Posts filed under ‘REPORTS’

A patient-level pooled analysis of treatment-shortening regimens for drug-susceptible pulmonary tuberculosis

Nature Medicine November 5, 2018

Marjorie Z. Imperial, Payam Nahid, Patrick P. J. Phillips, Geraint R. Davies, Katherine Fielding, Debra Hanna, David Hermann, Robert S. Wallis, John L. Johnson, Christian Lienhardt & Rada M. Savic

Tuberculosis kills more people than any other infectious disease. Three pivotal trials testing 4-month regimens failed to meet non-inferiority margins; however, approximately four-fifths of participants were cured.

Through a pooled analysis of patient-level data with external validation, we identify populations eligible for 4-month treatment, define phenotypes that are hard to treat and evaluate the impact of adherence and dosing strategy on outcomes.

In 3,405 participants included in analyses, baseline smear grade of 3+ relative to <2+, HIV seropositivity and adherence of ≤90% were significant risk factors for unfavorable outcome.

Four-month regimens were non-inferior in participants with minimal disease defined by <2+ sputum smear grade or non-cavitary disease. A hard-to-treat phenotype, defined by high smear grades and cavitation, may require durations >6 months to cure all.

Regimen duration can be selected in order to improve outcomes, providing a stratified medicine approach as an alternative to the ‘one-size-fits-all’ treatment currently used worldwide…

FULL TEXT

https://www.nature.com/articles/s41591-018-0224-2

PDF

https://www.nature.com/articles/s41591-018-0224-2.pdf

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November 14, 2018 at 8:31 am

Ecological Analyses of Mycobacteria in Showerhead Biofilms and Their Relevance to Human Health

mBio 2018 September/October 2018 V.9 N.5 P.e01614-18

Matthew J. Gebert, Manuel Delgado-Baquerizo, Angela M. Oliverio, Tara M. Webster, Lauren M. Nichols, Jennifer R. Honda, Edward D. Chan, Jennifer Adjemian, Robert R. Dunn, Noah Fierer

Bacteria within the genus Mycobacterium can be abundant in showerheads, and the inhalation of aerosolized mycobacteria while showering has been implicated as a mode of transmission in nontuberculous mycobacterial (NTM) lung infections.

Despite their importance, the diversity, distributions, and environmental predictors of showerhead-associated mycobacteria remain largely unresolved.

To address these knowledge gaps, we worked with citizen scientists to collect showerhead biofilm samples and associated water chemistry data from 656 households located across the United States and Europe.

Our cultivation-independent analyses revealed that the genus Mycobacterium was consistently the most abundant genus of bacteria detected in residential showerheads, and yet mycobacterial diversity and abundances were highly variable.

Mycobacteria were far more abundant, on average, in showerheads receiving municipal water than in those receiving well water and in U.S. households than in European households, patterns that are likely driven by differences in the use of chlorine disinfectants.

Moreover, we found that water source, water chemistry, and household location also influenced the prevalence of specific mycobacterial lineages detected in showerheads.

We identified geographic regions within the United States where showerheads have particularly high abundances of potentially pathogenic lineages of mycobacteria, and these “hot spots” generally overlapped those regions where NTM lung disease is most prevalent. Together, these results emphasize the public health relevance of mycobacteria in showerhead biofilms.

They further demonstrate that mycobacterial distributions in showerhead biofilms are often predictable from household location and water chemistry, knowledge that advances our understanding of NTM transmission dynamics and the development of strategies to reduce exposures to these emerging pathogens.

FULL TEXT

https://mbio.asm.org/content/9/5/e01614-18

PDF

https://mbio.asm.org/content/mbio/9/5/e01614-18.full.pdf

November 9, 2018 at 8:14 am

Identification of Epstein-Barr Virus in the Human Placenta and Its Pathologic Characteristics.

J Korean Med Sci. December 2017 V.32 N.12 P.1959-1966.   

Kim Y1,2, Kim HS3, Park JS3, Kim CJ4, Kim WH5.

1 Department of Pathology, Seoul National University College of Medicine, Seoul, Korea.

2 Laboratory of Epigenetics, Cancer Research Institute, Seoul National University, Seoul, Korea.

3 Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.

4 Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

5 Department of Pathology, Seoul National University College of Medicine, Seoul, Korea. woohokim@snu.ac.kr

Abstract

Epstein-Barr virus (EBV), a common pathogen in humans, is suspected as the cause of multiple pregnancy-related pathologies including depression, preeclampsia, and stillbirth. Moreover, transmission of EBV through the placenta has been reported. However, the focus of EBV infection within the placenta has remained unknown to date. In this study, we proved the expression of latent EBV genes in the endometrial glandular epithelial cells of the placenta and investigated the cytological characteristics of these cells. Sixty-eight placentas were obtained from pregnant women. Tissue microarray was constructed. EBV latent genes including EBV-encoding RNA-1 (EBER1), Epstein-Barr virus nuclear antigen 1 (EBNA1), late membrane antigen (LMP1), and RPMS1 were detected with silver in situ hybridization and/or mRNA in situ hybridization. Nuclear features of EBV-positive cells in EBV-infected placenta were compared with those of EBV-negative cells via image analysis. Sixteen placentas (23.5%) showed positive expression of all 4 EBV latent genes; only the glandular epithelial cells of the decidua showed EBV gene expression. EBV infection status was not significantly correlated with maternal, fetal, or placental factors. The nuclei of EBV-positive cells were significantly larger, longer, and round-shaped than those of EBV-negative cells regardless of EBV-infection status of the placenta. For the first time, evidence of EBV gene expression has been shown in placental tissues. Furthermore, we have characterized its cytological features, allowing screening of EBV infection through microscopic examination.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5680494/pdf/jkms-32-1959.pdf

November 9, 2018 at 7:06 am

Epstein-Barr Virus-Induced Mononucleosis as an Imitator of Severe Preeclampsia.

AJP Rep. January 2017 V.7 N.1 P.e5-e7.

Staley SA1, Smid MC2, Dotters-Katz SK2, Stringer EM2.

1 Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.

2 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.

Abstract

Background In pregnancy, conditions presenting with hematologic abnormalities, transaminitis, and proteinuria pose diagnostic challenges in pregnancy. Case We present the case of an 18-year-old woman, G1P0, at 33 weeks’ gestation with fever of unknown cause, who developed progressively elevated liver enzymes, proteinuria, and thrombocytopenia, due to Epstein-Barr virus (EBV) infection. Conclusion Acute infection with EBV should be included in the differential diagnosis of preeclampsia with severe features, particularly in the setting of fever. Supportive treatment and observation may prevent iatrogenic preterm birth.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5303016/pdf/10-1055-s-0036-1597265.pdf

November 9, 2018 at 7:05 am

Maternal depressive symptoms related to Epstein-Barr virus reactivation in late pregnancy.

Sci Rep. October 31, 2013 V.3 P.3096.

Zhu P1, Chen YJ, Hao JH, Ge JF, Huang K, Tao RX, Jiang XM, Tao FB.

1 1] Department of Maternal and Child Health, School of Public Health, Anhui Medical University, Hefei, China [2].

Abstract

We examined the relationship between maternal depressive symptoms in late pregnancy and Epstein-Barr virus reactivation before delivery. In this prospective observational study, prevalence of Epstein-Barr virus reactivation within one week before delivery was compared between 163 pregnant women with depressive symptoms at 33 to 34 weeks of gestation and a computer-generated control group of 163 pregnant healthy women without depressive symptoms. Depressive symptoms at 33 to 34 weeks of gestation were significantly related to the prevalence of Epstein-Barr virus reactivation before delivery after adjustment for potential confounders (adjusted OR = 2.74, 95%CI: 1.23-6.08). Compared to that in the control group, the prevalence of Epstein-Barr virus reactivation was higher in women with depressive symptoms accompanied by higher negative coping (24.2% compared with 7.9%; adjusted OR = 3.67, 95%CI: 1.47-9.16). Maternal depressive symptoms in late pregnancy are associated with Epstein-Barr virus reactivation, and this association could be moderated by maternal coping style.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3813936/pdf/srep03096.pdf

November 9, 2018 at 7:04 am

Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis

LANCET Infectious Diseases November 5, 2018

Background

Infections due to antibiotic-resistant bacteria are threatening modern health care. However, estimating their incidence, complications, and attributable mortality is challenging. We aimed to estimate the burden of infections caused by antibiotic-resistant bacteria of public health concern in countries of the EU and European Economic Area (EEA) in 2015, measured in number of cases, attributable deaths, and disability-adjusted life-years (DALYs).

Methods

We estimated the incidence of infections with 16 antibiotic resistance–bacterium combinations from European Antimicrobial Resistance Surveillance Network (EARS-Net) 2015 data that was country-corrected for population coverage. We multiplied the number of bloodstream infections (BSIs) by a conversion factor derived from the European Centre for Disease Prevention and Control point prevalence survey of health-care-associated infections in European acute care hospitals in 2011–12 to estimate the number of non-BSIs. We developed disease outcome models for five types of infection on the basis of systematic reviews of the literature.

Findings

From EARS-Net data collected between Jan 1, 2015, and Dec 31, 2015, we estimated 671 689 (95% uncertainty interval [UI] 583 148–763 966) infections with antibiotic-resistant bacteria, of which 63·5% (426 277 of 671 689) were associated with health care. These infections accounted for an estimated 33 110 (28 480–38 430) attributable deaths and 874 541 (768 837–989 068) DALYs. The burden for the EU and EEA was highest in infants (aged <1 year) and people aged 65 years or older, had increased since 2007, and was highest in Italy and Greece.

Interpretation

Our results present the health burden of five types of infection with antibiotic-resistant bacteria expressed, for the first time, in DALYs. The estimated burden of infections with antibiotic-resistant bacteria in the EU and EEA is substantial compared with that of other infectious diseases, and has increased since 2007. Our burden estimates provide useful information for public health decision-makers prioritising interventions for infectious diseases.

Funding

European Centre for Disease Prevention and Control.

FULL TEXT

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30605-4/fulltext

PDF

https://www.thelancet.com/action/showPdf?pii=S1473-3099%2818%2930605-4

November 7, 2018 at 8:38 am

Being PrEPared  – Preexposure Prophylaxis and HIV Disparities.

N Engl J of Med October 4, 2018 V.379 P.1293-1295

Perspective

Robert H. Goldstein, M.D., Ph.D., Carl G. Streed, Jr., M.D., and Sean R. Cahill, Ph.D.

If current trends persist, one in six U.S. men who have sex with men will be infected with human immunodeficiency virus (HIV) in their lifetime, according to the Centers for Disease Control and Prevention (CDC).1 This prediction highlights the long road ahead if we are to end the spread of HIV in the United States, but it does not tell the full story, which is complicated and nuanced….

FULL TEXT

https://www.nejm.org/doi/full/10.1056/NEJMp1804306?query=infectious-disease

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMp1804306

November 6, 2018 at 8:21 am

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