Current Infectious Disease Reports (Curr Infect Dis Rep)

Publications in this journal

• Article: Potential Roles for Infectious Agents in the Pathophysiology of Primary Biliary Cirrhosis: What's New?

  Daniel S Smyk, Eirini I Rigopoulou, Dimitrios P Bogdanos
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  ABSTRACT: Primary biliary cirrhosis (PBC) is a progressive cholestatic liver disease serologically characterized by the presence of high-titer antimitochondrial antibodies and, histologically by chronic nonsuppurative cholangitis and granulomata. The aetiology of the disease remains elusive, although genetic, epigenetic, environmental, and infectious factors have been considered important for the induction of the disease in genetically prone individuals. The disease shows a striking female predominance and becomes clinically overt at the fourth to sixth decade. These characteristics have prompted investigators to consider infections that predominate in women at these ages as the likely candidates for triggering the disease. Recurrent urinary tract infections due to Escherichia coli were the first infections to be considered pathogenetically relevant. Over the years, several other microorganisms have been linked to the pathogenesis of PBC owing to epidemiological, immunological, microbiological, or experimental findings in animal models. Recent studies have provided data supporting the pathogenic role of Novosphingobium aromaticivorans and betaretroviruses. Several reports have linked other organisms to the induction of the disease and/or the maintenance of the auto-aggressive responses that are perpetuated over the course of the disease. This review highlights the findings of the most recent studies investigating the link between infections and PBC. We also discuss the close interplay of the infectious agents with other environmental and genetic factors, which may explain the multifaceted nature of this puzzling disease.
  Current Infectious Disease Reports 11/2012;
• Article: The Role of Antibiotic Therapy in the Management of Acute Appendicitis.

  Roland E Andersson
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  ABSTRACT: Nonsurgical treatment with antibiotics has recently been proposed as the first line of treatment for noncomplicated appendicitis. This has met with considerable interest, illustrated by the number of reviews and meta-analyses, which exceed the number of original reports of the issue. The results in these studies are seriously biased due to inclusion of patients with resolving appendicitis. At a time when we need to reduce inappropriate use of antibiotics in the struggle against the increasing rate of antibiotics resistance, there must be strong requirements of a proven effect and an improved cost-benefit ratio before antibiotics treatment is introduced for a new group of patients. These requirements have not yet been met for nonsurgical treatment with antibiotics for assumed uncomplicated appendicitis. Due to the high rate of spontaneous resolution, a randomized placebo-controlled trial is needed that can compare the efficiency of antibiotics treatment and expectant management in this group of patients. Antibiotics treatment, however, remains indicated for treatment of perforated appendicitis with localized abscess or phlegmone and in selected surgical high-risk patients.
  Current Infectious Disease Reports 11/2012;
• Article: The Hispanic HIV Epidemic.

  Andrés F Henao-Martínez, José R Castillo-Mancilla
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  ABSTRACT: The Hispanic population in the U.S. has been dramatically affected by the HIV epidemic. The impact not only is related to the infection itself and its complications, but also is driven by social factors that lead to increased disparity in health-care access and cultural modeling and to increased social stigma, which leads to marginalization and exacerbates the existing gaps in medical care. Hispanics infected with HIV more frequently receive delayed diagnoses and more often present with AIDS, concomitant opportunistic infections, or coinfections related to their country of origin. The unique characteristics that define the HIV epidemic in Hispanics need further analysis in order to identify new opportunities to improve linkage to health care, increase efficacy in health-care provision, and decrease social disparities related to the Hispanic population.
  Current Infectious Disease Reports 11/2012;
• Article: HIV Drug Resistance and the Advent of Integrase Inhibitors.

  Peter K Quashie, Thibault Mesplède, Mark A Wainberg
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  ABSTRACT: This review focuses on the topic of HIV integrase inhibitors that are potent antiretroviral drugs that efficiently decrease viral load in patients. However, emergence of resistance mutations against this new class of drugs represents a threat to their long-term efficacy. Here, we provide new information about the most recent mutations identified and other mutations that confer resistance to several integrase inhibitors, such as new resistance mutations-for example, G118R, R263K, and S153Y-that have been identified through in vitro selection studies with second-generation integrase strand transfer inhibitors (INSTIs). These add to the three main resistance pathways involving mutations at positions Y143, N155, and Q148. Deep sequencing, structural modeling, and biochemical analyses are methods that currently help in the understanding of the mechanisms of resistance conferred by these mutations. Although the new resistance mutations appear to confer only low levels of cross-resistance to second-generation drugs, the Q148 pathway with numerous secondary mutations has the potential to significantly decrease susceptibility to all drugs of the INSTI family of compounds.
  Current Infectious Disease Reports 11/2012;
• Article: The Role of the Manipulation of the Gut Microbiota in Obesity.

  Matthieu Million, Didier Raoult
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  ABSTRACT: The manipulation of the gut microbiota by diet, antibiotics, or probiotics could promote, prevent, or reverse the development of specific diseases, including obesity. A link has been proposed between obesity and the growth promoters (probiotics and antibiotics) that have been used in animals for more than 40 years to induce weight gain. Several species of the Lactobacillus genus that are frequently used as probiotics for human consumption merit particular attention because they are increased in the gut microbiota under high-fat diets, are more abundant in obese humans, and are selected by growth-promoter antibiotics; moreover, the administration of these bacteria in experimental models is linked to the development of obesity. However, other species or strains of the same genus are associated with an antiobesity effect. Newborns and infants are a particularly susceptible population in which the administration of antibiotics or probiotics could be related to the development of obesity in adulthood.
  Current Infectious Disease Reports 11/2012;
• Article: Blood and Body Fluid Exposures in Health-Care Settings: Risk Reduction Practices and Postexposure Prophylaxis for Health-Care Workers.

  Inci Narin, Habip Gedik, Andreas Voss
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  ABSTRACT: This review of last year's literature on blood-borne pathogens (= pathogenic microorganisms that are found in human blood) focuses on hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) as the most common pathogens, despite the fact that other microorganisms may cause blood-borne diseases as well. Since the prevention of blood-borne diseases is something that, in the past, has gotten a lot of attention and by now is fully integrated in all safety structures in the U.S., the recent literatures mainly have been come from resource-limited/developing countries and Europe (which, in the definition of the financial word at the present time, in some parts overlap).
  Current Infectious Disease Reports 10/2012;
• Article: Donor-Derived Infection: Epidemiology and Outcomes.

  Daniel R Kaul
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  ABSTRACT: Over the past decade, the solid organ transplant community has focused increased attention on unexpected transmission of infectious pathogens from organ donor to recipient. While unexpected donor-derived infections are relatively uncommon, recent cases of transmission of human immunodeficiency virus (HIV) and hepatitis C to multiple recipients, as well as transmission of HIV from a living donor, have further increased interest in improving the safety of solid organ transplantation. This article will review the epidemiology and outcomes associated with unexpected donor-derived infection. Furthermore, the reporting and patient safety process will be discussed, as will preventative measures that can reduce the burden of donor-derived infection.
  Current Infectious Disease Reports 10/2012;
• Article: Emerging Invasive Fungal Diseases in Transplantation.

  Perrine Parize, Blandine Rammaert, Olivier Lortholary
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  ABSTRACT: Invasive fungal infections continue to be a major cause of morbidity and mortality in severely immunocompromised transplant patients. Although Candida spp. and Aspergillus spp. represent the majority of identified pathogens, other fungi have become increasingly prevalent among this patient population. Diagnosis and treatment of invasive fungal infections remain a challenge in transplant medicine despite recent major advances. In this review, we will emphasize emerging topics in invasive fungal infections in transplantations that occurred in 2011-2012. The current literature was reviewed to synthesize new trends in epidemiology, recent outbreaks, clinical findings, and advances in diagnostic and therapeutic resources.
  Current Infectious Disease Reports 10/2012;
• Article: Control of Drug-Resistant Pathogens in Endemic Settings: Contact Precautions, Controversies, and a Proposal for a Less Restrictive Alternative.

  Gonzalo Bearman, Michael P Stevens
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  ABSTRACT: Contact precautions are routinely employed for the control of multidrug-resistant organisms. Robust measures, however, for the incremental benefit of contact precautions, gowns, gloves, and active detection and isolation strategies for the prevention of cross-transmission in endemic settings are lacking. Unintended consequences and adverse effects from contact precautions, including patient dissatisfaction with care, depression, medication errors, and fewer provider visits, have been reported. Universal gloving strategies in lieu of contact precautions have produced mixed results and raise concerns about a decrease in hand hygiene by glove wearers. We suggest that the use of a sound, horizontal infection prevention strategy that widely and consistently implements infection prevention best practices may be a sufficient and least restrictive alternative strategy for the control of endemic multidrug-resistant pathogens.
  Current Infectious Disease Reports 10/2012;
• Article: Clostridium difficile: Changing Epidemiology, Treatment and Infection Prevention Measures.

  Jane A Cecil
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  ABSTRACT: Clostridium difficile was first reported as a cause of antibiotic-associated colitis in 1978. In more recent years we have witnessed disturbing trends associated with C. difficile infection (CDI). CDI has become more common, affecting populations previously considered at low risk, more severe with an associated increase in mortality, and more difficult to treat with some patients experiencing multiple relapses and a reduced responsiveness to previously effective antibiotics. These trends have been coincident with the emergence of a new hypervirulent strain responsible for several outbreaks in the last decade. Fortunately, we have also seen promising developments, particularly with regard to testing and treatment. This review discusses recent changes in the epidemiology of CDI and recent developments in the testing, treatment and prevention of CDI.
  Current Infectious Disease Reports 10/2012;
• Article: Cardiovascular management of septic shock in 2012.

  Maria Cristina Vazquez Guillamet, Chanu Rhee, Andrew J Patterson
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  ABSTRACT: Septic shock is a major cause of morbidity and mortality throughout the world. Source control, antimicrobial therapy, early goal-directed fluid resuscitation, and infusion of vasoactive pharmaceuticals remain the cornerstones of treatment. However, the cardiovascular management of septic shock is evolving. Basic science and clinical researchers have identified novel drug targets and are testing the efficacy of new therapeutic agents. For example, prevention of microvascular leak during septic shock is the focus of active investigations and may soon provide considerable benefit to patients. Among the important topics that will be discussed in this review are the following: the role of vascular endothelial dysfunction in microvascular leak, the impact of cytokines upon structural and functional proteins within the endothelial barrier and within the heart, and the ability of selective vasopressin 1a receptor agonists to minimize tissue edema and improve hemodynamic status.
  Current Infectious Disease Reports 10/2012; 14(5):493-502.
• Article: Emerging Parasitic Infections in Transplantation.

  Roberta Lattes, Laura Linares, Marcelo Radisic
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  ABSTRACT: This article concentrates on parasitic infections that are novel in solid organ transplantation for which there are meaningful data. It also addresses some issues that are either exceptional or a cause for new concern and where the evidence for a well-established recommendation is lacking.
  Current Infectious Disease Reports 09/2012;
• Article: Cytomegalovirus in Solid Organ Transplantation: Epidemiology, Prevention, and Treatment.

  Elena Beam, Raymund R Razonable
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  ABSTRACT: Cytomegalovirus (CMV) is one of the most important pathogens that infect solid organ transplant recipients. CMV is associated with increased morbidity and mortality in this population as a result of its numerous direct and indirect effects. Prevention strategies consist of preemptive therapy and antiviral prophylaxis, and the choice of which preventive approach to implement should be guided by advantages and drawbacks related to the population being managed. There are differences in the approaches to the laboratory diagnosis and treatment of CMV infection and disease depending on assay availability, clinical presentation, disease severity, and specific transplant populations. In this article, the authors aim to summarize recent publications and updates in the epidemiology, diagnosis, prevention, and treatment of CMV infection in solid organ transplant recipients during the past year, including a brief review of future directions in the field.
  Current Infectious Disease Reports 09/2012;
• Article: Tuberculosis in Transplantation: Diagnosis, Prevention, and Treatment.

  Sarah Kirsch, Martina Sester
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  ABSTRACT: Tuberculosis should always be taken into consideration as a possible infectious complication in transplant recipients. It is more frequent and fatal, and its diagnosis, prevention, and treatment are more challenging, in transplanted patients, as compared with the general population. Latent infection with M. tuberculosis is indirectly diagnosed by assessing the presence of a specific adaptive immune response, but depending on the assay used, the informative value of immunodiagnostic assays may be limited by the inhibitory action of immunosuppressive medication, and the positive predictive value for progression toward active tuberculosis is generally low. Diagnosis of active tuberculosis is challenging, since symptoms in immunocompromised patients are frequently less pronounced and atypical. Finally, treatment of tuberculosis is complicated by unpredictable drug interactions, drug-related organ toxicities, and development of drug resistance. This review provides an overview of the epidemiological characteristics of posttransplant tuberculosis and summarizes current knowledge on the prevention, diagnosis, and treatment of tuberculosis in transplant recipients.
  Current Infectious Disease Reports 09/2012;
• Article: Respiratory Viral Infections in Pediatric Solid Organ and Hematopoietic Stem Cell Transplantation.

  Defne Arslan, Lara Danziger-Isakov
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  ABSTRACT: Respiratory viruses are common in children, including pediatric recipients of both solid organ transplantation and hematopoietic stem cell transplantation. The prevalence and risk factors in each of these groups are reviewed. Furthermore, associated morbidity and mortality in pediatric transplant recipients with respiratory viral infections are addressed. The literature on specific prevention and treatment options for respiratory syncytial virus, adenovirus, influenza, and other respiratory viruses in pediatric solid organ and hematopoietic stem cell transplant recipients is reported.
  Current Infectious Disease Reports 09/2012;
• Article: Antimicrobial Stewardship as Part of the Infection Prevention Effort.

  Rebekah W Moehring, Deverick J Anderson
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  ABSTRACT: Antimicrobial stewardship programs (ASPs) optimize antimicrobial use to decrease the incidence of infection with multidrug-resistant organisms (MDRO) and the emergence of drug resistance, to improve patient outcomes and safety, and to decrease hospital costs. ASPs achieve these goals through several types of interventions that can occur before or after the antimicrobial has been prescribed; interventions can also be "active" or "passive." We believe that active post-prescription interventions such as post-prescription audit and feedback have the most supportive evidence and most promise. Stewardship activities must be integrated into already established efforts for infection prevention. We believe it is critical that antimicrobial stewardship, infection control, pharmacy, information technology, and clinical microbiology work collaboratively in order to decrease the incidence of infection due to MDRO.
  Current Infectious Disease Reports 09/2012;
• Article: Staphylococcus aureus Bacteriuria: Source, Clinical Relevance, and Management.

  Mayar Al Mohajer, Rabih O Darouiche
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  ABSTRACT: Staphylococcus aureus bacteriuria is a common condition with still largely undetermined clinical relevance. Although S. aureus bacteriuria can be secondary to bacteremia and systemic infection in some patients, it may predispose to bacteremia and invasive disease in others. Whereas most patients with S. aureus bacteriuria do not have symptomatic urinary tract infection, it is reportedly associated with endocarditis and other types of invasive diseases, thereby resulting in major morbidity and occasional mortality. This review summarizes and analyzes the results of previous reports of S. aureus bacteriuria and assesses the clinical relevance and management of this increasingly recognized entity.
  Current Infectious Disease Reports 09/2012;
• Article: Health-Care Worker Vaccination for Influenza: Strategies and Controversies.

  Catherine J Derber, Shivanjali Shankaran
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  ABSTRACT: Influenza infections cause significant morbidity and mortality throughout the world, and vaccination rates of health-care workers remain well below target goals. Strategies for increasing vaccination rates include mandatory vaccination of health-care workers, mandatory declination, employee incentives, intensive education, increased access to vaccines, and the use of social media to inform employees of the safety and efficacy of vaccination. While these strategies in combination have been shown to be effective in increasing vaccination rates, personal and religious objections, as well as the potential for infringing on individual autonomy, remain challenges in our efforts to bring health-care worker vaccination rates up to target goals.
  Current Infectious Disease Reports 09/2012;
• Article: Hand Hygiene: State-of-the-Art Review With Emphasis on New Technologies and Mechanisms of Surveillance.

  Alexandre R Marra, Michael B Edmond
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  ABSTRACT: Hand hygiene (HH) is an important measure in infection prevention to decrease transmission of microbial pathogens; however, HH compliance by health-care workers (HCWs) remains suboptimal. One of the principal recommendations of current guidelines is that waterless, alcohol-based hand rubs are the preferred method for HH in most situations, due to the superior efficacy of these agents in rapidly reducing bacterial counts on hands and their ease of use. Improving HH compliance is a good quality indicator for hospital patient safety programs. Observers can follow HCWs to perform direct HH observations; however, HCWs may be prompted to clean their hands when observers are nearby, which does not represent real-world conditions. Moreover, having observers walk into patient rooms violates patient privacy and is time consuming. HH strategies using indirect metrics for surveillance (e.g., measuring the volume of HH products consumed) and the use of new technologies (e.g., electronic dispenser counters, radiofrequency, alcohol sensors, and video recording) will also be discussed.
  Current Infectious Disease Reports 08/2012;
• Article: From ulcer to infection: an update on clinical practice and adjunctive treatments of diabetic foot ulcers.

  C Abad, N Safdar
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  ABSTRACT: Foot ulcers are a common complication of diabetes. A fifth of all individuals with diabetes develop a diabetic foot infection and are hospitalized at least once in their lifetime. Standard of care for treatment of diabetic foot ulcers and subsequent infection involves a multimodal, interdisciplinary team approach that includes wound care, systemic antimicrobials, and surgery. However, with the relatively poor outcome for chronic, longstanding ulcers and severe infections, recent research has focused on adjunctive therapies to promote wound healing and repair. This review summarizes the underlying pathology and classification of diabetic ulcers and focuses on recent advances that have important implications for the use of adjunctive therapy for diabetic foot infections.
  Current Infectious Disease Reports 08/2012; 14(5):540-50.