http://www.book4doc.com/42545 The Lancet ~ Infectious Diseases ~ Volume 9, Number 5, May 2009 pp330-265
Leading Edge
265
US supermarkets redefine antibiotic misuse
The Lancet Infectious Diseases
The discovery of penicillin in the early 20th century heralded an era of unprecedented advances in the fight against infectious disease. Bacterial diseases that had once sounded the death knell for many millions of people became treatable, and a period of discovery from the 1930s to the 1970s saw more agents become available to treat more effectively an ever growing number of diseases. However, the well-documented development of resistance began to undermine the great progress made in the battle against bacterial infection.
Reflection and Reaction
266
H5N1 influenza vaccination policy in Japan
Michiaki Masuda, Shigeo Sugita, Kazumichi Kuroda, Hidekazu Nishimura
Vaccine preparedness and the timely use of stockpiled vaccines are important issues for tackling pandemic influenza.1 In Japan, based on the government’s Pandemic Influenza Preparedness Action Plan (PIPAP),2 the National Institute of Infectious Diseases, affiliated with the Ministry of Health, Labour and Welfare (MHLW), took the initiative to develop H5N1 vaccines in collaboration with domestic manufacturers. Consequently, production of H5N1 inactivated whole-virion vaccine containing aluminium hydroxide gel adjuvant was approved in October, 2007, for two Japanese manufacturers.
267
Poor-quality medicines in developing countries
Raffaella M Ravinetto, Sandrine Cloz, Sophie-Marie Scouflaire-Mallet, Daniel Vandenbergh
We welcome the attention given to the serious public-health problem represented by the spread of poor-quality medicines in developing countries, and we would like to comment on some points expressed in the recent Newsdesk feature by Kathryn Senior1 on the global health-care implications of substandard medicines.
268
Not so SMART?
Justin Stebbing, Angus Dalgleish
There are a number of issues with the published data from the SMART study1 and a recently published follow-on paper by Kuller and colleagues2 that merit further scrutiny. Kuller and colleagues detailed information about excess mortality in US patients in the SMART study that have not been previously reported, nor fully discussed. While these data have led to concern amongst physicians and patients alike, notably outside of the USA, we feel this is unnecessary.
269
Funding of drugs: do vaccines warrant a different approach?
Andrew S Mitchell, David Isaacs, Jim Buttery, Rosalie Viney
Philippe Beutels and colleagues1 argue against standard cost-effectiveness methods to assess vaccines, and advocate a different approach allowing special features to be considered such as herd immunity, indirect costs, and alternative discounting techniques. We argue that this differential approach for vaccines will lead to increased prices for vaccines without a sufficient basis to warrant this greater cost.
270
Funding of drugs: do vaccines warrant a different approach? Authors’ reply
Philippe Beutels, Paul A Scuffham, C Raina MacIntyre
Andrew Mitchell and colleagues misinterpret our viewpoint,1 since they emphasise that the cost-effectiveness of drugs other than vaccines can also be sensitive to the methodological problems we discussed. Indeed, that is what we wrote. However, we argue that the sensitive features we outlined apply more frequently and more widely to vaccines than any other group of drugs. If guidelines were revised as we suggest they would still need to be applied to all drugs, not only vaccines.
Cross-talk
272
The hazards of pet ownership
Bernard Dixon
Investigators of puzzling infections may have to quiz their patients about several potentially relevant matters: from recent travels and food consumed, to ual encounters and occupational exposures. A recent case suggests that they might usefully include hobbies too, especially when dealing with pet owners.
Newsdesk
273
Buruli ulcer: dare we continue to ignore it?
Efforts to raise awareness of Buruli ulcer and its devastating impact on teenagers in west Africa continued last month with the Second International Conference on Buruli ulcer in Cotonou, Benin (March 30 to April 3, 2009). Benin, Ghana, and Cote d’Ivoire bear the brunt of the estimated 10 000 cases of Buruli ulcer that occur each year and consider the disease an important public health problem. The number of official cases is probably a gross underestimation due to patients not presenting to a clinic, lack of awareness of Buruli ulcer by health-care providers, and inadequate resources for laboratory diagnostic confirmation, Douglas Walsh of the US Army Medical Research Unit in Kenya told TLID.
274
Mobile phones connecting efforts to tackle infectious disease
Kelly Morris
With 22 billion mobile phones in developing countries, mobile technology can be used to detect and respond to disease outbreaks and improve public health and health care. Now, the mobile health (mHealth) Alliancea partnership between the Rockefeller Foundation, the UN Foundation, and the Vodafone Foundationis beginning to connect individuals, projects, and national and international agencies, to make the most of mHealth.
275
Positive deviantsrole models for MRSA control
Kelly Morris
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An approach to social and behavioural change positive deviance (PD)has been linked with improved control of meticillin-resistant Staphylococcus aureus (MRSA) in a US multicentre study. Reports of successful multicentre interventions to reduce the problems of endemic antimicrobial-resistance among US hospitals are rare, says John Jernigan, part of the US Centers for Disease Control and Prevention (Atlanta, GA, USA) team that did the analysis.
275
Infectious diseases surveillance update
Sally Hargreaves
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Washington, DC, is facing a generalised and severe epidemic of HIV/AIDS, according to a new report released by the city’s Department of Health. Data show a 3% prevalence rate of HIV among residents in the district (a total of 15 120 people living with HIV/AIDS) and rates have risen in the past 2 years, representing a 22% increase. Raymond Martins (Whitman-Walker clinic) told reporters: the prevalence is probably nearer 5%, but lots of people haven’t been tested yet. Among all HIV/AIDS cases in the district 717% are men and 763% reported their ethnicity as black, with the highest rates of HIV among residents aged 4049 years.
276
Time to end our neglect of liver flukes
Kathryn Senior
Clonorchis sinensis, one of the species of liver fluke that causes human infection has just been upgraded to a grade 1 carcinogen by WHO and the International Agency for Research on Cancer. It joins another liver fluke, Opisthorchis viverrini, which was given this classification in 1994. Infection with either pathogen is strongly associated with cholangiocarcinoma, the primary liver cancer that arises from biliary epithelial cells. Rates of cholangiocarcinoma in regions where liver flukes are endemic are unprecedented: it is responsible for about 865% of cancers in Thailand’s Khon Kaen region, the highest occurrence of liver cancer anywhere in the world, confirmed Banchob Sripa ( Liver Fluke and Cholangiocarcinoma Research Center, Khon Kaen University, Thailand).
277
Ongoing neglect of leishmaniasis
Talha Burki
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The expulsion of aid agencies from north Sudan by the Sudanese government will seriously hamper efforts to tackle visceral leishmaniasis, warn experts. The disease, also known as kala-azar, affects more than 20 000 people in Sudan; treatment programmes are largely funded by organisations such as Mdecins Sans Frontires (MSF). We were on the verge of starting a new kala-azar intervention in eastern Sudan, explains Koert Ritmeijer (MSF, Amsterdam, Netherlands), and this has had to be shelved.
278
Gene studies shed light on rhinovirus diversity
David M Lawrence
Two new analyses of the human rhinovirus (HRV) genome, published in the past month, shed light on the variability among viruses that cause the common cold, and offer hope of a better understanding of the diversity in pathogenicity among different strains and guidance toward developing improved treatments for colds. The results of the studies suggest that the odds of finding a common treatment or vaccine are remote, but the research paves way for development of treatments or vaccines for individual groups of closely related serotypes.
279
Research brief
Jane Bradbury
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Viral synapsescell to cell adhesions between immune cellsgreatly enhance the spread of HIV, but the underlying mechanism of viral transfer is unclear. Now, researchers have used a fluorescently labelled HIV clone and quantitative three-dimensional video microscopy to track HIV transfer between cells. They show that micrometre-sized buttons that contain oligomerised viral Gag protein and budding viral crescents rapidly form at the virological synapses between uninfected and infected T cells. Other experiments show that infection occurs preferentially through the synapses.
Media Watch
280
Neglected people and a neglected disease
Talha Burki
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Kala-azar: Inside Poverty(Ethiopia), WHO 2009, 33 min
Errata
280
Erratum
Mengoli C, Cruciani M, Barnes RA, Loeffler J, Donnelly JP. Use of PCR for diagnosis of invasive aspergillosis: systematic review and meta-analysis. Lancet Infect Dis 2009; 9: 8996The Results section of this Review (February 2009) contained an error in table 1 on p 91. The data by Florent et al (2006) cited in line 14 of table 1 should read 167 not 87 resulting in a prevalence of 197% and not 379%.
Review
281
Gram-positive toxic shock syndromes
Emma Lappin, Andrew J Ferguson
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Toxic shock syndrome (TSS) is an acute, multi-system, toxin-mediated illness, often resulting in multi-organ failure. It represents the most fulminant expression of a spectrum of diseases caused by toxin-producing strains of Staphylococcus aureus and Streptococcus pyogenes (group A streptococcus). The importance of Gram-positive organisms as pathogens is increasing, and TSS is likely to be underdiagnosed in patients with staphylococcal or group A streptococcal infection who present with shock. TSS results from the ability of bacterial toxins to act as superantigens, stimulating immune-cell expansion and rampant cytokine expression in a manner that bypasses normal MHC-restricted antigen processing.
291
Incubation periods of acute respiratory viral infections: a systematic review
Justin Lessler, Nicholas G Reich, Ron Brookmeyer, Trish M Perl, Kenrad E Nelson, Derek AT Cummings
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Knowledge of the incubation period is essential in the investigation and control of infectious disease, but statements of incubation period are often poorly referenced, inconsistent, or based on limited data. In a systematic review of the literature on nine respiratory viral infections of public-health importance, we identified 436 articles with statements of incubation period and 38 with data for pooled analysis. We fitted a log-normal distribution to pooled data and found the median incubation period to be 56 days (95% CI 4863) for adenovirus, 32 days (95% CI 2837) for human coronavirus, 40 days (95% CI 3644) for severe acute respiratory syndrome coronavirus, 14 days (95% CI 1315) for influenza A, 06 days (95% CI 0506) for influenza B, 125 days (95% CI 118133) for measles, 26 days (95% CI 2131) for parainfluenza, 44 days (95% CI 3949) for respiratory syncytial virus, and 19 days (95% CI 1424) for rhinovirus.
301
Infection control in the management of highly pathogenic infectious diseases: consensus of the European Network of Infectious Disease
Philippe Brouqui, Vincenzo Puro, Francesco M Fusco, Barbara Bannister, Stephan Schilling, Per Follin, Ren Gottschalk, Robert Hemmer, Helena C Maltezou, Kristi Ott, Renaat Peleman, Christian Perronne, Gerard Sheehan, Heli Siikamäki, Peter Skinhoj, Giuseppe Ippolito, for the EUNID Working Group
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The European Network for Infectious Diseases (EUNID) is a network of clinicians, public health epidemiologists, microbiologists, infection control, and critical-care doctors from the European member states, who are experienced in the management of patients with highly infectious diseases. We aim to develop a consensus recommendation for infection control during clinical management and invasive procedures in such patients. After an extensive literature review, draft recommendations were amended jointly by 27 partners from 15 European countries.
Problem Pathogens
312
Stenotrophomonas maltophilia: an emerging opportunist human pathogen
W John Looney, Masashi Narita, Kathrin Mhlemann
Stenotrophomonas maltophilia has emerged as an important opportunistic pathogen in the debilitated host. S maltophilia is not an inherently virulent pathogen, but its ability to colonise respiratory-tract epithelial cells and surfaces of medical devices makes it a ready coloniser of hospitalised patients. S maltophilia can cause blood-stream infections and pneumonia with considerable morbidity in immunosuppressed patients. Management of infection is hampered by high-level intrinsic resistance to many antibiotic classes and the increasing occurrence of acquired resistance to the first-line drug co-trimoxazole.
Grand Round
324
Chagasic encephalitis in HIV patients: common presentation of an evolving epidemiological and clinical association
Carlos A DiazGranados, Carlos H Saavedra-Trujillo, Monica Mantilla, Sandra L Valderrama, Carlos Alquichire, Carlos Franco-Paredes
We present a case of chagasic meningoencephalitis reactivation in an HIV-infected woman with advanced immunosuppression. Prolonged survival was attained with antiparasitic therapy and secondary prophylaxis, in conjunction with the use of highly-active antiretroviral therapy. The geographic expansion of the HIV epidemic around the world coupled with global migration and international travel have created a favourable situation for Trypanosoma cruzi and HIV coinfection. The clinical manifestations of Chagas disease in HIV-positive people usually represent reactivation and not acute infection with T cruzi (coinfection).
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