition with an acute onset predominantly affecting elderly people. Synergy between penicillin and gentamicin against some SD isolates was distinguished but the potential benefit of this must be weighed against the risk of aminoglycoside side effects.

PDF

https://link.springer.com/content/pdf/10.1007%2Fs10096-018-3367-7.pdf

November 21, 2018 at 12:27 pm

Infections in patients affected by rheumatologic diseases associated to glucocorticoid use or tumor necrosis factor-alpha inhibitors.

Rev Chilena Infectol. April 2014 V.31 N.2 P.181-95.

[Article in Spanish]

Fica A.

Abstract

A great diversity of infectious agents can affect patients that use steroids at immunosuppressive doses or tumor necrosis factor alpha (TNF-alpha) antagonists.

The list of participating microorganisms is more restricted in the case of anti TNF-alpha blockers.

Overlapping agents include intracellular bacteria, Mycobacterium tuberculosis, geographic fungal agents that have the ability to establish granulamotous infections, herpes zoster, and reactivation of chronic hepatitis B virus infection.

An important conceptual issue for these infections is the existence of a threshold prednisone daily dose for the emergence of opportunistic infections but higher levels of immunosuppression and cofactors are required in the case of Pneumocystis jiroveci and cytomegalovirus infections.

In order to prevent these threats, a detailed medical evaluation is needed before prescription to detect potential risks and manage them properly.

Prevention rules must be prescribed in every case, that include common sense behaviors, vaccines, and in selected cases, chemoprophylaxis for latent tuberculosis (TB) infection, P. jiroveci pneumonia (PCP) or other specific requirements.

Latent TB infection is probable and requires chemoprophylaxis in the case of remote or recent exposure to a patient with lung TB, a positive tuberculin or interferon-gamma release assay result or residual lung scars in a chest x-ray exam.

PCP prevention is suggested when the patient reaches a daily dose of prednisone of 30 mg but might be needed at lower doses in case of other concomitant immunosuppressive drugs or when lymphopenia arises shortly after prednisone initiation.

PDF

https://scielo.conicyt.cl/pdf/rci/v31n2/art09.pdf

 

November 19, 2018 at 11:12 am

IMAGES IN CLINICAL MEDICINE – Spinal Brucellosis

N Engl J of Med October 25, 2018 V.379 P.e28

Christine Cho, M.D., and Michihiko Goto, M.D.

A 62-year-old man presented to the emergency department with a 6-month history of worsening low back pain, fevers, chills, night sweats, and weight loss. He regularly traveled to Mexico and had occasionally consumed unprocessed dairy products. He had no history of tuberculosis infection or known exposure. Laboratory studies revealed a white-cell count of 10,600 per cubic millimeter (reference range, 3700 to 10,500) and an erythrocyte sedimentation rate of 65 mm per hour (reference range, 0 to 15)…..

FULL TEXT

https://www.nejm.org/doi/full/10.1056/NEJMicm1803513?query=infectious-disease

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMicm1803513

November 6, 2018 at 8:19 am

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