Description

Publisher details

Elsevier

Publications in this journal

• Epidemiological and laboratory characterization of a yellow fever outbreak in northern Uganda, October 2010-January 2011.

  Authors: Joseph F Wamala, Mugagga Malimbo, Charles L Okot, Ann D Atai-Omoruto, Emmanuel Tenywa, Jeffrey R Miller, Stephen Balinandi, Trevor Shoemaker, Charles Oyoo, Emmanuel O Omony, Atek Kagirita, Monica M Musenero, Issa Makumbi, Miriam Nanyunja, Julius J Lutwama, Robert Downing, Anthony K Mbonye

  International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

  BACKGROUND: In November 2010, following reports of an outbreak of a fatal, febrile, hemorrhagic illness in northern Uganda, the Uganda Ministry of Health established multisector teams to respond toBACKGROUND: In November 2010, following reports of an outbreak of a fatal, febrile, hemorrhagic illness in northern Uganda, the Uganda Ministry of Health established multisector teams to respond to the outbreak. METHODS: This was a case-series investigation in which the response teams conducted epidemiological and laboratory investigations on suspect cases. The cases identified were line-listed and a data analysis was undertaken regularly to guide the outbreak response. RESULTS: Overall, 181 cases met the yellow fever (YF) suspected case definition; there were 45 deaths (case fatality rate 24.9%). Only 13 (7.5%) of the suspected YF cases were laboratory confirmed, and molecular sequencing revealed 92% homology to the YF virus strain Couma (Ethiopia), East African genotype. Suspected YF cases had fever (100%) and unexplained bleeding (97.8%), but jaundice was rare (11.6%). The overall attack rate was 13 cases/100000 population, and the attack rate was higher for males than females and increased with age. The index clusters were linked to economic activities undertaken by males around forests. CONCLUSIONS: This was the largest YF outbreak ever reported in Uganda. The wide geographical case dispersion as well as the male and older age preponderance suggests transmission during the outbreak was largely sylvatic and related to occupational activities around forests.

• Vir typing for the analysis of group C and group G streptococcal genotypes.

  Authors: D Prabu, Thangam Menon

  International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

• Case fatality associated with a hypervirulent strain in patients with culture-positive Clostridium difficile infection: a retrospective population-based study.

  Authors: Reetta Huttunen, Risto Vuento, Jaana Syrjänen, Päivi Tissari, Janne Aittoniemi

  International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

  BACKGROUND: Clostridium difficile is a major infectious cause of healthcare-associated diarrhea. The epidemiology of C. difficile infection (CDI) is changing, with evidence of increased incidence andBACKGROUND: Clostridium difficile is a major infectious cause of healthcare-associated diarrhea. The epidemiology of C. difficile infection (CDI) is changing, with evidence of increased incidence and severity. The first patient with a hypervirulent strain type in Pirkanmaa Hospital District, Finland was reported in September 2008. METHODS: We reviewed all culture-positive C. difficile episodes that occurred in Pirkanmaa Hospital District during the period September 2008 to May 2010. RESULTS: A total of 780 episodes of C. difficile occurred in 622 patients. A hypervirulent strain caused 14.2% of all episodes. The day 30 case fatality associated with CDI was 8.5% in episodes with a non-hypervirulent strain and 20.7% in episodes with a hypervirulent strain type (p<0.001, odds ratio 2.8, 95% confidence interval 1.6-4.8). The median age among those infected by a hypervirulent strain was higher than among those infected by a non-hypervirulent strain (83 vs. 75 years, p<0.001). Hypervirulent strain type remained a significant factor associated with case fatality in a logistic regression model. Blood leukocytes were significantly higher in episodes due to a hypervirulent strain (11.0 vs. 9.4×10(9)/l, p=0.007). Blood leukocytes and C-reactive protein (CRP) on the day of diagnosis were significantly higher in non-survivors compared to survivors in CDI (13.2 vs. 9.6×10(9)/l, p=0.009, and 106.0 vs. 79.4mg/l, p<0.001, respectively). CONCLUSIONS: Infection due to a hypervirulent strain is a factor associated with increased case fatality in CDI. Blood leukocytes are significantly higher in CDI caused by a hypervirulent strain. Leukocyte count and CRP are useful prognostic biomarkers in patients with CDI.

• Estimating incidence rates with misclassified disease status: a likelihood-based approach, with application to hepatitis C virus.

  Authors: Fatma M Shebl, Samer S El-Kamary, Michelle Shardell, Patricia Langenberg, Laila S Dorgham, James H Maguire, Laurence S Magder

  International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

  BACKGROUND: In epidemiologic research, incidence is often estimated from data arising from an imperfect diagnostic test performed at unequally spaced intervals over time. METHODS: We developed aBACKGROUND: In epidemiologic research, incidence is often estimated from data arising from an imperfect diagnostic test performed at unequally spaced intervals over time. METHODS: We developed a likelihood-based method to estimate incidence when disease status is measured imperfectly and assays are performed at multiple unequally spaced visits. We assumed conditional independence, no remission, known constant levels of sensitivity and specificity, and constant incidence rates over time. The method performance was evaluated by examining its bias, accuracy (i.e., mean squared error (MSE)), and coverage probability in a simulation study of 4000 datasets, and then we applied the proposed method to a study of hepatitis C virus (HCV) infection in a cohort of pregnant women in the period 1997-2006. RESULTS: The simulation revealed that our method has minimal bias and low MSE, as well as good coverage probability of the resulting confidence intervals. In the application to HCV study, the standard incidence rate estimate which ignores the imperfections of the diagnostic test (number of events/person-years), was 13.7 new HCV cases per 1000 person-years (95% confidence interval 10.1, 17.4). The adjusted incidence estimates (obtained using our proposed method) ranged from 0.4 cases per 1000 person-years (when sensitivity and specificity were assumed to both be 95%) to 13.7 cases per 1000 person-years (when sensitivity and specificity were both 100%). The magnitude of difference between standard and adjusted estimates varied depending on specificity and sensitivity assumptions. Specificity had the greatest impact on the magnitude of bias. CONCLUSIONS: Scientists should be aware of the impact of misclassification on incidence estimates. Appropriate study design, proper selection of the diagnostic test, and adjustment for misclassification probabilities in the analysis is necessary to obtain the most accurate incidence estimates.

• Risk factors for tuberculin skin test conversion among HIV-infected patients in New York City.

  Authors: Saumil Doshi, Tina Fang Chen, Josue Zapata, Robert S Holzman, Luis C Zapata, Judith A Aberg, Sumathi Sivapalasingam

  International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

  BACKGROUND: We assessed the incidence of and risk factors for tuberculin skin test (TST) conversion among HIV-infected adults at a New York City clinic. METHODS: All adult HIV-infected patients wereBACKGROUND: We assessed the incidence of and risk factors for tuberculin skin test (TST) conversion among HIV-infected adults at a New York City clinic. METHODS: All adult HIV-infected patients were eligible for inclusion if they had a negative baseline TST result and at least one subsequent documented TST test result. RESULTS: A total of 414 HIV-infected patients had a negative baseline TST result; 288 (69.6%) were male. Among 348 patients who had a place of birth documented, 50% were born outside of mainland USA. Twenty-two (5.3%) of 414 patients had documented TST conversions, giving a crude incidence rate of 1.77 per 100 person-years. Being a foreign-born Asian individual (p=0.02), having lived in a shelter (p=0.004), and having an increase in CD4 cell count (p=0.02) while under care were independent risk factors for TST conversion. CONCLUSIONS: We found a high TST conversion rate among HIV-infected patients attending an urban clinic. Annual TST testing is particularly important for patients who are foreign-born from high-endemic countries, those with a history of homelessness, and those with an increase in CD4 cell count since the baseline negative TST test.

• Evaluation of a new interferon-gamma release assay and comparison to tuberculin skin test during a tuberculosis outbreak.

  Authors: Qisheng Song, Huishan Guo, Hui Zhong, Zuoguang Liu, Xiuqin Chen, Cui Wang, Neal Touzjian, Yichen Lv, Xiwei Lu, Qi Wang

  International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

  BACKGROUND: The tuberculin skin test (TST) is commonly used for the diagnosis of latent tuberculosis infection (LTBI) in non-bacille Calmette-Guérin (BCG) vaccination settings. In recent years,BACKGROUND: The tuberculin skin test (TST) is commonly used for the diagnosis of latent tuberculosis infection (LTBI) in non-bacille Calmette-Guérin (BCG) vaccination settings. In recent years, attention has been drawn to interferon-gamma release assays (IGRAs), especially in BCG-vaccinated populations. In this study, we evaluated the TST and a new whole blood IGRA in BCG-vaccinated individuals during a tuberculosis (TB) outbreak in China. METHODS: A TB outbreak occurred at a university in Dalian, China from March to November 2010. The TST and a whole blood IGRA were used to screen for TB infection. The correlation between exposure levels, TST, and the IGRA were evaluated. RESULTS: We found that agreement between the IGRA and TST was poor (kappa 0.182-0.290). IGRA positivity was associated with the level of exposure, and IGRA positivity and the level of exposure were risk factors for TB incidence. Neither the IGRA nor the TST alone picked up all TB incidences. However, if a 10mm cutoff for the TST was used in the highest risk exposure group and IGRA positivity was used in the other risk groups, 19 of the 20 (95%) TB cases were identified. CONCLUSIONS: A recommended preventive treatment regimen for China should be based on the level of exposure in conjunction with IGRA and TST test results.

• A case series of spotted fever rickettsiosis with neurological manifestations in Sri Lanka.

  Authors: S A M Kularatne, K G A D Weerakoon, R P V J Rajapakse, S C Madagedara, D Nanayakkara, R Premaratna

  International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

  BACKGROUND: Spotted fever group (SFG) rickettsial infections are increasingly detected in Sri Lanka. We describe 17 patients with SFG who developed neurological manifestations. METHODS: The casesBACKGROUND: Spotted fever group (SFG) rickettsial infections are increasingly detected in Sri Lanka. We describe 17 patients with SFG who developed neurological manifestations. METHODS: The cases were studied prospectively from 2008 at the Teaching Hospital, Peradeniya. An immunofluorescent antibody assay (IFA) was used to confirm the diagnosis. RESULTS: All had an IFA IgG titer ranging from 1/64 to 1/4096 and a positive IFA IgM titer against Rickettsia conorii antigen; in 10 (59%) cases the IgG titers were ≥1/256 (definitive cases). The median age of the patients was 62 years (range 26-82 years); 10 were male and seven female. The median duration of fever was 12 days (range 4-35 days). Neurological manifestations on admission were drowsiness or confusion in 14 (82%) and a semi-comatose state in three (18%). Rigidity of the limbs occurred in 14 (82%), bradykinesia and resting tremors in 12 (71%), which persisted after defervescence, neck stiffness in seven (42%), weakness of the limbs in five (29%), deafness in two (12%), and stupor in three (18%). Electroencephalograms in three (18%) showed generalized slow waves. Cerebrospinal fluid examination showed a cellular reaction, predominantly lymphocytes, in three cases. Two patients died (fatality rate 12%). CONCLUSION: We have documented for the first time the neurological features of SFG rickettsioses in the Central Province, Sri Lanka. These were predominantly extrapyramidal features in patients of older age.

• A mixed methods approach to identifying factors related to voluntary HIV testing among injection drug users in Shanghai, China.

  Authors: Jiang Du, Christina Lombardi, Elizabeth Evans, Haifeng Jiang, Min Zhao, Ying-Ying Meng

  International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

  OBJECTIVES: Injection drug use is a major route of HIV transmission in China, yet relatively little is known about why so few injection drug users utilize free HIV testing services. This study aimedOBJECTIVES: Injection drug use is a major route of HIV transmission in China, yet relatively little is known about why so few injection drug users utilize free HIV testing services. This study aimed to examine barriers to HIV testing and voluntary counseling and testing (VCT) service utilization among injection drug users in Shanghai, China. METHODS: Utilizing mixed methods, we analyzed data from a survey of 540 compulsory drug abuse treatment patients and data from focus groups with 70 service providers and patients. RESULTS: Only 24.4% of patients expressed willingness to be tested for HIV. Willingness to be tested was associated with younger age and more positive attitudes towards condom use. Patients reported several barriers to utilization of voluntary HIV testing services, including lack of information about these services, perceptions of no risk or low-risk for HIV infection, fear of positive results, and the stigma or discrimination that may be experienced by the patient or their family. Having limited skills related to HIV counseling was reported by service providers as the primary barrier to encouraging patients to utilize HIV testing/VCT services. CONCLUSIONS: Special intervention programs targeting injection drug users, their family members, and service providers may increase HIV testing in China.

• Association between the risk of congenital toxoplasmosis and the classification of toxoplasmosis in pregnant women and prenatal treatment in Brazil, 1994-2009.

  Authors: Liú Campello Porto, Elisabeth Carmen Duarte

  International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

  OBJECTIVES: The objectives of this study were to analyze the association between the classification of toxoplasmosis in the pregnant woman (TP) according to the classification of Lebech et al. andOBJECTIVES: The objectives of this study were to analyze the association between the classification of toxoplasmosis in the pregnant woman (TP) according to the classification of Lebech et al. and the incidence of congenital toxoplasmosis (CT), also taking into consideration prenatal treatment. METHODS: A clinical cohort study of 524 children followed-up until 1 year of age was conducted. Adjusted odds ratios (OR) were estimated by logistic regression. RESULTS: Of 519 pregnant women, 61.3% were not classified due to the incompleteness of hospital records. Among the pregnant women classified as confirmed cases of TP (n=19), the CT risk was six times greater than in the probable/possible group. No case of CT was identified in the group of pregnant women classified as unlikely to have TP. The children with no prenatal treatment (46.2% n=242/524) presented a risk almost three times greater of CT than the treated children (OR 2.77, 95% confidence interval (CI) 1.54-4.97; p=0.001). Complete prenatal treatment was identified as a protecting factor for CT (OR 0.35, 95% CI 0.19-0.65; p=0.001). CONCLUSIONS: A lack or incomplete prenatal treatment was identified as an important risk factor for CT in this study. The proportions of non-classified mothers and children with no prenatal treatment reflect the need to improve prenatal care in Brazil.

• The epidemiology and clinical characteristics of respiratory syncytial virus infection in children at a public pediatric referral hospital in Mexico.

  Authors: Juan Pablo Rodríguez-Auad, Margarita Nava-Frías, Jesús Casasola-Flores, Kyle M Johnson, Alejandra Nava-Ruiz, Víctor Pérez-Robles, Miguela A Caniza

  International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

  OBJECTIVES: The aim of this study was to determine the epidemiological and clinical characteristics of children with respiratory syncytial virus (RSV) treated at a public referral children's hospitalOBJECTIVES: The aim of this study was to determine the epidemiological and clinical characteristics of children with respiratory syncytial virus (RSV) treated at a public referral children's hospital in Mexico. METHODS: We reviewed RSV infection in patients aged 0-18 years who were treated at Hospital Infantil from January 2004 to December 2008. RESULTS: During the 5 years, 2797 samples were tested for respiratory viruses; 356 samples were positive for any virus, including 266 (74.7%) positive for RSV. Complete clinical information was available for 205 RSV patients. The mean age was 22 months, and 33.7% of the infections were nosocomially acquired. Hospitalization occurred in 187 children. Of 14 deaths, nine were directly attributed to RSV infection. During the study, RSV infections were seen throughout the year, predominating in the colder months. Of the 205 patients, 79.0% (162/205) had an underlying disease. Congenital heart disease was found in 30.2% (49/162), including three children (33.3%) who died of RSV. Thirty-three patients (16.1%) with RSV required mechanical ventilation. None of the children with RSV received palivizumab or ribavirin. CONCLUSIONS: RSV caused high hospitalization rates and admission to intensive care units, especially among those with underlying illnesses and young infants. The data presented here will be useful for strategies to improve outcomes in children at risk of complications.

• Clinical characteristics of influenza A H1N1 versus other influenza-like illnesses amongst outpatients attending a university health center in Oman.

  Authors: Abdulaziz Al-Mahrezi, Nafisa Samir, Ibrahim Al-Zakwani, Zakaria Al-Muharmi, Abdulla Balkhair, Mohammed Al-Shafaee

  International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

  OBJECTIVES: To identify the clinical characteristics of outpatients with flu-like illnesses stratified by influenza A H1N1 status. METHODS: The study was conducted at the H1N1 staff clinic of SultanOBJECTIVES: To identify the clinical characteristics of outpatients with flu-like illnesses stratified by influenza A H1N1 status. METHODS: The study was conducted at the H1N1 staff clinic of Sultan Qaboos University Hospital in Muscat, Oman. The population consisted of university students and university/hospital staff and their family members. All adult patients who presented to the H1N1 clinic with an influenza-like illness over a 4-month period (from August until the end of November 2009) were included. Real-time reverse transcriptase (rRT) PCR was used for the diagnosis of H1N1 influenza. Demographic data, clinical signs and symptoms, history of exposure to H1N1, history of recent travel, and co-morbid conditions were documented. Analyses were conducted using univariate and multivariate statistical techniques. RESULTS: Out of the 2318 patients identified, 27% (n=616) were positive for H1N1 influenza. The mean temperature in the H1N1-positive group was significantly higher than in the negative group (38.3°C vs. 37.2°C; p<0.001). Proportions of patients who reported cough, sore throat, headache, myalgia, gastrointestinal symptoms, exposure to a confirmed case of H1N1, and a history of travel were significantly higher in the H1N1-positive group as compared to the swab-negative group. However, the multivariable logistic model identified only the following significant predictor variables of H1N1 infection: younger age, fever (≥37.8°C), sore throat, myalgia, diarrhea, and exposure to a confirmed H1N1 case within the last 7 days. CONCLUSIONS: This study provides useful data on the clinical characteristics of H1N1 influenza in a large outpatient population from the Middle East. Patients who tested positive for H1N1 were more likely to have fever, sore throat, diarrhea, and myalgia compared to those with other influenza-like illnesses.

• Repeated dengue shock syndrome and 'dengue myocarditis' responding dramatically to a single dose of methyl prednisolone.

  Authors: R Premaratna, K M D J Rodrigo, A Anuratha, V K D de Alwis, U D C A Perera, H J de Silva

  International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

  The place of steroids in the management of severe forms of dengue is unclear. A retrospective observational study showed the benefits of a single dose of intravenous methyl prednisolone in a highlyThe place of steroids in the management of severe forms of dengue is unclear. A retrospective observational study showed the benefits of a single dose of intravenous methyl prednisolone in a highly selected group of patients who developed severe dengue during the febrile phase of infection. We report the case of a 14-year-old boy with dengue who developed three episodes of severe hemodynamic compromise while having high fever, 'myocarditis', third space fluid accumulation, progressive reduction in urine output, and altered mentation, who made a dramatic recovery following a single dose of intravenous methyl prednisolone. Results justify a well powered randomized controlled trial to evaluate the efficacy of this treatment in severe dengue.

• Emerging clinico-epidemiological trends in melioidosis: analysis of 95 cases from western coastal India.

  Authors: K Vidyalakshmi, S Lipika, S Vishal, S Damodar, M Chakrapani

  International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

  OBJECTIVES: To study the clinico-epidemiological trends in melioidosis, an emerging disease in the western coastal region of India. METHODS: Data of 95 patients with melioidosis in the westernOBJECTIVES: To study the clinico-epidemiological trends in melioidosis, an emerging disease in the western coastal region of India. METHODS: Data of 95 patients with melioidosis in the western coastal region of India were retrospectively analyzed with respect to monthly rainfall, risk factors, clinical presentations, and outcome. RESULTS: A strong linear correlation was seen between average monthly rainfall and the occurrence of cases (p=0.002). Mortality was seen only in patients with bacteremia (p<0.001). Nine (40.9%) patients with septic shock died (p<0.001). Age ≥40 years and diabetes mellitus were seen in 75.8% of cases, each. Pneumonia was the most common clinical presentation (32.6%), followed by musculoskeletal disease (20%), melioidotic lymphadenopathy (7.4%), and dental abscess (6.3%). Only 36.8% of patients had exposure to wet soil/surface water. CONCLUSIONS: Melioidosis is quite prevalent in the western coastal region of India, and is strongly associated with rainfall, age, and diabetes mellitus. Higher proportions of musculoskeletal, dental, and lymph node melioidosis were seen in this region as compared to endemic areas. Bacteremic melioidosis has a poorer prognosis than non-bacteremic melioidosis. The presence of septic shock is a strong predictor of mortality. Percutaneous inoculation may not be the main portal of entry for Burkholderia pseudomallei in this region.

• Unexplained neonatal jaundice as an early diagnostic sign of urinary tract infection.

  Authors: Mozhgan Shahian, Parisa Rashtian, Mehdi Kalani

  International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

  BACKGROUND: Hyperbilirubinemia is one of the presenting signs of bacterial infection in newborns, and the association of neonatal jaundice with urinary tract infection (UTI) has been particularlyBACKGROUND: Hyperbilirubinemia is one of the presenting signs of bacterial infection in newborns, and the association of neonatal jaundice with urinary tract infection (UTI) has been particularly emphasized. The aim of this study was to determine the prevalence of UTI in asymptomatic jaundiced neonates younger than 4 weeks old. METHODS: We prospectively evaluated 120 asymptomatic jaundiced and 122 healthy neonates without jaundice younger than 4 weeks old for UTI. Patients with UTI, defined as >10 000 colony-forming units of a single pathogen per milliliter urine obtained by bladder catheterization, were evaluated for sepsis. RESULTS: Of 120 asymptomatic jaundiced neonates with a mean age of 7 ± 4 days, 15 (12.5%) had a UTI. Of 122 healthy neonates, positive urine cultures from a urine bag were found in eight cases; however on reevaluation, urine cultures from bladder catheterization were negative. The most common pathogen isolated from the UTI cases was Klebsiella pneumoniae. Also, unconjugated hyperbilirubinemia was detected in all jaundiced patients with UTI. CONCLUSION: UTI was found in 12.5% of the asymptomatic jaundiced neonates with the onset of unconjugated hyperbilirubinemia in the first week of life. Therefore, we suggest that urine culture should be considered as a part of the diagnostic evaluation of jaundiced neonates older than 3 days with an unexplained etiology.

• Predictors of septic shock in patients with methicillin-resistant Staphylococcus aureus bacteremia.

  Authors: Simon W Lam, Seth R Bauer, Elizabeth A Neuner

  International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

  OBJECTIVES: Risk factors for septic shock associated with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia are not well described. We designed this study to assess the independentOBJECTIVES: Risk factors for septic shock associated with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia are not well described. We designed this study to assess the independent predictors of septic shock in patients with MRSA bacteremia. METHODS: This retrospective chart review included 234 patients with MRSA bacteremia admitted to a tertiary care academic medical center. Cases of septic shock and non-septic shock MRSA bacteremia were compared in terms of patient baseline characteristics and co-morbidities, modes of acquisition, and MRSA genotyping. Independent risk factors were determined by multivariable analysis. RESULTS: On univariate analysis the presence of chronic kidney disease, respiratory failure, acute renal failure, staphylococcal cassette chromosome (SCCmec) type II, and higher APACHE II scores were significantly correlated with the presence of septic shock. On multivariate analysis, baseline APACHE II score (adjusted odds ratio (AOR) for 1-point increase 1.13, 95% confidence interval (CI) 1.04-1.22, p=0.005), acute renal failure (AOR 2.57, 95% CI 1.02-6.48, p=0.045), and SCCmec type II (AOR 2.60, 95% CI 1.01-6.75, p=0.049) were independently associated with MRSA bacteremic septic shock. CONCLUSIONS: The development of septic shock associated with MRSA bacteremia was independently correlated with baseline severity of illness, presence of acute renal failure, and an MRSA genotyping consistent with nosocomially acquired MRSA infection.

• Characterization of Staphylococcus lugdunensis endocarditis in patients with cardiac implantable electronic devices.

  Authors: Yu-Tzu Tsao, Wei-Jie Wang, Shih-Wei Lee, Jin-Chyr Hsu, Feng-Ming Ho, Wei-Liang Chen

  International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

  OBJECTIVES: Although the application of cardiac implantable electronic devices (CIED) has greatly increased over the past few decades, CIED endocarditis is becoming a challenging scenario in clinicalOBJECTIVES: Although the application of cardiac implantable electronic devices (CIED) has greatly increased over the past few decades, CIED endocarditis is becoming a challenging scenario in clinical practice. Recently, Staphylococcus lugdunensis has emerged as a pathogen in CIED endocarditis. However, a detailed phenotypic characterization has not been addressed. METHODS: We conducted a systematic literature review covering the period between 1989 and 2011 using the PubMed, Medline, Cochrane, and Embase databases. All cases included had a CIED in use and met the modified Duke criteria for infective endocarditis, and all had isolates of S. lugdunensis. The clinical features, predisposing conditions, echocardiographic findings, and therapeutic strategies/outcomes were evaluated. Polymorphonuclear neutrophil functions were examined to test whether the defect of innate immunity may play a permissive role in host susceptibility to tissue destruction in S. lugdunensis endocarditis. RESULTS: Eleven patients with CIED endocarditis caused by S. lugdunensis were identified. Their mean age was 61.7±11.2 years, and there was a male preponderance (72.7%). Six patients (54.5%) had undergone re-manipulation of the pacing system within a few months to years before the occurrence of clinical symptoms. The median time of symptoms before the diagnosis of CIED endocarditis was 60 days. On echocardiography, vegetations in the CIED were detected in nine cases (81.8%). Nine patients (81.8%) underwent surgical removal of the entire device, and one patient received medical treatment alone. The overall mortality rate was 18.2%. One patient had a septic perforation of the ventricular septum, with a high serum level of N-terminal prohormone of brain natriuretic peptide (NT-pro-BNP) in the absence of pump failure. The assessment of polymorphonuclear neutrophil (PMN) functions revealed normal PMN responses to the various stimuli and normal oxidative burst responses. CONCLUSIONS: Identification and differentiation of staphylococcal species in a timely manner would allow us to intervene more aggressively at an earlier stage to prevent unfavorable outcomes. Clinicians should never consider the isolation of S. lugdunensis as contamination. In selected individuals, therapeutic abstention may be preferable to exposing patients to a high risk of S. lugdunensis CIED endocarditis due to re-manipulation of the pacing system. The prognostic value of NT-pro-BNP warrants further investigations.

• Highly effective and inexpensive parasitological technique for diagnosis of intestinal parasites in developing countries: spontaneous sedimentation technique in tube.

  Authors: Raúl Tello, Angélica Terashima, Luis A Marcos, Jorge Machicado, Marco Canales, Eduardo Gotuzzo

  International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

  Millions of low-income people in the world are affected by intestinal parasites. Inexpensive, simple, and effective techniques for diagnosis are necessary. The spontaneous sedimentation technique inMillions of low-income people in the world are affected by intestinal parasites. Inexpensive, simple, and effective techniques for diagnosis are necessary. The spontaneous sedimentation technique in tube (SSTT), for application in poor healthcare settings and under field-work conditions, was described 25 years ago in Peru by Tello. The advantages of the SSTT are its ability to detect the majority of intestinal parasites, including eggs, larvae, cysts, and trophozoites, and its low cost.

• Epidemiology of Japanese encephalitis in South Korea, 2007-2010.

  Authors: Dong-Woo Lee, Young June Choe, Jong Hee Kim, Kyung Min Song, Heeyeon Cho, Geun-Ryang Bae, Jong-Koo Lee

  International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

  BACKGROUND: Japanese encephalitis (JE) was the leading cause of viral encephalitis among children in South Korea in the 20(th) century. This study summarizes recent changes in the epidemiology of JEBACKGROUND: Japanese encephalitis (JE) was the leading cause of viral encephalitis among children in South Korea in the 20(th) century. This study summarizes recent changes in the epidemiology of JE following the implementation of a vigorous immunization program in the country. METHODS: Epidemiological investigations were performed for all reported laboratory-confirmed JE cases, and the cumulative incidence was calculated for the surveillance years 2007-2010. RESULTS: During the surveillance period, 45 cases of JE were confirmed in the country, resulting in a cumulative incidence of 0.013-0.055 cases per 100 000 population. The median age of cases was 49.4 years, and by age group, 44.4% were aged 40-49 years. Just under a quarter (22.2%) of the cases were found to live close to a pigsty, while 42.2% of the cases were found to reside in the metropolitan areas of Seoul, Incheon, and Gyeonggi-do. None of the cases had a history of vaccination. CONCLUSIONS: Although JE has traditionally been regarded as a children's disease, the majority of cases now occur in adults in countries where strong immunization programs exist, such as in South Korea. Consideration should be given to an adult vaccination policy in the near future.

• Healthcare-associated vs. hospital-acquired Staphylococcus aureus bacteremia.

  Authors: Jihad Bishara, Elad Goldberg, Leonard Leibovici, Zmira Samra, Hila Shaked, Nariman Mansur, Mical Paul

  International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

  OBJECTIVE: To analyze clinical features and outcomes of patients with hospital-acquired (HA) and healthcare-associated (HCA) Staphylococcus aureus bacteremia. METHODS: A retrospective cohort studyOBJECTIVE: To analyze clinical features and outcomes of patients with hospital-acquired (HA) and healthcare-associated (HCA) Staphylococcus aureus bacteremia. METHODS: A retrospective cohort study was conducted from 1988 to 2007. We compared patients with clinically significant HA with those with HCA S. aureus bacteremia. Risk factors for 30-day all-cause mortality were assessed using multivariable logistic regression analysis. Cox regression analysis was used to estimate the hazard ratio (HR) for 5-year mortality with 95% confidence intervals (CI). RESULTS: Of 1261 episodes, 735 (58.3%) were HA and 526 (41.7%) were HCA. The percentage of MRSA was 48.2% (354/735) in HA vs. 42.2% (222/526) in HCA bacteremia; p=0.04. The percentages of HCA S. aureus bacteremia and MRSA bacteremia did not vary throughout the study period. Mortality at 30 days was 40.2% (507/1261) and at 1 year was 63.4% (800/1261); this was comparable for HA and HCA bacteremia. Five-year survival curves in both settings followed very similar patterns (HR 1.01, 95% CI 0.89-1.15). Risk factors for 30-day mortality were similar, except for primary bacteremia and pre-existing heart valve disease in the HA group. CONCLUSIONS: HCA S. aureus bacteremia shares many similarities with HA bacteremia with respect to the prevalence of MRSA strains, mortality rates, and risk factors for death, and should be managed similarly.

• Epidemiology and predictors of a poor outcome in elderly patients with candidemia.

  Authors: Thaís Guimarães, Márcio Nucci, João S Mendonça, Roberto Martinez, Ligia R Brito, Nivia Silva, Maria Luiza Moretti, Reinaldo Salomão, Arnaldo L Colombo

  International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

  BACKGROUND: Candidemia affects patient populations from neonates to the elderly. Despite this, little information is available about the epidemiology of candidemia in elderly patients. METHODS: WeBACKGROUND: Candidemia affects patient populations from neonates to the elderly. Despite this, little information is available about the epidemiology of candidemia in elderly patients. METHODS: We performed a retrospective analysis of 987 episodes of candidemia in adults (>14 years of age) from the databases of three laboratory-based surveys of candidemia performed at 14 tertiary care hospitals. Patients aged ≥60 years were considered elderly (group 1, n=455, 46%) and were compared to younger patients (group 2, n=532, 54%) regarding demographics, underlying diseases, comorbidities, exposure to medical procedures, species, treatment, and outcome. RESULTS: The median APACHE II score was significantly higher in the elderly patients (19 vs. 15, p=0.03). Variables that were observed significantly more frequently in elderly patients included admission to an intensive care unit, diabetes mellitus, renal failure, cardiac disease, lung disease, receipt of antibiotics or H2 blockers, insertion of a central venous catheter, mechanical ventilation, and candidemia due to Candida tropicalis. The 30-day mortality of elderly patients was significantly higher than that of younger patients (70% vs. 45%, p<0.001). Factors associated with higher mortality by multivariate analysis included APACHE II score and being in group 1 (elderly). Factors associated with mortality in elderly patients were lung disease and the receipt of mechanical ventilation. CONCLUSIONS: Elderly patients account for a substantial proportion of patients with candidemia and have a higher mortality compared to younger patients.

• Inequality and infection in China.

  Authors: Nicholas X Tan, Joseph D Tucker

  International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

• The effect of metformin on the efficacy of antiviral therapy in patients with genotype 1 chronic hepatitis C and insulin resistance.

  Authors: Jian-Wu Yu, Li-Jie Sun, Yong-Hua Zhao, Peng Kang, Bing-Zhu Yan

  International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

  OBJECTIVES: Insulin resistance (IR) affects sustained virological response (SVR) in chronic hepatitis C (CHC). The aim of this study was to investigate the effect of adding metformin to peginterferonOBJECTIVES: Insulin resistance (IR) affects sustained virological response (SVR) in chronic hepatitis C (CHC). The aim of this study was to investigate the effect of adding metformin to peginterferon alfa-2a and ribavirin on the efficacy in patients with genotype 1 CHC and IR. METHODS: Ninety-eight patients with genotype 1 CHC and IR were randomized into the treatment group (n=49) and the control group (n=49). Patients in the control group received peginterferon alfa-2a and ribavirin, and patients in the treatment group received metformin in addition to peginterferon alfa-2a and ribavirin. The rate of virological response, changes in the homeostasis model assessment of insulin resistance (HOMA-IR) index, and the incidence of side effects were compared between the two groups. Factors influencing the SVR were studied by multivariate analysis. RESULTS: The SVR rate of the treatment group was significantly higher than that of the control group (59.2%, 29/49 vs. 38.8%, 19/49; Chi-square=4.083, p=0.043). The HOMA-IR index of patients in the treatment group was lower than that of patients in the control group at weeks 12, 24, and 48 of the treatment period, and at week 24 of follow-up (3.00±0.65 vs. 3.50±0.72, 1.90±0.45 vs. 2.90±0.64, 1.75±0.40 vs. 2.74±0.48, and 1.60±0.35 vs. 2.60±0.55, respectively; t=3.610, 8.947, 11.091, and 10.738, respectively; p<0.01). Diarrhea was more often seen in the treatment group (28.6%, 14/49 vs. 10.2%, 5/49; Chi-square=5.288, p=0.021). In the multivariate logistic regression analysis, the independent factors associated with SVR were treatment method (p=0.009) and HOMA-IR <2 at week 24 (p=0.011). CONCLUSIONS: A combination of metformin, peginterferon alfa-2a, and ribavirin improved insulin sensitivity and increased the SVR rate of patients with hepatitis C genotype 1 and IR, with a good safety profile.

• Extrapolating respiratory tract infection incidences to a rural area of Ghana using a probability model for hospital attendance.

  Authors: R Krumkamp, N G Schwarz, N Sarpong, W Loag, H Zeeb, Y Adu-Sarkodie, J May

  International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

  OBJECTIVE: The aim of the current study was to extrapolate incidences for respiratory tract infections (RTI) using referral data from a local hospital in Ghana weighted by the individual likelihoodOBJECTIVE: The aim of the current study was to extrapolate incidences for respiratory tract infections (RTI) using referral data from a local hospital in Ghana weighted by the individual likelihood of a hospital visit. METHODS: Diagnoses from children visiting a rural hospital in Ghana during August 2007 to September 2008 were recorded. A logistic regression model, based on a population study conducted within the hospital catchment area, was used to calculate the individual probability of clinic attendance and to extrapolate the number of recorded cases. Cumulative incidences for children living in the hospital catchment area were estimated. RESULTS: Upper RTI was the most common respiratory diagnosis, with an extrapolated incidence of 17481 cases per 100000 per year, followed by pneumonia with an incidence of 2496 per 100 000 per year. All diseases analyzed were most common in the first year of life. CONCLUSIONS: In general the study results are in line with comparable studies. Several methodological issues biasing the results in different directions were identified. For example, opportunistic infections that are more often observed in hospital attendees are likely to be overestimated. However, the applied approach presents a tool for areas where disease monitoring systems are not established.

• Comparison of attitudes about polio, polio immunization, and barriers to polio eradication between primary health center physicians and private pediatricians in India.

  Authors: Naveen Thacker, Panna Choudhury, Lisa M Gargano, Paul S Weiss, Karen Pazol, Sunil Bahl, Hamid S Jafari, Manisha Arora, A P Dubey, Vipin M Vashishtha, Rohit Agarwal, Amod Kumar, Walter A Orenstein, Saad B Omer, James M Hughes

  International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

  OBJECTIVES: The objectives of this study were to compare attitudes and perceptions of primary health center (PHC) physicians and pediatricians in Uttar Pradesh and Bihar toward polio disease,OBJECTIVES: The objectives of this study were to compare attitudes and perceptions of primary health center (PHC) physicians and pediatricians in Uttar Pradesh and Bihar toward polio disease, immunization, and eradication, and to identify barriers to polio eradication. METHODS: PHC physicians from blocks with at least one confirmed polio case during January 2006 to June 2009 were selected for an in-person survey. Pediatricians were members of the Indian Academy of Pediatrics and were selected from a national directory of members for telephone or mail survey. RESULTS: A higher percentage of PHC physicians than pediatricians reported that an unvaccinated child was susceptible to polio (82.1% vs. 63.0%, p<0.0001) and that polio disease was severe in a child aged 1-5 years (77.7% vs. 62.2%, p<0.0001). PHC physicians and pediatricians expressed confidence in the protectiveness and safety of oral polio vaccine and cited parents' lack of awareness of the importance of polio eradication as an important barrier to eradication. Strengthening routine immunization efforts was reported as the leading intervention required to eradicate polio. CONCLUSIONS: PHC physicians and pediatricians support and have confidence in the success of polio eradication efforts. These findings will be useful for policy-makers involved in the planning of eradication strategies. Providers and parents need to maintain confidence in polio vaccination if polio is to be eradicated.

• Healthcare-associated infection in hematopoietic stem cell transplantation patients: risk factors and impact on outcome.

  Authors: Elisa Teixeira Mendes, Frederico Dulley, Mariusa Basso, Marjorie Vieira Batista, Fabio Coracin, Thais Guimarães, Maria Aparecida Shikanai-Yasuda, Anna Sara Levin, Silvia Figueiredo Costa

  International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

  OBJECTIVE: The objective of this study was to analyze the incidence of and risk factors for healthcare-associated infections (HAI) among hematopoietic stem cell transplantation (HSCT) patients, andOBJECTIVE: The objective of this study was to analyze the incidence of and risk factors for healthcare-associated infections (HAI) among hematopoietic stem cell transplantation (HSCT) patients, and the impact of such infections on mortality during hospitalization. METHODS: We conducted a 9-year (2001-2009) retrospective cohort study including patients submitted to HSCT at a reference center in São Paulo, Brazil. The incidence of HAI was calculated using days of neutropenia as the denominator. Data were analyzed using EpiInfo 3.5.1. RESULTS: Over the 9-year period there were 429 neutropenic HSCT patients, with a total of 6816 days of neutropenia. Bloodstream infections (BSI) were the most frequent infection, presenting in 80 (18.6%) patients, with an incidence of 11.7 per 1000 days of neutropenia. Most bacteremia was due to Gram-negative bacteria: 43 (53.8%) cases were caused by Gram-negative species, while 33 (41.2%) were caused by Gram-positive species, and four (5%) by fungal species. Independent risk factors associated with HAI were prolonged neutropenia (odds ratio (OR) 1.07, 95% confidence interval (CI) 1.04-1.10) and duration of fever (OR 1.20, 95% CI 1.12-1.30). Risk factors associated with death in multivariate analyses were age (OR 1.02, 95% CI 1.01-1.43), being submitted to an allogeneic transplant (OR 3.08, 95% CI 1.68-5.56), a microbiologically documented infection (OR 2.96, 95% CI 1.87-4.6), invasive aspergillosis disease (OR 2.21, 95% CI 1.1-4.3), and acute leukemias (OR 2.24, 95% CI 1.3-3.6). CONCLUSIONS: BSI was the most frequent HAI, and there was a predominance of Gram-negative microorganisms. Independent risk factors associated with HAI were duration of neutropenia and fever, and the risk factors for a poor outcome were older age, type of transplant (allogeneic), the presence of a microbiologically documented infection, invasive aspergillosis, and acute leukemia. Further prospective studies with larger numbers of patients may confirm the role of these risk factors for a poor clinical outcome and death in this transplant population.

Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.