Posts filed under ‘Infecciones e Insuf. renal’

Pre-existing medical conditions associated with Vibrio vulnificus septicaemia.

Epidemiol Infect. 2014 Apr;142(4):878-81.

Menon MP1, Yu PA1, Iwamoto M1, Painter J1.

Author information

1Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.

Abstract

Vibrio vulnificus (Vv) can result in severe disease. Although pre-existing liver disease is a recognized risk factor for serious infection, the relative importance of other comorbidities has not been fully assessed.

We analysed reports of Vv infections submitted to CDC from January 1988 to September 2006 in order to assess the role of pre-existing conditions contributing to severe outcomes.

A total of 1212 patients with Vv infection were reported. Only patients with liver disease [adjusted odds ratio (aOR) 5.1)] were more likely to become septic when exposure was due to contaminated food.

Patients with liver disease (aOR 4.1), a haematological disease (aOR 3.2), or malignancy (aOR 3.2) were more likely to become septic when infection was acquired via a non-foodborne exposure.

As such, patients with these pre-existing medical conditions should be advised of the risk of life-threatening illness after eating undercooked contaminated seafood or exposing broken skin to warm seawater

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4598054/pdf/nihms727972.pdf

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February 17, 2017 at 4:39 pm

Incidence of Infection and Inhospital Mortality in Patients With Chronic Renal Failure After Total Joint Arthroplasty

Journal of Arthroplasty November 2016 V.31 N.11 P.2473-2441

Omer F. Erkocak, Joanne Y. Yoo, Camilo Restrepo, Mitchell G. Maltenfort, Javad Parvizi

Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania

Background

Patients with chronic renal failure (CRF) may require total joint arthroplasty (TJA) to treat degenerative joint disease, fractures, osteonecrosis, or amyloid arthropathy. There have been conflicting results, however, regarding outcomes of TJA in patients with chronic renal disease. The aim of this case-controlled study was to determine the outcome of TJA in patients with CRF, with particular interest in the incidence of infections and inhospital mortality.

Methods

We queried our electronic database to determine which patients among the 29,389 TJAs performed at our institution between January 2000 and June 2012 had a diagnosis of CRF. A total of 359 CRF patients were identified and matched for procedure, gender, age (±4 years), date of surgery (±2 years), and body mass index (±5 kg/m2) in a 2:1 ratio to 718 control patients.

Results

The incidence of infection and inhospital mortality was not significantly different between the nondialysis CRF patients and controls, whereas it was significantly higher in dialysis-dependent end-stage renal failure patients compared to controls. Of the 50 CRF patients receiving hemodialysis, 10 (20%) developed surgical site infection, of which 4 (8%) were periprosthetic joint infection, and 4 (8%) died during hospital stay. The odds ratio for infection in the dialysis group was 7.54 (95% confidence interval: 2.83-20.12) and 10.46 (95% confidence interval: 1.67-65.34) for the inhospital mortality.

Conclusion

We conclude that end-stage renal failure patients receiving hemodialysis have higher postoperative infection and inhospital mortality rates after an elective TJA procedure, whereas nondialysis CRF patients have similar outcomes compared with the general TJA population.

PDF

http://www.arthroplastyjournal.org/article/S0883-5403(16)30130-9/pdf

October 29, 2016 at 10:27 am

Influenza in immunosuppressed populations: a review of infection frequency, morbidity, mortality, and vaccine responses.

Lancet Infect Dis. 2009 Aug;9(8):493-504.

Kunisaki KM1, Janoff EN.

1Pulmonary Section, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN 55417, USA. kunis001@umn.edu

Abstract

Patients that are immunosuppressed might be at risk of serious influenza-associated complications.

As a result, multiple guidelines recommend influenza vaccination for patients infected with HIV, who have received solid-organ transplants, who have received haemopoietic stem-cell transplants, and patients on haemodialysis.

However, immunosuppression might also limit vaccine responses. To better inform policy, we reviewed the published work relevant to incidence, outcomes, and prevention of influenza infection in these patients, and in patients being treated chemotherapy and with systemic corticosteroids.

Available data suggest that most immunosuppressed populations are indeed at higher risk of influenza-associated complications, have a general trend toward impaired humoral vaccine responses (although these data are mixed), and can be safely vaccinated–although longitudinal data are largely lacking.

Randomised clinical trial data were limited to one study of HIV-infected patients with high vaccine efficacy. Better trial data would inform vaccination recommendations on the basis of efficacy and cost in these at-risk populations.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775097/pdf/nihms-133861.pdf

 

May 30, 2014 at 6:47 pm

The epidemiology of hematogenous vertebral osteomyelitis – A cohort study in a tertiary care hospital.

BMC Infect Dis. 2010 Jun 7;10:158.

Bhavan KP, Marschall J, Olsen MA, Fraser VJ, Wright NM, Warren DK.

Division of Infectious Diseases, Washington University School of Medicine, St, Louis, MO, USA.

Abstract

BACKGROUND:

Vertebral osteomyelitis is a common manifestation of osteomyelitis in adults and associated with considerable morbidity. Limited data exist regarding hematogenous vertebral osteomyelitis. Our objective was to describe the epidemiology and management of hematogenous vertebral osteomyelitis.

METHODS:

We performed a 2-year retrospective cohort study of adult patients with hematogenous vertebral osteomyelitis at a tertiary care hospital.

RESULTS:

Seventy patients with hematogenous vertebral osteomyelitis were identified. The mean age was 59.7 years (+/-15.0) and 38 (54%) were male.

Common comorbidities included diabetes (43%) and renal insufficiency (24%).

Predisposing factors in the 30 days prior to admission included bacteremia (19%), skin/soft tissue infection (17%), and having an indwelling catheter (30%).

Back pain was the most common symptom (87%). Seven (10%) patients presented with paraplegia.

Among the 46 (66%) patients with a microbiological diagnosis, the most common organisms were methicillin-susceptible S. aureus [15 (33%) cases], and methicillin-resistant S. aureus [10 (22%)].

Among the 44 (63%) patients who had a diagnostic biopsy, open biopsy was more likely to result in pathogen recovery [14 (93%) of 15 with open biopsy vs. 14 (48%) of 29 with needle biopsy; p = 0.003]. Sixteen (23%) patients required surgical intervention for therapeutic purposes during admission.

CONCLUSIONS:

This is one of the largest series of hematogenous vertebral osteomyelitis. A microbiological diagnosis was made in only approximately two-thirds of cases. S. aureus was the most common causative organism, of which almost half the isolates were methicillin-resistant.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2894835/pdf/1471-2334-10-158.pdf

 

February 7, 2014 at 9:28 pm

The hantaviruses causing hemorrhagic fever with renal syndrome and pulmonary syndrome.

Salud Publica Mex. 2008 Jul-Aug;50(4):334-40.

[Article in Spanish]

Ramos C.

Source

Departamento de Arbovirus, Centro de Investigaciones sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México. cramos@insp.mx

Abstract

The goal of this review is to provide basic information on hantaviruses as causative agents of Hemorrhagic Fever with Renal Syndrome (HFRS) and Hantavirus Pulmonary Syndrome (HPS), two zoonotic diseases widely distributed in Asia/Europe, and the American continent, respectively.

Hantaviruses are rodent-borne and transmitted to humans by direct contact with infected rodents or their secretions (urine, feces and saliva). Both, HFRS and HPS share some clinical aspects, however, hemorrhage and renal failure are the hallmark of HFRS, while respiratory problems are distinctive signs and symptoms of patients with HPS.

Studies on hantavirus infection in rodents from Mexico are included, some recomendations to prevent or avoid contact with rodents are mentioned, and some determinant ecologic factors of hantaviruses distribution and their natural rodents, are also included.

PDF

http://www.scielosp.org/pdf/spm/v50n4/a13v50n4.pdf

December 23, 2013 at 11:09 am

Reglas de interpretación de las infecciones por Candida

Acta Bioquímica Clínica Latinoamericana Oct / Dic 2007 V.41 N.4

A. Enache-Angoulvant

Laboratoire de Parasitologie, Hôpital Tenon. AP-HP. Paris

Resumen

Las candidiasis son infecciones cosmopolitas y oportunistas, debidas a levaduras del género Candida. Sus aspectos clínicos son variados cualquiera que sea su localización. El carácter comensal de algunas de ellas hace que la interpretación de los exámenes microbiológicos sea delicada. Éstos sólo pueden ser interpretados después de confrontar los datos clínicos con la existencia de factores de riesgo. Las candidiasis son infecciones cosmopolitas por levaduras del género Candida. Sus aspectos clínicos son variados, ya se trate de afecciones superficiales o profundas (o sistémicas). Estas levaduras son oportunistas porque necesitan factores favorecedores (véase 1.2) para provocar la candidiasis. Las afecciones sistémicas, esencialmente en sujetos que presentan un déficit inmunitario, no serán tratadas aquí. Tampoco nos ocuparemos del tratamiento de la candidiasis superficial, basada en general en la administración de antifúngicos tópicos y la eliminación de los factores favorecedores.

PDF

http://www.scielo.org.ar/pdf/abcl/v41n4/v41n4a16.pdf

November 17, 2012 at 3:08 pm

Spinal epidural abscess.

N Engl J Med. 2006 Nov 9 V.355 N.19 P.2012-20.

Darouiche RO.

Source

Infectious Disease Section, the Michael E. DeBakey Veterans Affairs Medical Center, and the Center for Prostheses Infection, Baylor College of Medicine, Houston, TX 77030, USA. rdarouiche@aol.com

Despite advances in medical knowledge, imaging techniques, and surgical interventions, spinal epidural abscess remains a challenging problem that often eludes diagnosis and receives suboptimal treatment. The incidence of this disease — two decades ago diagnosed in approximately 1 of 20,000 hospital admissions — has doubled in the past two decades, owing to an aging population, increasing use of spinal instrumentation and vascular access, and the spread of injection-drug use. Still, spinal epidural abscess remains rare: the medical literature contains only 24 reported series of at least 20 cases each. This review addresses the pathogenesis, clinical features, diagnosis, treatment, common diagnostic and therapeutic pitfalls, and outcome of bacterial spinal epidural abscess …

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMra055111

Comment in

CORRESPONDENCE

Spinal Epidural Abscess

http://www.nejm.org/doi/pdf/10.1056/NEJMc063456

October 18, 2012 at 2:38 pm

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