Posts filed under ‘GUIDELINES’

Clinical practice of respiratory virus diagnostics in critically ill patients with a suspected pneumonia: A prospective observational study.

J Clin Virol. 2016 Oct;83:37-42.

van Someren Gréve F1, Ong DS2, Cremer OL3, Bonten MJ4, Bos LD5, de Jong MD6, Schultz MJ5, Juffermans NP5; MARS consortium.

Author information

1Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address:

2Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address:

3Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.

4Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.

5Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

6Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.



Clinical guidelines suggest testing for respiratory viruses during the influenza season, but are unclear which categories of patients on the intensive care unit (ICU) should be tested.


We described the clinical practice of diagnostic testing for respiratory virus infections in patients presenting to ICU with suspected community-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP).


Prospective observational study in consecutive CAP and HAP patients with an ICU stay of more than 24h in two tertiary care hospitals in The Netherlands, from 2011 to December 2013. The proportion of patients receiving diagnostic testing with PCR for the presence of respiratory viruses in respiratory tract specimens was determined.


In total, 1452 patients were included, of which 712 patients presented with CAP and 740 with HAP. In CAP, 282 of 712 (40%) were tested for respiratory viruses (190 of 417 (46%) during the influenza season). In HAP, 95 of 740 (13%) were tested (50 of 372 (13%) during the influenza season). Regardless of the season, virus diagnostic tests were ordered significantly more often in patients with comorbidities, and in those presenting with elevated CRP and leucopenia. In patients who were tested during the influenza season, the prevalence of influenza was 14% in patients with CAP and 10% in those with HAP. Influenza was absent during the summer in both groups.


Less than half of patients admitted to the ICU with suspected pneumonia were tested for the presence of viral pathogens, either in or outside the influenza season.


October 20, 2016 at 8:23 am

Consensus on surgical aspects of managing osteomyelitis in the diabetic foot.

Diabet Foot Ankle. 2016 Jul 12;7:30079.

Allahabadi S1, Haroun KB1, Musher DM2, Lipsky BA3,4,5, Barshes NR6.

Author information

1Baylor College of Medicine, Houston, Texas.

2Division of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas.

3Department of Medicine, University of Washington, Seattle.

4Department of Medicine (Infectious Diseases), University of Geneva, Geneva, Switzerland.

5Department of Medicine, Green Templeton College, University of Oxford, Oxford, United Kingdom.

6Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine / Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas;



The aim of this study was to develop consensus statements that may help share or even establish ‘best practices’ in the surgical aspects of managing diabetic foot osteomyelitis (DFO) that can be applied in appropriate clinical situations pending the publication of more high-quality data.


We asked 14 panelists with expertise in DFO management to participate. Delphi methodology was used to develop consensus statements. First, a questionnaire elicited practices and beliefs concerning various aspects of the surgical management of DFO. Thereafter, we constructed 63 statements for analysis and, using a nine-point Likert scale, asked the panelists to indicate the extent to which they agreed or disagreed with the statements. We defined consensus as a mean score of greater than 7.0.


The panelists reached consensus on 38 items after three rounds. Among these, seven provide guidance on initial diagnosis of DFO and selection of patients for surgical management. Another 15 statements provide guidance on specific aspects of operative management, including the timing of operations and the type of specimens to be obtained. Ten statements provide guidance on postoperative management, including wound closure and offloading, and six statements summarize the panelists’ agreement on general principles for surgical management of DFO.


Consensus statement on the perioperative management of DFO were formed with an expert panel comprised of a variety of surgical specialties. We believe these statements may serve as ‘best practice’ guidelines until properly performed studies provide more robust evidence to support or refute specific surgical management steps in DFO.


October 20, 2016 at 8:20 am


Ministerio de Salud de Argentina Marzo 2010


Pág 3. Información para el equipo de salud

  1. Introducción
  2. Manifestaciones Clínicas
  3. ¿Cuándo sospechar leishmaniasis visceral?
  4. ¿Cómo confirmar la sospecha diagnóstica de leishmaniasis visceral?
  5. ¿Cómo se tratan los pacientes con leishmaniasis visceral?
  6. Flujograma de manejo de caso sospechoso
  7. ¿Cuándo sospechar leishmaniasis en los perros?
  8. ¿Cómo se confirma la leishmaniasis en los perros?
  9. ¿Qué se debe hacer si se confirma caso sospechoso de leishmaniasis visceral?
  10. ¿Cómo notificar el caso de leishmaniasis visceral?
  11. Prevención en la familia y la comunidad

Pág 25. Recomendaciones para la organización de las actividades en el Equipo de Salud

  1. ¿Qué pueden Ud. y su equipo de salud hacer para contribuir al control de la leishmaniasis en su área?

Pág 29. Información para la población

  1. ¿Qué es la leishmaniasis?
  2. ¿Cómo se contagia?
  3. ¿Cómo puedo hacer para prevenir la leishmaniasis visceral?
  4. ¿Cuáles son las zonas de riesgo para la leishmaniasis visceral?
  5. ¿Cómo puedo saber si tengo leishmaniasis visceral?

Pág 33. Anexos

  1. Asociación leishmaniasis visceral / HIV
  2. Retratamiento de leishmaniasis visceral
  3. Diagnósticos diferenciales de leishmaniasis visceral
  4. Leishmaniasis y embarazo
  5. Diagnóstico parasitológico de leishmaniasis visceral
  6. Algoritmo diagnóstico de leishmaniasis visceral


October 18, 2016 at 3:04 pm

IDSA GUIDELINE – Official American Thoracic Society – Centers for Disease Control and Prevention – Infectious Diseases Society of America Clinical Practice Guidelines – Treatment of Drug-Susceptible Tuberculosis

Clinical Infectious Diseases October 1, 2016 V.63 N.7 e147-e195

Payam Nahid1, Susan E. Dorman2, Narges Alipanah1, Pennan M. Barry3, Jan L. Brozek4, Adithya Cattamanchi1, Lelia H. Chaisson1, Richard E. Chaisson2, Charles L. Daley5, Malgosia Grzemska6, Julie M. Higashi7, Christine S. Ho8, Philip C. Hopewell1, Salmaan A. Keshavjee9, Christian Lienhardt6, Richard Menzies10, Cynthia Merrifield1, Masahiro Narita12, Rick O’Brien13, Charles A. Peloquin14, Ann Raftery1, Jussi Saukkonen15, H. Simon Schaaf16, Giovanni Sotgiu17, Jeffrey R. Starke18, Giovanni Battista Migliori11, and Andrew Vernon8

1University of California, San Francisco

2Johns Hopkins University, Baltimore, Maryland

3California Department of Public Health, Richmond

4McMaster University, Hamilton, Ontario, Canada

5National Jewish Health, Denver, Colorado

6World Health Organization, Geneva, Switzerland

7Tuberculosis Control Section, San Francisco Department of Public Health, California

8Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia

9Harvard Medical School, Boston, Massachusetts

10McGill University, Montreal, Quebec, Canada

11WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri Care and Research Institute, Tradate, Italy

12Tuberculosis Control Program, Seattle and King County Public Health, and University of Washington, Seattle

13Ethics Advisory Group, International Union Against TB and Lung Disease, Paris, France

14University of Florida, Gainesville

15Boston University, Massachusetts

16Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa

17University of Sassari, Italy

18Baylor College of Medicine, Houston, Texas

The American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America jointly sponsored the development of this guideline for the treatment of drug-susceptible tuberculosis, which is also endorsed by the European Respiratory Society and the US National Tuberculosis Controllers Association. Representatives from the American Academy of Pediatrics, the Canadian Thoracic Society, the International Union Against Tuberculosis and Lung Disease, and the World Health Organization also participated in the development of the guideline. This guideline provides recommendations on the clinical and public health management of tuberculosis in children and adults in settings in which mycobacterial cultures, molecular and phenotypic drug susceptibility tests, and radiographic studies, among other diagnostic tools, are available on a routine basis. For all recommendations, literature reviews were performed, followed by discussion by an expert committee according to the Grading of Recommendations, Assessment, Development and Evaluation methodology. Given the public health implications of prompt diagnosis and effective management of tuberculosis, empiric multidrug treatment is initiated in almost all situations in which active tuberculosis is suspected. Additional characteristics such as presence of comorbidities, severity of disease, and response to treatment influence management decisions. Specific recommendations on the use of case management strategies (including directly observed therapy), regimen and dosing selection in adults and children (daily vs intermittent), treatment of tuberculosis in the presence of HIV infection (duration of tuberculosis treatment and timing of initiation of antiretroviral therapy), as well as treatment of extrapulmonary disease (central nervous system, pericardial among other sites) are provided. The development of more potent and better-tolerated drug regimens, optimization of drug exposure for the component drugs, optimal management of tuberculosis in special populations, identification of accurate biomarkers of treatment effect, and the assessment of new strategies for implementing regimens in the field remain key priority areas for research. See the full-text online version of the document for detailed discussion of the management of tuberculosis and recommendations for practice.


September 21, 2016 at 4:52 pm

IDSA GUIDELINE – 2016 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline for the Treatment of Coccidioidomycosis

Clinical Infectious Diseases September 15, 2016 V.63 N.6 e112-e146

John N. Galgiani, Neil M. Ampel, Janis E. Blair, Antonino Catanzaro, Francesca Geertsma, Susan E. Hoover, Royce H. Johnson, Shimon Kusne, Jeffrey Lisse, Joel D. MacDonald, Shari L. Meyerson, Patricia B. Raksin, John Siever, David A. Stevens, Rebecca Sunenshine, and Nicholas Theodore

1Valley Fever Center for Excellence

2Division of Infectious Diseases, University of Arizona, Tucson

3Division of Infectious Diseases, Mayo Clinic, Scottsdale, Arizona

4Division of Pulmonary and Critical Care, University of California, San Diego

5Department of Pediatrics, Infectious Diseases, Stanford University School of Medicine, California

6Division of Sanford Health, Sioux Falls, South Dakota

7David Geffen School of Medicine at UCLA, Department of Medicine, Kern Medical Center, Bakersfield, California

8Department of Rheumatology, University of Arizona, Tucson

9Department of Neurosurgery School of Medicine, University of Utah, Salt Lake City

10Division of Thoracic Surgery, Northwestern University, Feinberg School of Medicine

11Division of Neurosurgery, John H. Stroger Jr Hospital of Cook County, Chicago, Illinois

12Arizona Pulmonary Specialists, Ltd, Phoenix

13Division of Infectious Diseases, Stanford University School of Medicine, California

14Career Epidemiology Field Officer Program, Division of State and Local Readiness, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention

15Maricopa County Department of Public Health

16Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona

It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. Infectious Diseases Society of America considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient’s individual circumstances.


Coccidioidomycosis, also known as San Joaquin Valley fever, is a systemic infection endemic to parts of the southwestern United States and elsewhere in the Western Hemisphere. Residence in and recent travel to these areas are critical elements for the accurate recognition of patients who develop this infection. In this practice guideline, we have organized our recommendations to address actionable questions concerning the entire spectrum of clinical syndromes. These can range from initial pulmonary infection, which eventually resolves whether or not antifungal therapy is administered, to a variety of pulmonary and extrapulmonary complications. Additional recommendations address management of coccidioidomycosis occurring for special at-risk populations. Finally, preemptive management strategies are outlined in certain at-risk populations and after unintentional laboratory exposure.


September 21, 2016 at 4:50 pm

Review article: novel therapies for hepatitis B virus cure – advances and perspectives.

Aliment Pharmacol Ther. 2016 Aug V.44 N.3 P.213-22.

Lin CL1,2, Kao JH3,4,5,6.

Author information

1Department of Gastroenterology, Renai branch, Taipei City Hospital, Taipei, Taiwan.

2Department of Psychology, National Chengchi University, Taipei, Taiwan.

3Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.

4Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.

5Hepatitis Research Center, National Taiwan University, National Taiwan University Hospital, Taipei, Taiwan.

6Department of Medical Research, National Taiwan University, National Taiwan University Hospital, Taipei, Taiwan.



Current anti-viral therapies, interferon and nucleos(t)ide analogues, have been proven to reduce the progression of chronic hepatitis B (CHB). However, covalently closed circular DNA (cccDNA) of hepatitis B virus (HBV)  persists, resulting in viral relapse after the discontinuation of treatment.



To discuss and review novel therapies for chronic hepatitis B infection.



Recent published studies which searched from PubMed were comprehensive reviewed. The key words include chronic hepatitis B, hepatitis B virus cure, covalently closed circular DNA, direct acting anti-virals and host targeting agents.



Several novel agents through viral and host targets approaches are under investigations towards functional cure of HBV. On the one hand, direct acting anti-virals targeting virus itself, such as HBV new polymerase inhibitor,  entry inhibitor, engineered site-specific nucleases and RNA interference, could inhibit amplification of cccDNA as well as intrahepatic HBV infection and eliminate or silence cccDNA transcription. Inhibitors of HBV nucleocapsid assembly suppress capsid formation and prevent synthesis of HBV DNA. On the other hand, host targeting agents (HTA) include lymphotoxin-β receptor agonist, toll-like receptor agonist, immune checkpoint inhibitors and adenovirus-based therapeutic vaccine. Through enhancing innate and adaptive immune responses, these agents could induce noncytolytic destruction of cccDNA or attack HBV-infected hepatocytes.



With these promising approaches, we hope to reach global hepatitis B virus control in the middle of this century.



September 10, 2016 at 10:30 am

Clinical approach to fever of unknown origin in children.

J Microbiol Immunol Infect. 2015 Oct 9.

Chien YL1, Huang FL2, Huang CM2, Chen PY3.

Author information

1Section of Pediatric Infectious Disease, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Pediatrics, Lin Shin Medical Corporation Lin Shin Hospital, Taichung, Taiwan.

2Section of Pediatric Infectious Disease, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan.

3Section of Pediatric Infectious Disease, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan. Electronic address:



Fever of unknown origin (FUO) can be caused by many clinical conditions and remains a diagnostic challenge in clinical practice. The etiology of FUO varies markedly among different age groups, geographic areas, and seasons. A four-stage investigative protocol for FUO is widely applied in clinical practice. The aim of this study was to evaluate the usefulness of this four-stage protocol for identifying the etiology of FUO in children.


We enrolled children younger than 18 years of age who were admitted to the Taichung Veterans General Hospital during the period from January 2006 to December 2014 with FUO persisting for more than 3 weeks. The four-stage FUO investigative guideline was used to evaluate the etiology of fever in all patients enrolled in the study.


The etiology of FUO was identified in 79 (84.9%) of the 93 patients enrolled in the study. The most common cause of FUO was infectious disease (37.6%), followed by malignancy (17.2%), miscellaneous disease (16.1%), and collagen vascular disease (14.0%). With respect to the four-stage survey of FUO, 36 of the 79 patients (45.6%) were identified in Stage 3, 28 patients (35.4%) in Stage 2, 13 patients (16.5%) in Stage 4, and only two patients (2.5%) in Stage 1.


A well-designed systemic review of the epidemiological information, medical history, physical examination, laboratory analysis, and adequate invasive procedures provide adequate data to identify the most common causes of FUO in children.


September 8, 2016 at 4:55 pm

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