Posts filed under ‘Inmunizaciones’

European consensus-based (S2k) Guideline on the Management of Herpes Zoster – guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV), Part 2: TREATMENT.

J Eur Acad Dermatol Venereol. January 2017 V.31 N.1 P.20-29.                        

Werner RN1, Nikkels AF2, Marinović B3, Schäfer M4, Czarnecka-Operacz M5, Agius AM6, Bata-Csörgő Z7, Breuer J8, Girolomoni G9, Gross GE10, Langan S11, Lapid-Gortzak R12, Lesser TH13, Pleyer U14, Sellner J15, Verjans GM16, Wutzler P17, Dressler C1, Erdmann R1, Rosumeck S1, Nast A1.

Author information

1 Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine in Dermatology (dEBM), Charité – Universitätsmedizin Berlin, Berlin, Germany.

2 Department of Dermatology, University Medical Center of Liège, Liège, Belgium.

3 Department of Dermatology and Venereology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia.

4 Department of Anesthesiology, Charité – Universitätsmedizin Berlin, Berlin, Germany.

5 Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland.

6 Department of Otorhinolaryngology, The Medical School, University of Malta, Msida, Malta.

7 Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary.

8 Division of Infection and Immunity, University College London, London, United Kingdom.

9 Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy.

10 Department of Dermatology and Venerology, Universitätsklinik Rostock, Rostock, Germany.

11 Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.

12 Department of Ophthalmology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

13 Department of Otolaryngology, University Hospital Aintree NHS Foundation Trust, Liverpool, UK.

14 Department of Ophthalmology, Charité – Universitätsmedizin Berlin, Berlin, Germany.

15 Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.

16 Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands.

17 Department of Virology and Antiviral Therapy, Jena University Hospital, Jena, Germany.

Abstract

Herpes zoster (HZ, shingles) is a frequent medical condition which may severely impact the quality of life of affected patients. Different therapeutic approaches to treat acute HZ are available.

The aim of this European project was the elaboration of a consensus-based guideline on the management of patients who present with HZ, considering different patient populations and different localizations.

This interdisciplinary guideline aims at an improvement of the outcomes of the acute HZ management concerning disease duration, acute pain and quality of life of the affected patients and at a reduction in the incidence of postherpetic neuralgia (PHN) and other complications.

The guideline development followed a structured and pre-defined process, considering the quality criteria for guidelines development as suggested by the AGREE II instrument.

The steering group was responsible for the planning and the organization of the guideline development process (Division of Evidence-Based Medicine, dEBM).

The expert panel was nominated by virtue of clinical expertise and/or scientific experience and included experts from the fields of dermatology, virology/infectiology, ophthalmology, otolaryngology, neurology and anaesthesiology.

Recommendations for clinical practice were formally consented during the consensus conference, explicitly considering different relevant aspects.

The guideline was approved by the commissioning societies after an extensive internal and external review process. In this second part of the guideline, therapeutic interventions have been evaluated.

The expert panel formally consented recommendations for the treatment of patients with HZ (antiviral medication, pain management, local therapy), considering various clinical situations.

Users of the guideline must carefully check whether the recommendations are appropriate for the context of intended application.

In the setting of an international guideline, it is generally important to consider different national approaches and legal circumstances with regard to the regulatory approval, availability and reimbursement of diagnostic and therapeutic interventions.

PDF

http://onlinelibrary.wiley.com/doi/10.1111/jdv.13957/epdf

 

June 28, 2017 at 8:53 am

2016-11 European consensus – Guideline on the Management of H Zoster – guided by the EDF in cooperation with the EADV, Part 1: DIAGNOSIS

Authors

R.N. Werner, A.F. Nikkels, B. Marinović, M. Schäfer, M. Czarnecka-Operacz, A.M. Agius, Z. Bata-Csörgő, J. Breuer, G. Girolomoni, G.E. Gross, S. Langan, R. Lapid-Gortzak, T.H. Lesser, U. Pleyer, J. Sellner, G.M. Verjans, P. Wutzler, C. Dressler, R. Erdmann, S. Rosumeck, A. Nast

PDF

http://onlinelibrary.wiley.com/doi/10.1111/jdv.13995/full

http://onlinelibrary.wiley.com/doi/10.1111/jdv.13995/epdf

June 28, 2017 at 8:51 am

Therapeutic Vaccine for Genital Herpes Simplex Virus-2 Infection: Findings From a Randomized Trial

J Infect Dis 2017 March  215 (6): 856-864.

EDITOR’S CHOICE

David I. Bernstein  Anna Wald  Terri Warren  Kenneth Fife  Stephen Tyring  Patricia Lee Nick Van Wagoner  Amalia Magaret  Jessica B. Flechtner  Sybil Tasker 

Background.

Genital herpes simplex virus type 2 (HSV-2) infection causes recurrent lesions and frequent viral shedding. GEN-003 is a candidate therapeutic vaccine containing HSV-2 gD2∆TMR and ICP4.2, and Matrix-M2 adjuvant.

Methods.

Persons with genital herpes were randomized into 3 dose cohorts to receive 3 intramuscular doses 21 days apart of 10 µg, 30 µg, or 100 µg of GEN-003, antigens without adjuvant, or placebo. Participants obtained genital swab specimens twice daily for HSV-2 detection and monitored genital lesions for 28-day periods at baseline and at intervals after the last dose.

Results.

One hundred and thirty-four persons received all 3 doses. Reactogenicity was associated with adjuvant but not with antigen dose or dose number. No serious adverse events were attributed to GEN-003. Compared with baseline, genital HSV-2 shedding rates immediately after dosing were reduced with GEN-003 (from 13.4% to 6.4% for 30 μg [P < .001] and from 15.0% to 10.3% for 100 µg [P < .001]). Lesion rates were also significantly (P < .01) reduced immediately following immunization with 30 µg or 100 µg of GEN-003. GEN-003 elicited increases in antigen binding, virus neutralizing antibody, and T-cell responses.

Conclusions.

GEN-003 had an acceptable safety profile and stimulated humoral and cellular immune responses. GEN-003 at doses of 30 µg and 100 µg reduced genital HSV shedding and lesion rates.

Clinical Trials Registration. NCT01667341 (funded by Genocea).

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/jid/215/6/10.1093_infdis_jix004/2/jix004.pdf?Expires=1497965455&Signature=LauwpzltUYdtPj-H4tzcv2QzeU0yI3QyDcTqjGRLhjT~-XCUpAxn5BbzFiTp0ULZNyAvV-WM1DB1W0yaAhUFMS-IBk9m5ZwRyCmL~4xJE2-Lv2rP3ulYPSwj7pBBulLdtF8uAioy6Ux3qfPWSaVsQuvODlSK-jCGvf3xNmq28536uP8sr3mUO12YEXNss8BjjdigOEPGWz8rNL64V5vYHXgBmfSvLArPryGPTLn3gNgPKqU8JHQVUJ~obkccGjIAOfn-XRd8KwzbzLHhlxj0lUZQvqLpNnJs-n~DMe8N9jY0WINI4-gehCrKkfzY3Y4mwZVXXqPioYdoLhIgqqrkAA__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

 

J Infect Dis. March 2017 15;215(6):844-846.             

EDITORIAL COMMENTARY – Vaccination to Reduce Reactivation of Herpes Simplex Virus Type 2.

Cohen JI1.

Author information

1 Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.

A protein vaccine containing two herpes simplex antigens with adjuvant in patients with recurrent genital herpes appeared to be safe and modestly reduced viral shedding and lesion number, but the effect duration is uncertain.

abstract

https://academic.oup.com/jid/article-lookup/doi/10.1093/infdis/jix006

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/jid/215/6/10.1093_infdis_jix006/2/jix006.pdf?Expires=1497965228&Signature=gwESX5NV2RD2GozSjrMAEFaEYaf3vIjFRiQC2XG8jcqqlijr94CfhTm7efRIQ9I69d77L2-XHMHtpU~1jBDeIib3jVulLhT71~HytY0YIP2Ya4ltHmgyxOiMw5ZJUmnaZUt1P-GXnnPetSISsZQSRAYNtyUqhxd0tBy5ss0sjeGprnnukP13Ea-YA7b~svo3w5gBf4bR8hb5R0Xa7EYbBwbxP1OejrExMz3USyJr2EHFs2igtcWng2HUNtVzwpGIC33SVRgu8EuC31S8afvMRtihFmhZch3iAWEYDtaYoRoAZoMa0BUhMceRIbkk993QeQpz8wioDFuxS7dbZW1GMQ__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

June 19, 2017 at 8:37 am

Association of C-Reactive Protein With Bacterial and Respiratory Syncytial Virus–Associated Pneumonia Among Children Aged <5 Years in the PERCH Study

Clinical Infectious Diseases June 15, 2017 V.64 Suppl.3

Melissa M. Higdon; Tham Le; Katherine L. O’Brien; David R. Murdoch; Christine Prosperi …

Background.

Lack of a gold standard for identifying bacterial and viral etiologies of pneumonia has limited evaluation of C-reactive protein (CRP) for identifying bacterial pneumonia. We evaluated the sensitivity and specificity of CRP for identifying bacterial vs respiratory syncytial virus (RSV) pneumonia in the Pneumonia Etiology Research for Child Health (PERCH) multicenter case-control study.

Methods.

We measured serum CRP levels in cases with World Health Organization–defined severe or very severe pneumonia and a subset of community controls. We evaluated the sensitivity and specificity of elevated CRP for “confirmed” bacterial pneumonia (positive blood culture or positive lung aspirate or pleural fluid culture or polymerase chain reaction [PCR]) compared to “RSV pneumonia” (nasopharyngeal/oropharyngeal or induced sputum PCR-positive without confirmed/suspected bacterial pneumonia). Receiver operating characteristic (ROC) curves were constructed to assess the performance of elevated CRP in distinguishing these cases.

Results.

Among 601 human immunodeficiency virus (HIV)–negative tested controls, 3% had CRP ≥40 mg/L. Among 119 HIV-negative cases with confirmed bacterial pneumonia, 77% had CRP ≥40 mg/L compared with 17% of 556 RSV pneumonia cases. The ROC analysis produced an area under the curve of 0.87, indicating very good discrimination; a cut-point of 37.1 mg/L best discriminated confirmed bacterial pneumonia (sensitivity 77%) from RSV pneumonia (specificity 82%). CRP ≥100 mg/L substantially improved specificity over CRP ≥40 mg/L, though at a loss to sensitivity.

Conclusions.

Elevated CRP was positively associated with confirmed bacterial pneumonia and negatively associated with RSV pneumonia in PERCH. CRP may be useful for distinguishing bacterial from RSV-associated pneumonia, although its role in discriminating against other respiratory viral-associated pneumonia needs further study.

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/cid/64/suppl_3/10.1093_cid_cix150/5/cix150.pdf?Expires=1496600619&Signature=J-F12EhgW1VPcJBiMXUloqEyKztq55IWP9lyY5Ylf0jYA-wG22zby6L58chlh~Uq0QKTh-NTKX2beC2Lvq46k0MRGTIG0wad4Uy6d5HZzmGR4H3Z1uQXvjTi2NBDiVyHpn-LCGwhtw~43M9h4iFVaBOF9DsViCqj35VUXS1i3rQvACHDhEjxqOoV4mgXABjg3MG5vMhQoyEGhtfIQ16sqUZD8pXDifQ~TyrfhXcUaausfjrxM~QJXukFT3o26R8QW-iJhg4Ksabk0xlwgCWEttZM~G3PB8rkq3vJ2SsjXA7zbx1p-4yaoLaOx7BH7Ct4HyEyJAQ2pUDe~FxLSZxqpQ__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

June 3, 2017 at 2:37 pm

The Effect of Antibiotic Exposure and Specimen Volume on the Detection of Bacterial Pathogens in Children With Pneumonia

Clinical Infectious Diseases June 15, 2017 V.64 Suppl.3

Amanda J. Driscoll; Maria Deloria Knoll; Laura L. Hammitt; Henry C. Baggett; W. Abdullah Brooks …

Background.

Antibiotic exposure and specimen volume are known to affect pathogen detection by culture. Here we assess their effects on bacterial pathogen detection by both culture and polymerase chain reaction (PCR) in children.

Methods.

PERCH (Pneumonia Etiology Research for Child Health) is a case-control study of pneumonia in children aged 1–59 months investigating pathogens in blood, nasopharyngeal/oropharyngeal (NP/OP) swabs, and induced sputum by culture and PCR. Antibiotic exposure was ascertained by serum bioassay, and for cases, by a record of antibiotic treatment prior to specimen collection. Inoculated blood culture bottles were weighed to estimate volume.

Results.

Antibiotic exposure ranged by specimen type from 43.5% to 81.7% in 4223 cases and was detected in 2.3% of 4863 controls. Antibiotics were associated with a 45% reduction in blood culture yield and approximately 20% reduction in yield from induced sputum culture. Reduction in yield of Streptococcus pneumoniae from NP culture was approximately 30% in cases and approximately 32% in controls. Several bacteria had significant but marginal reductions (by 5%–7%) in detection by PCR in NP/OP swabs from both cases and controls, with the exception of S. pneumoniae in exposed controls, which was detected 25% less frequently compared to nonexposed controls. Bacterial detection in induced sputum by PCR decreased 7% for exposed compared to nonexposed cases. For every additional 1 mL of blood culture specimen collected, microbial yield increased 0.51% (95% confidence interval, 0.47%–0.54%), from 2% when volume was ≤1 mL to approximately 6% for ≥3 mL.

Conclusions.

Antibiotic exposure and blood culture volume affect detection of bacterial pathogens in children with pneumonia and should be accounted for in studies of etiology and in clinical management.

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/cid/64/suppl_3/10.1093_cid_cix101/5/cix101.pdf?Expires=1496600569&Signature=aOWswaw-KQP9GmchsNT27D3OWrCqzN07J3C~l7QMQ2Vy0VPt6N5KmMJpgTrICHv3bXwe380vfIZIOYqv9ujmXEZurmlruqBYCrMS1XfKI8MtPO7lCGi0Pegavg4nHUEpYh0S1~I4syu3Lrc6nRSxNZEzGt8y~ZJ0Zd6GZjq85iQAyQUgfjGQaHhXuRhY43tb2VzPmJBLlULM82perxJyiYjcwC7w1kBIc5zB5nBygidpPqRvDafC7FXkQ0frTyNisztRB4bevYivo6rA2OBKBKJTdfKQsSxqdnE65zfzW-26DcQ-njQuYnZQLAbh4E3ASwizBLU9n87K4aTf0sHp0g__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

June 3, 2017 at 2:36 pm

Evaluation of Pneumococcal Load in Blood by Polymerase Chain Reaction for the Diagnosis of Pneumococcal Pneumonia in Young Children in the PERCH Study

Clinical Infectious Diseases June 15, 2017 V.64 Suppl.3

Maria Deloria Knoll; Susan C. Morpeth; J. Anthony G. Scott; Nora L. Watson; Daniel E. Park …

Background.

Detection of pneumococcus by lytA polymerase chain reaction (PCR) in blood had poor diagnostic accuracy for diagnosing pneumococcal pneumonia in children in 9 African and Asian sites. We assessed the value of blood lytA quantification in diagnosing pneumococcal pneumonia.

Methods.

The Pneumonia Etiology Research for Child Health (PERCH) case-control study tested whole blood by PCR for pneumococcus in children aged 1–59 months hospitalized with signs of pneumonia and in age–frequency matched community controls. The distribution of load among PCR-positive participants was compared between microbiologically confirmed pneumococcal pneumonia (MCPP) cases, cases confirmed for nonpneumococcal pathogens, nonconfirmed cases, and controls. Receiver operating characteristic analyses determined the “optimal threshold” that distinguished MCPP cases from controls.

Results.

Load was available for 290 of 291 cases with pneumococcal PCR detected in blood and 273 of 273 controls. Load was higher in MCPP cases than controls (median, 4.0 × 103 vs 0.19 × 103 copies/mL), but overlapped substantially (range, 0.16–989.9 × 103 copies/mL and 0.01–551.9 × 103 copies/mL, respectively). The proportion with high load (≥2.2 log10 copies/mL) was 62.5% among MCPP cases, 4.3% among nonconfirmed cases, 9.3% among cases confirmed for a nonpneumococcal pathogen, and 3.1% among controls. Pneumococcal load in blood was not associated with respiratory tract illness in controls (P = .32). High blood pneumococcal load was associated with alveolar consolidation on chest radiograph in nonconfirmed cases, and with high (>6.9 log10 copies/mL) nasopharyngeal/oropharyngeal load and C-reactive protein ≥40 mg/L (both P < .01) in nonconfirmed cases but not controls.

Conclusions.

Quantitative pneumococcal PCR in blood has limited diagnostic utility for identifying pneumococcal pneumonia in individual children, but may be informative in epidemiological studies.

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/cid/64/suppl_3/10.1093_cid_cix149/5/cix149.pdf?Expires=1496600525&Signature=YoMwAhFxM-t1vAzY3Cegk3tKWXdT08tlntMUZzZt73kKwbkC3XIUEtcir9o5j8cPyScAJF9K2Qmkvq50-xiEUi-a2MrL9UgyVwRZ-fmlKt85PKdAG49OZCaoxRhqcXrC9PSNILrR2wWxRM9Q2MI9FUC5cdpPWe6dX7kajSYQ5-37uvrtNUisLhoLiotMpTJPrlBygr7xropYVwLIoZuryz1kBLUl7w-74lzW0YiOvh-FIURTx~2eRZG6p-0Smplw~glRvXyEkVZR~SBScq1EZznkDh-PsA5a1wY7aCb1lPCdqIKA3BPvkBvwdnTHk3niPfJsiwJi54GZhjOVB4MeeQ__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

 

June 3, 2017 at 2:35 pm

Detection of Pneumococcal DNA in Blood by Polymerase Chain Reaction for Diagnosing Pneumococcal Pneumonia in Young Children From Low- and Middle-Income Countries

Clinical Infectious Diseases June 15, 2017 V.64 Suppl.3

Susan C. Morpeth; Maria Deloria Knoll; J. Anthony G. Scott; Daniel E. Park; Nora L. Watson …

Background.

We investigated the performance of polymerase chain reaction (PCR) on blood in the diagnosis of pneumococcal pneumonia among children from 7 low- and middle-income countries.

Methods.

We tested blood by PCR for the pneumococcal autolysin gene in children aged 1–59 months in the Pneumonia Etiology Research for Child Health (PERCH) study. Children had World Health Organization–defined severe or very severe pneumonia or were age-frequency–matched community controls. Additionally, we tested blood from general pediatric admissions in Kilifi, Kenya, a PERCH site. The proportion PCR-positive was compared among cases with microbiologically confirmed pneumococcal pneumonia (MCPP), cases without a confirmed bacterial infection (nonconfirmed), cases confirmed for nonpneumococcal bacteria, and controls.

Results.

In PERCH, 7.3% (n = 291/3995) of cases and 5.5% (n = 273/4987) of controls were blood pneumococcal PCR-positive (P < .001), compared with 64.3% (n = 36/56) of MCPP cases and 6.3% (n = 243/3832) of nonconfirmed cases (P < .001). Blood pneumococcal PCR positivity was higher in children from the 5 African countries (5.5%–11.5% among cases and 5.3%–10.2% among controls) than from the 2 Asian countries (1.3% and 1.0% among cases and 0.8% and 0.8% among controls). Among Kilifi general pediatric admissions, 3.9% (n = 274/6968) were PCR-positive, including 61.7% (n = 37/60) of those with positive blood cultures for pneumococcus.

Discussion.

The utility of pneumococcal PCR on blood for diagnosing childhood pneumococcal pneumonia in the 7 low- and middle-income countries studied is limited by poor specificity and by poor sensitivity among MCPP cases.

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/cid/64/suppl_3/10.1093_cid_cix145/5/cix145.pdf?Expires=1496600478&Signature=TNpXh2rrpOUtXMV7vsv4frCtK75Ap7lauZDbBnElIBS6ElvxJFq3DdxWldAKmJTypCsAiZuzf7l2bxXbwZBufHonvRO7o9v7fMskKZR9E0GjuTXzyECdyZleAg0zt~fjOYSAkSKMJO50B0Y4qTdmp0cS-PzluJ~AMW0YklgNO-oR391lFhBqibSWoQ~koASa1GY6q~8pmQSCqJ9e86iAWRqtC0KEklh3hDbc6hbR-Jci8BOC7D0J577FNG-U3qYGr8eJfZKJIme9VegnSUaNZC-WTMRfW6FPcjYo51-3E~BDJfCOZ0M6yyNZS8DIVCjs4o1nc3bfPTZIMxX4sxreDQ__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

 

June 3, 2017 at 2:34 pm

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