Infectious Disease: Part II
Editor’s Note: In this feature, brief items, primarily gleaned from abstracts or articles in journals and other resources not commonly perused by most US infectious disease physicians, will be presented, usually without comment. — Stan Deresinski, MD, FACP
| Bacterial Infection |
Mortality in S aureus Bacteremia
Retrospective analysis of 186 patients with S aureus bacteremia found that the following variables were associated with a fatal outcome: persistent focus of infection, septic shock, age > 60 years, a total daily dose of a penicillinase stable penicillin < 4 g. Among 155 patients who survived beyond the period of treatment, treatment duration < 14 days was also associated with increased mortality (Jensen AG, et al. Arch Intern Med. 2002;162:25-32).
Surgical Management of Necrotizing Fasciitis & Fournier’s Gangrene
Fifty-seven patients with necrotizing soft tissue infections managed in a burn unit required a mean of 4.1 operative procedures (range, 1-15) to achieve definitive wound closure. Survivors had a mean length of stay of 28.5 days (Faucher LD, et al. Am J Surg. 2001;182:563-569).
Reactive Arthritis After Epidemic S typhimurium Infection
The apparent incidence of occurrence of reactive arthritis following epidemic infection with S typhimurium was 8% in a Finnish study. This retrospective experience suggested that antibiotic therapy for the infection may have been protective (Hannu T, et al. Ann Rheum Dis. 2002;61:264-266).
Bacillary Angiomatosis & Pyomyositis
Isolated pyomyositis in an HIV-infected patient was the result of bacillary angiomatosis (Husain S, Singh N. Infection. 2002;30:50-53).
MRSA: Risk Factors at the Time of Admission
Risk factors, for methicillin resistance in S aureus isolates from blood obtained at the time of admission to hospital were: hospitalization in the previous 6 months, receipt of antibiotics in the previous 3 months, the presence of an indwelling urinary catheter, and nursing home residence (Rezende NA, et al. Am J Med Sci. 2002;323:117-123).
Fulminant C difficile Colitis
Sixty-four of 2334 (2.7%) hospitalized patients with C difficile colitis either died or required colectomy as a result. Lung transplant patients were most likely to have severe disease. While abdominal CT correctly identified all cases, 12.5% of toxin assays and 10% of endoscopies were falsely negative. (Dallal RM, et al. Ann Surg. 2002; 235:363-372).
Liver Abscess in Chronic Granulomatous Disease
Of 61cases of liver abscess in 22 patients with chronic granulomatous disease, 12 (20%) were primary, 29 (48%) were recurrent, and 20 (33%) were persistent. S aureus was recovered from 88% of positive cultures (Lublin M, et al. Ann Surg. 2002;235:383-391).
Chewing and Endotoxemia
Gentle mastication is associated with the release of bacterial endotoxin into the bloodstream; endotoxemia was greater in patients with severe periodontitis than in those without (Geerts SO, et al. J Periodontol. 2002;73:73-78).
Extension of Infection/Inflammation Within the Foot
MRI evaluation of patients with suspected pedal osteomyelitis found that soft tissue inflammation of the forefoot fails to respect fascial planes in spreading into neighboring compartments. Spread from the hindfoot and malleolus occurred in only 7% and spread from the foot to the lower leg was seen in only 1% (Lederman HP, et al. AJR Am J Roentgenol. 2002;178:605-612).
BMT, GVHD, & Sinusitis
Acute graft vs. host disease in bone marrow transplant recipients is associated with an increased risk of development of paranasal sinusitis (Thompson AM, et al. Bone Marrow Transplant. 2002;29:257-261).
Relative Adrenocortical Insufficiency & Sepsis Syndrome
Based on a short ACTH stimulation test, 6 of 41 (14.6%) patients with severe sepsis had evidence of relative adrenocortical insufficiency (peak serum cortisol < 680 nmol/L with rise of < 260 nmol/L) (Loisa P, et al. Acta Anaesthesiol Scand. 2002;46:145-151).
AECB & Legionella
Forty of 213 (16.7%) patients admitted to a European hospital because of acute exacerbation of chronic lung disease had serological evidence of Legionella infection; in two thirds of these there also evidence of a second pathogen (Lieberman D, et al. European Resp J. 2002; 19:392-397).
HLA & Infection in Sickle Cell Anemia
Severe infection in patients with sickle cell anemia were significantly negatively associated with the presence of HLA class II DRB*15 specificity and positively associated with the DBQ1*03 specificity (Tamouza R, et al. Human Immunol. 2002;63: 194-199).
| Viral Infection |
Foscarnet vs. Ganciclovir as Preemptive CMV Therapy
In a randomized trial of preemptive therapy of CMV infection in allogeneic blood or marrow stem cell transplant recipients, foscarnet and ganciclovir had similar efficacy. Foscarnet recipients had significantly less frequent severe neutropenia and need for discontinuation of antiviral therapy as a result of toxicity. Nephrotoxicity occurred in 5% of foscarnet recipients and 2% of ganciclovir recipients (P = 0.4) (Reusser P, et al. Blood. 2002;99:1159-1164).
Parvovirus B19 & Acute Glomerulonephritis
A case of acute glomerulonephritis associated with acute parvovirus B19 infection is described (Mori Y, et al. Clin Nephrol. 2002;57:69-73).
Vertical Transmission of SEN Virus
Evaluation of SEN virus seropositive mothers and their infants found evidence of frequent vertical transmission but without persistent viremia in most. No related clinical events were detected (Pirovano S, et al. J Med Virol. 2002;66:421-427).
TTV Virus Replication in Cancer Patients
Replicative intermediates of TTV virus were detected significantly more frequently (55.6% vs 7%; P < 0.001) in peripheral blood mononuclear cells of cancer patients than of healthy controls (Zhong S, et al. J Med Virol. 2002;66:428-434).
Transfusion-Transmitted Bacterial Infection
There were 34 cases of transfusion-transmitted bacteremic infection (with 9 deaths) reported to the CDC from 1998 through 2000, for an incidence per million units of 9.98 for single donor platelets, 10.64 for pooled platelets, and 0.21 for RBC units (Kuehnert MJ, et al. Transfusion. 2001;41:1493-1499).
No TTV Transmission By IVIG
TTV virus appears to not be transmitted by commercial immunoglobulin preparations (Azzari C, et al. Transfusion. 2001;41:1505-1508).
Parvovirus B19 in Blood Donors
The prevalence of parvovirus B19 DNA in the blood of blood donors was 1 in 3915 (Hitzler WE, Runkel S. Vox Sang. 2002;82:18-23).
Prophylaxis of HSV Reactivation in Stem Cell Recipients
A retrospective analysis of recipients of stem cell transplants found that orally administered valacyclovir appeared to be as effective as intravenously administered acyclovir in the prevention of HSV reactivation. The rates of reactivation in those 2 cohorts were, respectively, 2.7% and 2%, while it was 45% in those who received no prophylaxis (Dignani MC, et al. Bone Marrow Transplant. 2002; 29:263-267).
Evidence for Contagious Potential of Patients with Herpes Zoster
A study of 12 hospitalized patients with herpes zoster found VZV DNA by PCR in skin lesions from all and in throat samples in 8 (67%). In addition, VZV DNA was detected on air filter samples from the rooms of 9 of the 12 (75%). (Suzuki K, et al. J Med Virol. 2002;66:567-570).
SV40 & NHL
Two studies detected human simian virus 40 genome significantly more frequently in non-Hodgkins lymphoma tissue than in control tissues (Vilchez RA, et al. Lancet. 2002;359:817-823; Shivapurkar N, et al. Lancet. 2002;359:851-852).
| Miscellaneous |
Killing Head Lice
In vitro testing of pediculicidal activity against head lice (Pediculus capitis) collected in Florida found that the most active agent was Ovide lotion, followed by A-200 shampoo, undiluted Nix (1% permethrin), diluted permethrin, diluted Nix, RID, and 1% lindane shampoo. (Meinking TL, et al. Arch Dermatol. 2002;138:220-224).
Prenatal Treatment of Congenital Toxoplasmosis
A retrospective analysis failed to find evidence of benefit at age 3 years from prenatal pyrimethamine/sulfadiazine retreatment on the outcome of congential toxoplasmosis in 181 liveborn children (Gras L, et al. Int J Epidemiol. 2001;30:1309-1313).
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