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En este número

Boletín de la Sociedad de Enfermedades Infecciosas de la Comunidad Valenciana
VOLUMEN 2
NÚ M E R O 4
En este número:
1. Portada. Nuevas guías
de PPE: el RAL gana protagonismo
2. Impactos (y enlaces) a
artículos de interés en
aspectos generales, bacterias, virus, hongos y
parásitos
Que el Boletín de la
SEICV sea de utilidad
SEPTIEMBRE 2013
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GENERAL
A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious
Diseases: 2013 Recommendations by the Infectious Diseases Society of America
(IDSA) and the American Society for Microbiology (ASM)
Ellen Jo Baron et al. Clin Infect Dis. (2013) doi: 10.1093/cid/cit278
The critical role of the microbiology laboratory in infectious disease diagnosis calls
for a close, positive working relationship between the physician and the microbiologists who provide enormous value to the health care team. This document, developed by both laboratory and clinical experts, provides information on which tests
are valuable and in which contexts, and on tests that add little or no value for diagnostic decisions. Sections are divided into anatomic systems (enlace)
Review of Infectious Diseases Applications for iPhone/iPad and Android: from
Pocket to Patient
Amaran Moodley, et al. Clin Infect Dis (published 9 July 2013), (enlace)
The explosion of medical apps creates challenges amongst providers trying to find
reliable trustworthy infectious disease apps. This has opened the door for regulation
by the FDA. We reviewed over 900 apps to find eleven new useful ID apps.
Physical exercise is associated with less neurocognitive impairment among HIVinfected adults
Catherine A. Dufour et al. J. Neurovirol. June 2013
"In summary, NCI still affects nearly half of the HIV+ population. Our results suggest
that exercise is associated with less NCI among HIV-infected persons and may
have specific impact on working memory and speed of information processing. Future intervention studies would help better determine whether exercise is an effective tool to address the neurocognitive deficits associated with this disease."
Medical Students’ Perceptions and Knowledge About Antimicrobial Stewardship:
How Are We Educating Our Future Prescribers?
Lilian M. Abbo et al.
Clin Infect Dis published 31 May 2013, doi 10.1093/cid/cit370 (enlace)
This study highlights an important education gap among US medical schools, suggesting that more attention should be given to instruction of medical students about
the principles of antimicrobial stewardship. Medical schools should be partners in
global efforts to reduce antimicrobial resistance.
BACTERIAS
Is Fidaxomicin Worth the Cost? An Economic Analysis
Sarah M. Bartsch, et al.
Clin Infect Dis (published 23 May 2013), doi 10.1093/cid/cit346 (enlace)
Our model suggests that when approximately 50% of isolates are NAP1/BI/027, fidaxomicin use for Clostridium difficile infection is not cost-effective at its current
cost. However, typing and treatment with fidaxomicin based on strain may be more
promising depending on its costs.
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Colistin and Rifampicin Compared With Colistin Alone for the Treatment of Serious
Infections Due to Extensively Drug-Resistant Acinetobacter baumannii: A Multicenter, Randomized Clinical Trial
Emanuele Durante-Mangoni, et al
Clin Infect Dis 2013 57: 349-358 (enlace)
In this randomized trial including patients with serious extremely drug-resistant Acinetobacter baumannii infections, the combination of rifampicin with colistin did not
reduce 30-day mortality, infection-related death, or hospitalization length. It did increase the eradication rate from the primary infectious source.
U.S. Hospitalizations for Pneumonia after a Decade of Pneumococcal Vaccination
Marie R. Griffin, et al
N Engl J Med 2013; 369:155-163
Declines in hospitalizations for childhood pneumonia were sustained during the decade after the introduction of PCV7. Substantial reductions in hospitalizations for
pneumonia among adults were also observed.
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Treatment Trials for Post-Lyme Disease Symptoms Revisited
Mark S. Klempner, e al.
American Journal of Medicine 2013; 126: 665-669.
Some patients given recommended antibiotic therapy for Lyme disease have nonspecific symptoms, believed—but not proven—to be caused by a persistent Borrelia
infection. Four clinical trials report that extended antibiotic therapy is of little or no
benefit; however, others claim that these trials are flawed.
The present analysis of all 4 trials reaffirms that extended antibiotic therapy provides no meaningful benefit.
VIRUS
Interhuman transmissibility of Middle East respiratory syndrome coronavirus: estimation of pandemic risk
Romulus Breban et al
Lancet 2013; 382: 694 – 699 (enlace)
Our analysis suggests that MERS-CoV does not yet have pandemic potential. We
recommend enhanced surveillance, active contact tracing, and vigorous searches for
the MERS-CoV animal hosts and transmission routes to human beings.
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Marijuana Smoking Does Not Accelerate Progression of Liver Disease in HIV–
Hepatitis C Coinfection: A Longitudinal Cohort Analysis
Laurence Brunet, et al.
Clin Infect Dis published 28 June 2013, doi: 10.1093/cid/cit378 (enlace)
In a large HIV-HCV coinfection cohort, we found no evidence that marijuana smoking accelerated progression to significant liver fibrosis, cirrhosis, or end-stage liver
disease. Previous studies reporting an association may have been biased by reverse
causation due to self-medication.
HCV reinfection incidence and treatment outcome among HIV-positive MSM in
London
Martin, Thomas C.S et al
AIDS 2013 June 3 Epub (enlace)
"Combining first, second and third reinfections, there were 54 reinfections in total"
"Our results demonstrate a high risk of HCV reinfection among HIV-positive MSM
who are either treated for or who spontaneously clear their initial HCV infection. As
many as 25% of individuals treated for HCV will become reinfected within 2 years.
These results emphasize the need for effective sexual education for HIV-positive
MSM presenting with primary HCV infection and the implementation of preventative
interventions to reduce the risk of reinfection. Given their high risk, we recommend
enhanced surveillance of previously infected individuals to enable the early detection and treatment of any reinfections. New UK guidelines have been updated to reflect this by recommending HCV PCR testing every 3-6 months among individuals
who remain at risk following incident infection clearance [30]."
HIV/AIDS: Is Intrapartum Intravenous Zidovudine for Prevention of Mother-toChild HIV-1 Transmission Still Useful in the Combination Antiretroviral Therapy
Era?
Nelly Briand, et al
Clin Infect Dis published 31 May 2013, doi: 10.1093/cid/cit374 (enlace)
Intrapartum intravenous zidovudine in antiretroviral therapy–treated women mays
not be necessary when maternal viral load is low at delivery, but it remains an effective tool to reduce mother-to-child HIV transmission in cases of virological failure.
Investigational treatment suspension and enhanced cell-mediated immunity at
rebound followed by drug-free remission of simian AIDS
Iart Luca Shytaj et al
Retrovirology 2013, 10:71 doi:10.1186/1742-4690-10-71 (Enlace)
Our data suggest that a combined H-iART/auranofin/BSO treatment was followed by
aradical change in disease progression after therapy suspension. This change was associated with enhanced specific immune responses following viral rebound after
therapy suspension, thus suggesting the establishment of an “immune state” [7].
Similar effects had previously been observed only in the period immediately after
acute infection but not in a pre-AIDS stage [21,39-41]. Although fully controlled studies involving larger numbers of macaques will be necessary in order to obtain further
mechanistic insight, it is becoming increasingly evident that dramatic changes in disease progression cannot be evaluated only in terms of sheer numbers of study subjects [38,43]. Whether these results may pave the way to a significant improvement
of current “ART-for-life” therapies will need to be assessed in human clinical trials.
Antiretroviral Therapy Initiated within Six Months of HIV Infection is Associated
with Lower T-cell Activation and Smaller HIV Reservoir Size
Vivek Jain et al
J Infect Dis published 12 July 2013, 10.1093/infdis/jit311 (enlace)
ART initiation <6 months following infection is associated with lower T-cell activation
and smaller HIV DNA and RNA reservoir size during long-term therapy
Figure 2. HIV DNA and cell-associated RNA levels in participants initiating early versus later ART.
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(A) Box plots showing median log10(HIV DNA level), IQR (box), and adjacent values
(1.5x IQR; whiskers) in patients starting early ART (green boxes) or later ART (orange
boxes) assessed one year following ART initiation (“1Y ART”) and at particpants’ last
available timepoint (“Max ART”). (B) Analogous box plots depicting cell-associated
HIV RNA levels (S/Co units) in same subject groups and timepoints.
High incidence of serious adverse events in HIV-infected patients treated with a
telaprevir-based hepatitis C virus treatment regimen
Cachay, E.R.et al.
AIDS. 2013 Jul 9. doi: 10.1097/01.aids.0000432466.15885.14 (enlace)
Of the 24 consecutive patients treated for HCV using telaprevir/pegylated interferon
/ribavirin, 50% (12/24) developed serious adverse events and 29% (7/24) discontinued HCV treatment due to adverse events, despite an intensive multidisciplinary
monitoring approach.
Response to Rituximab-Based Therapy and Risk Factor Analysis in Epstein Barr Virus–Related Lymphoproliferative Disorder After Hematopoietic Stem Cell Transplant in Children and Adults: A Study From the Infectious Diseases Working Group
of the European Group for Blood and Marrow Transplantation
Jan Styczynski, et al
Clin Infect Dis published 13 June 2013, 10.1093/cid/cit391 (enlace)
More than two-thirds of patients with Epstein-Barr virus–related posttransplant
lymphoproliferative disorder after hematopoietic stem cell transplant can be cured
with rituximab-based treatment. Reduction of immunosuppression is associated
with improved outcome; older age, extranodal disease, and acute graft-vs-host disease predict poor outcome.
Figure 2. Posttransplant lymphoproliferative disease (PTLD)–related mortality (PRM),
overall survival (OS), and prognostic survival model.
A, Cumulative incidence of PRM in 144 patients with PTLD treated with rituximab. B,
Probability of OS (estimate and confidence interval at 3 years) in the same cohort.
C, Cumulative incidence of PRM of the 51 patients who could reduce immunosuppression therapy upon PTLD diagnosis (RI) compared with the 93 patients who could
not reduce immunosuppression (no RI). D, Probability of OS in patients with RI compared with patients with no RI. Combined approach with rituximab and RI was associated with significantly reduced PRM (P = .006) and improved OS (P = .024). E, Cumulative incidence of PRM according to the number of the following risk factors for
each patient: age ≥ 30 years at transplant, extranodal involvement, acute graft-vshost disease (GVHD) ≥ grade II at PTLD diagnosis, and no RI. The higher the number
of risk factors, the worse the outcome: PRM with 0–1, 2, or 3 factors were 7%, 37%,
and 72%, respectively (P < .0001), and the number of events was 4 of 58, 22 of 59,
and 13 of 18, respectively. No patient presented with 4 factors simultaneously. F,
Probability of OS according to the number of the following risk factors for each patient: age ≥30 years at transplant, malignant disease, acute GVHD ≥grade II at PTLD
diagnosis, and no RI. A higher number of risk factors was associated with an increasingly poor prognosis: 3-year OS rates with 0–1, 2, or 3 factors were 73%, 52%, and
26%, respectively (P < .0001), and the number of events was 12 of 49, 19 of 41, and
35 of 45, respectively. No patient presented with 4 factors simultaneously. Abbreviations: CI, confidence interval; OS, overall survival; PTLD, posttransplant lymphoproliferative disorder; RI, reduction of immunosuppression.
Clinical effects of viral relapse after interferon plus ribavirin inpatients co-infected
with human immunodeficiency virus and hepatitis C virus
Berenguer J et al.
J Hepatol. 2013;58(6):1104-12. doi: 10.1016/j.jhep.2013.01.042.
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Fig. 1.Proportion of patients free from events. (A)Overall mortality,(B)liver- related
events (liver-related mortality, liver decompensation, hepatocellular carcinoma, liver
transplantation) according to treatment respons e,(C) liver decompensation, and
(D)hepatocellular carcinoma. ⁄p <0.05 with the NR group (Log-Rank test); _p <0.05
with the REL group (Log-Rank test). SVR, Sustained virologic response; REL, end-oftreatment response with subsequent relapse; NR, no response.
Ritonavir-boosted lopinavir plus nucleoside or nucleotide reverse transcriptase
inhibitors versus ritonavir-boosted lopinavir plus raltegravir for treatment of HIV-1
infection in adults with virological failure of a standard first-line ART regimen
(SECOND-LINE): a randomised, open-label, non-inferiority study.
SECOND-LINE Study Group
Lancet. 2013;381:2091-9. doi: 10.1016/S0140-6736(13)61164-2. (enlace)
NS5A inhibitors in the treatment of hepatitis C.
Pawlotsky JM.
J Hepatol. 2013; 59:375-82. doi: 10.1016/j.jhep.2013.03.030
Hepatitis C virus infection is a major health problem worldwide and no vaccine has
yet been developed against this virus. In addition, currently approved pharmacotherapies achieve suboptimal cure rates and have side effects that result in noncompliance and premature treatment discontinuation. Significant research has been
devoted to developing direct-acting antiviral agents that inhibit key viral functions.
In particular, several novel drug candidates that inhibit the viral non-structural protein 5A (NS5A) have been demonstrated to possess high potency, pan-genotypic activity, and a high barrier to resistance. Clinical trials using combination therapies
containing NS5A inhibitors have reported results that promise high cure rates and
raise the possibility of developing interferon-free, all-oral regimens.
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Improvements of neurocognitive function in responders to an antiviral therapy for
chronic hepatitis C.
Kraus MR, et al.
Hepatology. 2013;58:497-504. doi: 10.1002/hep.26229.
Conclusion: Successful eradication of HCV eads to a significant improvement of relevant aspects of attentional and neurocognitive performance, indicating that the neurocognitive impairment caused by chronic HCV infection is potentially reversible.
This therefore suggests an added therapeutic benefit of antiviral treatment in HCV
infection. Improvement of neurocognitive function may be an additional treatment
indication in patients with HCV.
Relationship Between Weight, Efavirenz Exposure, and Virologic Suppression in HIVInfected Patients on Rifampin-Based Tuberculosis Treatment in the AIDS Clinical
Trials Group A5221 STRIDE Study
Anne F. Luetkemeyer, et al
In human immunodeficiency virus (HIV)/tuberculosis–coinfected patients, coadministration of efavirenz (EFV) and rifampin-based tuberculosis therapy was associated
with a trend toward higher, not lower, EFV trough concentrations compared to EFV
alone. Neither weight ≥50 kg nor ≥60 kg was associated with decreased HIV virologic
suppression.
Dolutegravir versus raltegravir in antiretroviral-experienced, integrase-inhibitornaive adults with HIV: week 48 results from the randomised, double-blind, noninferiority SAILING study
Pedro Cahn, et al.
Lancet 2013; 382:700-708 (enlace)
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HONGOS
Antifungal Therapy and Management of Complications of Cryptococcosis due to
Cryptococcus gattii
Sharon C.-A. et al.
Induction amphotericin plus 5-flucytosine is indicated for Cryptococcus gattii lung (2
weeks) and neurologic disease (6 weeks), followed by fluconazole (total course 6–12
and 18 months, respectively). Shunting for raised intracranial pressure is frequent.
Immune reconstitution inflammatory syndrome occurs in 9% of cases.
Figure 1. Bar chart showing body sites of infection in 86 patients with Cryptococcus
gattii infection. Abbreviations: CNS, central nervous system; lung–CNS, lung infection
in the absence of CNS infection; CNS-lung, CNS infection in the absence of lung infection; CNS + skin, both CNS and skininfection; blood + other, bloodstream infection
plus at least 1 other siteof infection; lung, lung infection only.
PARASITOS
Exchange Transfusion for Severe Malaria: Evidence Base and Literature Review
Kathrine R. Tan, et al
Clin Infect Dis published 24 June 2013, doi: 10.1093/cid/cit429 (enlace)
Despite biologic plausibility for using exchange transfusion (ET) as an adjunct to antimalarial drugs for treatment of severe malaria, this matched study and a comprehensive literature review provided no evidence for ET's efficacy on survival. Adjunct
ET cannot be recommended.
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