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PubMed1995

[New immunopathogenetic aspects of infectious diseases].

The clinical course of infectious diseases depends on the complicated interaction between the microorganism and the immune system of the host. The vast amount of knowledge acquired during recent years in the field of immunology will probably lead to new ways of treating infectious diseases by selective immunomodulation. In this paper, we review some newer aspects of host defence mechanisms of relevance to immunomodulation of infectious diseases. The cytokine network, apoptosis, superantigens, and oxidative stress are all discussed with reference to various infectious diseases. Furthermore, the possible role of physical and psychological stress in the immunopathogenesis of infectious disease is discussed in the light of the interplay between the immune system and the neuroendocrine system.

Antigens, Bacterial↗
PubMedDate not supplied

[Epidemiological, clinical, etiological features of neuromeningeal diseases at the Fann Hospital Infectious Diseases Clinic, Dakar (Senegal)].

OBJECTIVES: This retrospective study was carried out to determine the prevalence of cerebromeningeal diseases at the Fann Teaching Hospital Infectious Diseases Clinic, in Dakar, and to describe their epidemiological, clinical, and etiological features. PATIENTS AND METHODS: Data was collected for analysis from patients files recorded from January 1, 2001 to December 31, 2003. RESULTS: Four hundred seventy cases were identified (11.4% of total admissions) with a M/F sex ratio of 1.38 and a mean age of 33 years. Eighty-nine patients were infected by HIV and clinical presentations included fever (78%), meningeal syndrome (57.4%), coma (64.9%), convulsions (19%), focal neurological deficits (15.5%), and cranial nerves dysfunction (7.2%). Etiologies presented as cerebral malaria (85 cases), purulent meningitis (51 cases), neuromeningeal cryptococcosis (37 cases), tuberculous meningitis (11 cases), intracranial abscess (10 cases), toxoplasma encephalitis (4 cases), cerebrovascular attack (11 cases), and cerebromeningeal hemorrhages (3 cases). In as many as 248 cases (52.8%) no etiology could be found. The case fatality rate was 44.5% overall (209 deaths) and 68.5% among HIV-infected patients. Neurological sequels were found in 22 survivors (8.8%), consisting in focal neurological deficit (12 cases), deafness (5 cases), diplopia (2 cases), dementia (2 cases), postmeningitic encephalitis (1 case). CONCLUSION: These results show the need to improve our technical capacities in our diagnostic laboratories, the prevention of opportunistic infections in the course of HIV/AIDS infection, and the involvement of various specialists in the management of cerebromeningeal diseases.

Adolescent↗
PubMedDate not supplied

Seasonal variation in host susceptibility and cycles of certain infectious diseases.

Seasonal cycles of infectious diseases have been variously attributed to changes in atmospheric conditions, the prevalence or virulence of the pathogen, or the behavior of the host. Some observations about seasonality are difficult to reconcile with these explanations. These include the simultaneous appearance of outbreaks across widespread geographic regions of the same latitude; the detection of pathogens in the off-season without epidemic spread; and the consistency of seasonal changes, despite wide variations in weather and human behavior. In contrast, an increase in susceptibility of the host population, perhaps linked to the annual light/dark cycle and mediated by the pattern of melatonin secretion, might account for many heretofore unexplained features of infectious disease seasonality. Ample evidence indicates that photoperiod-driven physiologic changes are typical in mammalian species, including some in humans. If such physiologic changes underlie human resistance to infectious diseases for large portions of the year and the changes can be identified and modified, the therapeutic and preventive implications may be considerable.

Communicable Diseases↗
PubMed2001

Preventing opportunistic infections after hematopoietic stem cell transplantation: the Centers for Disease Control and Prevention, Infectious Diseases Society of America, and American Society for Blood and Marrow Transplantation Practice Guidelines and beyond.

This review presents evidence-based guidelines for the prevention of infection after blood and marrow transplantation. Recommendations apply to all myeloablative transplants regardless of recipient (adult or child), type (allogeneic or autologous) or source (peripheral blood, marrow or cord blood) of transplant. In Section I, Dr. Dykewicz describes the methods used to rate the strength and quality of published evidence supporting these recommendations and details the two dozen scholarly societies and federal agencies involved in the genesis and review of the guidelines. In Section II, Dr. Longworth presents recommendations for hospital infection control. Hand hygiene, room ventilation, health care worker and visitor policies are detailed along with guidelines for control of specific nosocomial and community-acquired pathogens. In Section III, Dr. Boeckh details effective practices to prevent viral diseases. Leukocyte-depleted blood is recommended for cytomegalovirus (CMV) seronegative allografts, while ganciclovir given as prophylaxis or preemptive therapy based on pp65 antigenemia or DNA assays is advised for individuals at risk for CMV. Guidelines for preventing varicella-zoster virus (VZV), herpes simplex virus (HSV) and community respiratory virus infections are also presented. In Section IV, Drs. Baden and Rubin review means to prevent invasive fungal infections. Hospital design and policy can reduce exposure to air contaminated with fungal spores and fluconazole prophylaxis at 400 mg/day reduces invasive yeast infection. In Section V, Dr. Sepkowitz details effective clinical practices to reduce or prevent bacterial or protozoal disease after transplantation. In Section VI, Dr. Sullivan reviews vaccine-preventable infections and guidelines for active and passive immunizations for stem cell transplant recipients, family members and health care workers.

Humans↗
PubMed1996

Trends in infectious diseases mortality in the United States.

OBJECTIVE: To evaluate recent trends in infectious diseases mortality in the United States. DESIGN: Descriptive study of infectious disease mortality, classifying International Classification of Diseases, Ninth Revision codes as infectious diseases, consequence of infectious diseases, or not infectious diseases. Multiple cause-of-death tapes from the National Center for Health Statistics for the years 1980 through 1992 were used, with a focus on underlying cause-of-death data and on codes that exclusively represent infectious diseases. SETTING: United States. SUBJECTS: All persons who died between 1980 and 1992. MAIN OUTCOME MEASURE: Death. RESULTS: Between 1980 and 1992, the death rate due to infectious diseases as the underlying cause of death increased 58%, from 41 to 65 deaths per 100,000 population in the United States. Age-adjusted mortality from infectious diseases increased 39% during the same period. Infectious diseases mortality increased 25% among those aged 65 years and older (from 271 to 338 per 100,000), and 6.3 times among 25- to 44-year-olds (from six to 38 deaths per 100,000). Mortality due to respiratory tract infections increased 20%, from 25 to 30 deaths per 100,000, deaths attributed to human immunodeficiency virus increased from virtually none to 13 per 100,000 in 1992, and the rate of death due to septicemia increased 83% from 4.2 to 7.7 per 100,000. CONCLUSIONS: Despite historical predictions that infectious diseases would wane in the United States, these data show that infectious diseases mortality in the United States has been increasing in recent years.

Adolescent↗
PubMed2000

Detection of epidemics in their early stage through infectious disease surveillance.

BACKGROUND: Surveillance of infectious diseases is done in many countries. The aims of such surveillance include the detection of epidemics. In the present study, the possibility of detecting an epidemic in its early stage using a simple method was evaluated for 16 infectious diseases. METHODS: We used as an index the number of cases per week per sentinel medical institution in the area covered by a health centre in infectious disease surveillance in Japan in 1993-1997. Periods of epidemics in health centre areas were determined according to the reported indices. The simple method used for detecting the early stage of an epidemic is that if the index exceeds a critical value, then an epidemic will begin in the following 4 weeks. The sensitivity, specificity and positive predictive value for this epidemic warning were evaluated for given critical values. RESULTS: When the specificity of the epidemic warning was more than 95%, the sensitivity was more than 60% in ten diseases, and more than 80% in four diseases (influenza-like illness, rubella, hand-foot-and-mouth disease, and herpangina). The positive predictive value was between 15.6% and 31.4% in these ten diseases. CONCLUSION: The early stage of epidemics of some infectious diseases might be detectable using this simple method.

Communicable Diseases↗
PubMedDate not supplied

Classics in infectious diseases. Toxic products of Bacterium enteritidis and of related micro-organisms. By Sara Elizabeth Branham. Journal of Infectious Diseases 1925.

Filtrates of fluid cultures of Bact. enteritidis usually are toxic for rabbits and mice, but not guinea-pigs, when injected intravenously, but are apparently harmless when given by other routes. The time between the introduction of the poisonous fluids into the blood stream and symptoms of intoxication seems to bear no relation to the size of the dose, but is constantly about 40 to 45 minutes, whether the amount given be lethal or sublethal. The symptoms are restlessness, dyspnea, prostration, often diarrhea, and either death within 1 to 12 hours or slow recovery. The acute stage lasts about from 30 minutes to 1 hour. The most conspicuous finding at necropsy is marked general vasodilation, with edema of the lungs, and in many animals, both agglutination and platelet thrombi in the capillaries. The occurrence of toxicity in cultures is variable, but it may be found in any medium in which the organism grows. The poisons are thermostabile. Toxicity of broth and synthetic medium cultures appears after the number of living cells has reached its maximum and has begun to decrease. The toxic properties are demonstrable not only in filtrates of fluid cultures, but in autolysates, and with dead and living bacteria. Toxic materials, in dilutions in which no protein could be detected, stimulate the production of antibodies. The serum of rabbits immunized with them bestows definite protection on other rabbits when injected intravenously. Similar poisons are demonstrable with other members of the colon-typhoid group. The results appear to indicate that the poison demonstrated by these experiments is within the bacterial cells, is set free on cell disintegration, and probably is not a true soluble toxin.

Animals↗
PubMed2004

[Infectious diseases in Poland in 2002].

New regulations concerning infectious diseases effective in Poland since 2002 did not changed surveillance of infectious diseases. The most frequent infectious disease as in the previous years was influenza. 228.055 cases were reported (596.5/100,000). Number of foodborne infections and intoxications remains high--26.734 cases (69.0/100,000). 77% of them were caused by Salmonella. In this high number of foodborne infections in 4,492 (16.8%) etiologic factor was not found. In this number Campylobacter infections, rarely tested in Poland may be found. Especially alarming is number of cases of diarrhea among children 0-2. Age adjusted incidence of 2.464/100,000 is the highest occurrence among infectious diseases in Poland. There was noted decrease of incidence of newly diagnosed cases of viral hepatitis B (5.3/100,000) which dropped to the level of the incidence of viral hepatitis C (5.17/100,000). Hepatitis A remains at the low level (0.9/100,000). Level of newly diagnosed cases of AIDS (113 cases, 0.3/100,000) remains relatively stable for last few years. The major problem is decreasing reporting of possible risk factors. Infectious diseases caused 0.74% of deaths. Mortality from infectious diseases was 6.9/100,000 and was significantly higher among men (8.9) then among women. (5.1). In the age groups 35-64 it was 3-4 times higher. In urban settings mortality from infectious diseases was higher (7.2/100,000) then in the country (6.6). In particular districts (voivodeships) mortality indices remained in the range of 4.3 (opolskie) to 11.4 (ślaskie). As in previous years, the highest number of deaths was caused by tuberculosis and its late sequels (35.4%). Attention should be given to the increased number of deaths due to sepsis (33.6%, without neonatal sepsis).

Adolescent↗
PubMed1988

New challenges in infectious diseases.

Predicting the behaviour of infectious disease is particularly difficult because it is inextricably linked with microbial mutation and the potentially rapid expression of that change. Nevertheless, the dominant issue in infectious disease in New Zealand into the 1990s, and perhaps in all medicine, is the impact of the spread of HIV infection. Many other new agents and new causes for old familiar syndromes have also been unearthed in recent years and will continue to be so. We need to continue to explore aetiology, mechanisms of prevention and treatment for both the old and the new infectious diseases. Optimal vaccine delivery to those who most need it is a continuing challenge. New vaccines coming will complicate this. In treatment there has been a refreshing shift from chemotherapy to alternative approaches, perhaps summarised as attempts to enhance host immunity. All these treatments will need to be evaluated, and potentially uncomfortable cost benefit decisions made about the relative needs of all these competing costs in our health service. There are enormous research implications in this for basic scientists, laboratory microbiologists, infectious disease physicians and those in community health.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Infectious disease emergencies in primary care.

Infectious disease emergencies can be described as infectious processes that, if not recognized and treated immediately, can lead to significant morbidity or mortality. These emergencies can present as common or benign infections, fooling the primary care provider into using more conservative treatment strategies than are required. This review discusses the pathophysiology, history and physical findings, diagnostic criteria, and treatment strategies for the following infectious disease emergencies: acute bacterial meningitis, ehrlichiosis, Rocky Mountain spotted fever, meningococcemia, necrotizing soft tissue infections, toxic shock syndrome, food-borne illnesses, and infective endocarditis. Because most of the discussed infectious disease emergencies require hospital care, the primary care clinician must be able to judge when a referral to a specialist or a higher-level care facility is indicated.

Adult↗
PubMed2004

[Amendment to the infectious disease control law].

The Law Concerning the Prevention of Infectious Diseases and Medical Care for Patients of Infections (the Infectious Diseases Control Law) enacted on April 1, 1999, accompanies an additional rule for reconsideration in five years after putting the law in operation and for taking necessary steps when needed. The responses against bioterrorism involving anthrax and smallpox after the terrorist attacks on September 11, 2001, in the United States of America (a notice on October 11, 2001 by the Tuberculosis and Infectious Diseases Control Division, MHLW) and the response to severe acute respiratory syndrome (SARS), an emerging infectious disease upon which a Global Alert was issued on March 12, 2003, by WHO, were discussed. On November 5, 2003, partial amendment of the Infectious Diseases Control Law and the Quarantine Law was approved and put into operation on. In the present amendment, the following three points were principally reconsidered: 1. strengthening infectious disease control in an emergency, particularly the role of national government, 2. reviewing control strategy of infectious diseases of animal origin, and 3. reviewing target diseases of the Infectious Diseases Control Law and categories of infectious diseases.

Animals↗
PubMed1996

Relative bradycardia in infectious diseases.

Relative bradycardia in infectious diseases is a poorly defined term. No exact and useful definition exists and the underlying mechanisms are unknown. Despite this, the term is often used in the literature and in clinical practice both as a clinical sign for an individual patient and as a characteristic feature of certain specific diseases. In this study a definition of relative bradycardia as a clinical sign in an individual patient and a definition of relative bradycardia as a characteristic feature of a specific disease were established based on a reference population comprising 673 patients with various infectious diseases. Relative bradycardia as a clinical sign in an individual patient held no predictive value regarding the likely type of infection. Relative bradycardia as a characteristic feature of specific disease was found for typhoid fever (P = 0.003), Legionnaire's disease (P = 0.005), and pneumonia caused by Chlamydia sp. (P = 0.0005), but not for mycoplasma pneumonia. It was not found for other pulmonary infections, infections caused by other Salmonella sp., other extracellular Gram-negative infections, or viral infections. Thus, relative bradycardia as a clinical sign has no predictive value for obtaining a tentative diagnosis, but relative bradycardia as a feature of specific disease is seen in typhoid fever, Legionnaire's disease, and pneumonia caused by Chlamydia sp. It seems that relative bradycardia as a feature of specific disease only occurs in diseases caused by organisms that are both Gram-negative and intracellular.

Adolescent↗
PubMed2002

Emerging and re-emerging infectious diseases.

In human history, numerous infectious diseases have emerged and re-emerged. Aside from many others, the so-called 'exotic' agents in particular are a threat to our public health systems due to limited experience in case management and lack of appropriate resources. Many of these agents are zoonotic in origin and transmitted from animals to man either directly or via vectors. The reservoirs are often infected subclinically or asymptomatically and the distribution of the diseases basically reflects the range and the population dynamics of their reservoir hosts. As examples, emergence/re-emergence is discussed here for diseases caused by filoviruses, hantaviruses, paramyxoviruses, flaviviruses and Yersinia pestis. In addition, bioterrorism is addressed as one factor which has now to be considered in infectious disease emergence/re-emergence. Preparedness for known and unknown infectious diseases will be a top priority for our public health systems in the beginning of the millennium.

Animals↗