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PubMed1994

Drugs of abuse and infectious diseases.

The association of increased severity of infectious diseases and recreational drug abuse can be traced to the last century with the finding that alcoholics often suffered more severely from bacterial pneumonia than nonalcoholics. More recently there have been numerous associations with use of opiate and other psychogenic drugs and increased incidence and severity of a variety of infectious diseases including the human immunodeficiency virus and development of AIDS. In fact, the AIDS epidemic has heightened awareness of the importance of abused drugs as cofactors in disease precipitation and severity. Evidence is examined for the role of opiates, marijuana, and alcohol as substances that promote infectious diseases.

Acquired Immunodeficiency Syndrome↗
PubMed2001

[Infectious diseases in Poland in 1999].

Improvement of epidemiological situation of infectious diseases was continued in Poland in 1999. The end of epidemics of measles, pertussis, mumps, scarlatine, chickenpox, and rubella was observed. In comparison with the number of cases of infectious diseases registered in 1998, decrease in the number of notified cases of salmonellosis, dysentery, meningitis, encephalitis, and hepatitis type B and A as well as increase in the number of influenza cases and trichinosis was noticed. In 1999, compared with 1998, among all notified deaths percentage of deaths attributed to infectious diseases (0.80%) and infectious diseases death rate (7.71 per 100,000) were slightly higher as an effect of the influenza deaths increase.

Adolescent↗
PubMed1995

Sleep, sleep deprivation and infectious disease: studies in animals.

Common perceptions that the desire for sleep is increased during mild infectious diseases like colds and 'the flu' have fostered beliefs that sleep promotes recovery from infectious disease and that lack of sleep increases susceptibility to infections. However, until recently, the relationship between infectious disease and vigilance received relatively little systematic study. At present, several model systems provide evidence that infectious disease is accompanied by alterations in sleep. Indeed, increased sleepiness, like fever and anorexia, may be viewed as a facet of the acute phase response to infectious challenge. Recent studies also suggest that sleep, sleep deprivation and infectious disease may be related via mechanisms of the immune system (Fig. 1). Data are now accumulating to address questions such as whether immune processes alter sleep, whether sleep or sleep deprivation influences immune competence, and whether sleep facilitates recovery from infectious disease.

Acetylmuramyl-Alanyl-Isoglutamine↗
PubMed2006

Influence of diabetes and hyperglycaemia on infectious disease hospitalisation and outcome.

AIMS/HYPOTHESIS: Diabetes mellitus is believed to increase susceptibility to infectious diseases. The effects of hyperglycaemia per se on infectious disease risk are unknown and the influence of diabetes on infectious disease outcome is controversial. MATERIALS AND METHODS: We studied 10,063 individuals from the Danish general population, who were participants in The Copenhagen City Heart Study, over a follow-up period of 7 years. Risk of hospitalisation caused by any infectious disease, and subsequent risk of disease progression to death were estimated by Cox proportional hazards regression analysis. RESULTS: At baseline, 353 individuals reported having diabetes. During 71,509 person-years of follow-up, a total of 1,194 individuals were hospitalised because of an infection. The risk of pneumonia (adjusted hazard ratio [aHR] 1.75, 95% CI 1.23-2.48), urinary tract infection (aHR 3.03, 95% CI 2.04-4.49) and skin infection (aHR 2.43, 95% CI 1.49-3.95) was increased in subjects with diabetes compared with subjects without. Each 1 mmol/l increase in plasma glucose at baseline was associated with a 6-10% increased relative risk of pneumonia, urinary tract infection and skin infection after adjustment for other possible confounders. Among patients hospitalised for urinary tract infection, diabetic patients were at an increased risk of death at 28 days after admission compared with non-diabetic subjects (HR 3.90, 95% CI 1.20-12.66). CONCLUSIONS/INTERPRETATION: In the Danish general population, diabetes and hyperglycaemia are strong and independent risk factors for hospitalisation as a result of pneumonia, urinary tract infection and skin infection. Further, diabetes has a negative impact on the prognosis of urinary tract infection.

Blood Glucose↗
PubMed2000

Economic cost to New Zealand of foodborne infectious disease.

AIMS: To estimate the annual economic cost to New Zealand of foodborne infectious disease. METHODS: Annual incidence rates were combined with unit cost data to derive estimates of the annual economic cost to society of each foodborne infectious disease. Market prices and wages were used as proxies for the unit costs of resource utilisations. A decision analytic model was developed to estimate the costs of each disease and to undertake sensitivity analysis. RESULTS: There are an estimated 119 320 episodes of foodborne infectious disease per year in New Zealand (3241 per 100 000 population). The total cost of these cases was $55.1 million ($462 per case) made up of direct medical costs of $2.1 million, direct non-medical costs of $0.2 million, indirect cost of lost productivity of $48.1 million, and intangible cost of loss of life of $4.7 million. Campylobacteriosis generated most of the costs. Lost productivity was the major cost component for all diseases. The total cost of potentially foodborne infectious disease was estimated to be $88.8 million. Broad estimates of additional costs due to cases of infectious intestinal diseases caused by non-foodborne pathogens or for which no pathogen is identified could raise the cost to $215.7 million. CONCLUSION: The findings imply that resources of $55 million could be devoted to prevention of foodborne infectious disease. Efforts should focus on lowering the incidence of campylobacteriosis as this disease accounts for most of foodborne illness costs.

Disease Outbreaks↗
PubMed2005

Infectious diseases during wartime.

PURPOSE OF REVIEW: The infectious disease challenges of war include pathogens endemic to the geographic area of operations as well as wound infections with common environmental microorganisms. This review summarizes papers, unpublished data and personal communications from 2004-2005 pertaining to infectious diseases during war with a focus on the current operations in Iraq and Afghanistan. RECENT FINDINGS: To date, there have been several hundred cases of cutaneous leishmaniasis and five cases of visceral leishmaniasis among US military personnel serving in southwest Asia. There have been reports of malaria in soldiers serving in Afghanistan and an outbreak of acute eosinophilic pneumonia among soldiers serving in or near Iraq. Diarrheal illness is a well-known threat to military operations and remains problematic for combatants throughout the theater of operations. Infectious complications caused by multiply drug-resistant Acinetobacter baumannii have been particularly challenging for healthcare providers managing the wounded evacuated from Iraq. We are now facing outbreaks of nosocomial infection with this pathogen in military treatment facilities in Europe and the USA. SUMMARY: Historically, infectious diseases have had significant impact on the conduct of military operations, and the conflict in southwest Asia is no exception. Physicians caring for returning military personnel should be aware of the diseases prevalent in this campaign, particularly cutaneous leishmaniasis and infections with multiply drug-resistant A. baumannii.

Afghanistan↗
PubMedDate not supplied

[Relevance of infectious diseases in a pediatric practice].

According to official statistics, infectious diseases only play a minor role in German children. To test this assumption, 1685/3405 charts of a private pediatrician were randomly chosen for further evaluation. 1112/1685 children had been seen in the office during the study period, 934 of them because of an infectious disease (83%). 700/934 charts were further reviewed in a standardized fashion. Pharyngo-tonsillitis was the most frequent diagnosis (18.6%), followed by (non-obstructive) bronchitis (18.5%), infectious diseases of the skin (10.2%) and Otitis media (9.9%). Typical "childhood diseases" (measles, mumps, rubella, varicella) only played a minor role. For some diseases age-specific as well as seasonal changes in incidence could be observed. These data suggest that infectious diseases largely contribute to the morbidity in German children. Prospective epidemiological trials are needed to obtain reliable data for appropriate public health decisions.

Adolescent↗
PubMed2004

Emerging infectious diseases: vulnerabilities, contributing factors and approaches.

We live in an ever more connected global village linked through international travel, politics, economics, culture and human-human and human-animal interactions. The realization that the concept of globalization includes global exposure to disease-causing agents that were formerly confined to small, remote areas and that infectious disease outbreaks can have political, economic and social roots and effects is becoming more apparent. Novel infectious disease microbes continue to be discovered because they are new or newly recognized, have expanded their geographic range, have been shown to cause a new disease spectrum, have jumped the species barrier from animals to humans, have become resistant to antimicrobial agents, have increased in incidence or have become more virulent. These emerging infectious disease microbes may have the potential for use as agents of bioterrorism. Factors involved in the emergence of infectious diseases are complex and interrelated and involve all classifications of organisms transmitted in a variety of ways. In 2003, outbreaks of interest included severe acute respiratory syndrome, monkeypox and avian influenza. Information from the human genome project applied to microbial organisms and their hosts will provide new opportunities for detection, diagnosis, treatment, prevention, control and prognosis. New technology related not only to genetics but also to satellite and monitoring systems will play a role in weather, climate and the approach to environmental manipulations that influence factors contributing to infectious disease emergence and control. Approaches to combating emerging infectious diseases include many disciplines, such as animal studies, epidemiology, immunology, ecology, environmental studies, microbiology, pharmacology, other sciences, health, medicine, public health, nursing, cultural, political and social studies, all of which must work together. Appropriate financial support of the public health infrastructure including surveillance, prevention, communication, adherence techniques and the like will be needed to support efforts to address emerging infectious disease threats.

Climate↗
PubMed2002

A re-appraisal of the burden of infectious disease in New Zealand: aggregate estimates of morbidity and mortality.

AIM: To assess the aggregate burden of infectious disease in New Zealand in terms of mortality and hospital admissions. METHODS: New Zealand mortality records for the years 1980-1998, and hospital discharges for the period 1988-2000, were re-analysed using a recoding of ICD-9 codes to estimate the aggregate burden of infectious disease. The recoding scheme was modified, as in an earlier analysis, from that developed by Centers for Disease Control and Prevention. RESULTS: Following recoding, the proportion of deaths attributable to infectious disease increased from 0.7% of deaths to 6.6% of deaths. Likewise recoding of hospital discharges showed an increase in the proportion due to infectious disease from 2.2% to 12.6%, second only to "complications of pregnancy, childbirth and the puerperium". Over the study period infectious disease mortality rates have showed little decline, and there has been a nearly 60% increase in infectious disease hospital discharge rates. CONCLUSIONS: The findings confirm and extend those of an earlier study, indicating the substantial burden of disease that is still attributable to infectious disease in New Zealand. The burden remains inequitable.

Adolescent↗
PubMed2003

Treating obsessive compulsive disorder: a new role for infectious diseases physicians?

BACKGROUND: Patients with psychiatric disorders are often seen by infectious disease physicians. Sometimes the psychiatric condition is the primary disorder, and the physician's main task is the early identification of the disorder and referral to specialist psychiatric services. On other occasions, the psychiatric condition will need to be addressed in addition to the infectious disease, and the physician aims to treat in conjunction with a psychiatrist. It is rare for referrals to be made from psychiatry to infectious diseases physicians. METHOD: A single case study is used to describe a modification of Danger Ideation Reduction Therapy (DIRT), a novel intervention for obsessive compulsive disorder (OCD). In our modification the infectious diseases physician plays a key, collaborative role in the psychological treatment of the patient. RESULTS: Although an uncontrolled trial, results from the modified DIRT protocol are encouraging and warrant replication in a randomised controlled trial. CONCLUSIONS: A collaborative approach by the infectious diseases physician, the microbiology laboratory and the psychologist can provide a valuable means of retaining patients with OCD in treatment and in the management of this common, disabling condition.

Adult↗
PubMed1995

Infectious diseases.

Routine antenatal screening can detect some potentially serious infectious diseases or susceptibility to infection and allow intervention to prevent adverse outcomes. However, screening programmes can only be justified if appropriate criteria are met for the quality of laboratory tests and interventions. For many infections that are associated with adverse maternal or fetal effects, there are no suitable, cost-effective methods of screening or prevention. However, early diagnosis of infection in high-risk women or those with symptoms can allow preventive intervention. Acute febrile illness or other symptoms consistent with infection during pregnancy should be investigated more diligently than in a non-pregnant woman. Early diagnosis of an apparently trivial maternal infection may prevent serious fetal disease. When the diagnosis of maternal infection is made, appropriate action depends on the nature of infection and the stage of pregnancy at which it occurs. The results of serological test should be confirmed, preferably by a reference laboratory, by retesting the original specimen(s) and/or testing further specimens, as appropriate. Management decisions generally should be made in consultation with an infectious disease physician or clinical microbiologist with experience of infectious diseases in pregnancy.

Female↗
PubMed1985

Declining fertility in England and Wales as a major cause of the twentieth century decline in mortality. The role of changing family size and age structure in infectious disease mortality in infancy.

The decline in infectious disease mortality in England and Wales beginning about 1880 has been attributed to improved nutrition, hygiene, and sanitation. Such an explanation does not adequately explain the lack of improvement in infant and diarrheal disease mortality before 1900 nor the abrupt subsequent decline. A hypothesis was proposed that the decline in fertility rate was a major cause of the decline in infant mortality by raising the median age at infection. The hypothesis could only be tested indirectly. A review of morbidity data demonstrates the importance of family characteristics on the median age at infection for measles, pertussis, and common respiratory illness. The association of parity with infectious disease mortality supports the hypothesis. A method was developed for estimating the change in birth order distribution resulting from declining fertility. Using 1949-1950 data, it was shown that declining fertility could account for at least a 24% decline in postneonatal mortality due to bronchitis and pneumonia. Age-specific measles mortality rates are consistent, with an increase in age at infection. Declining fertility appears to have played a major role in the decline in infectious disease mortality in England and Wales by increasing the median age at infection.

Adolescent↗
PubMed2001

Infectious diseases: career preparation.

The human resources for the discipline of Infectious Diseases are inadequate in many countries. There is no global definition of "Infectious Diseases" physicians and cover competency. Preparation for a career in this speciality varies greatly. In large populations in Asia and Africa, few individuals exist who have been trained to be Infectious Disease Clinicians. There is a great need by national and international societies to embrace this speciality and address the global deficiencies in this discipline by directing funding agencies as well as training institutions to redirect resources to strengthen the capacity of health professionals to deal with infectious diseases adequately throughout the world.

Africa↗
PubMed1997

[Optimal antibacterial chemotherapy for infectious diseases associated with hematological malignancies].

The status quo of infectious diseases associated with hematological malignancies was examined for clinical consideration. In addition, in vitro antibacterial activities and combination effects were also examined by means of various isolated strains derived from sepsis. In clinical practice, 76% of the fevers in patients with hematological malignancies was attributed to infectious diseases mainly involving "fever with granulocytopenia", sepsis, and pneumonia. The detection rate of causal pathogen remained at a low level and more than half of the causes of death were infectious diseases. In the in vitro examination, a favorable antibacterial effect was noted with vancomycin (VCM) for methicillin resistant Staphylococcus aureus (MRSA) and Enterococcus spp., imipenem (IPM) for methicillin sensitive S. aureus (MSSA), and ciprofloxacin, amikacin (AMK), and IPM for Pseudomonas aeruginosa and intestinal flora. But its clinical effect is not enough. Synergic and/or additive effect can be expected by combining IPM with VCM for MRSA and Enterococcus spp., and IPM with AMK for P. aeruginosa. These combination therapies were considered to be optimal as antibacterial chemotherapy for infectious diseases associated with hematological malignancies.

Adult↗
PubMed2001

Influence of an infectious disease consulting service on quality and costs of antibiotic prescriptions in a university hospital.

An infectious disease consulting service was set up at a large tertiary university hospital in 1996 to evaluate and to improve antibiotic prescription patterns. Treatment guidelines for the most common bacterial infections were implemented. On daily ward rounds antibiotic therapies without evidence of an infectious disease were stopped and inappropriate regimens were changed by an infectious disease specialist. During a 6-month prospective intervention period, 3,528 patients were studied on 13 wards of the department of internal medicine; 513 of these patients (14.5%) received antibiotic therapy. These treatment courses were evaluated as adequate in 394 cases (76.8%) and incorrect in 119 cases (23.2%). Inadequate antibiotic substances were chosen in 72 out of 119 cases (60.5%) and there was no indication for treatment in 38 out of 119 cases (32%). Pathogen-specific therapies were inadequate significantly more often than empirical antimicrobial therapies (p < 0.001). In addition, the duration of the perioperative prophylaxis could be limited to 1 d. Comparing the intervention period with a 3-month control interval without an infectious disease consulting service, a total of 31,510 Euro (including the costs for the infectious disease specialist) could be saved. No increase in infection-related mortality or length of stay was observed. These data show that an infectious disease consulting service optimizes antibiotic usage, and is cost-effective as a result of a significant cost reduction in hospitals, while not interfering with the quality of medical care.

Anti-Bacterial Agents↗
PubMed2004

[Comparative study of infectious diseases in immigrant children from various countries].

INTRODUCTION: Immigrants have a higher risk of contracting some infectious diseases. The aim of this study was to determine and compare the morbidity profile of immigrant children according to their country of origin. MATERIAL AND METHODS: We performed a descriptive study of all immigrants aged less than 14 years old who attended the Tropical Medicine Unit of the Ramon y Cajal Hospital in Madrid between 1989 and 2001. RESULTS: A total of 170 children were included (73 % from Africa, 19 % from Latin America, and 5 % from Asia). Seventy-five percent had at least one infectious disease (78 % of Africans and 62 % of Latin Americans) and 27 % were co-infected (> 2 pathogenic agents). The proportion of healthy children was higher (p < 0.05) among Latin Americans (21 %) than among Africans (9 %). The most frequent infectious diseases were malaria (35 %), intestinal parasites (48 %), filariasis (23 %), and viral hepatitis (19 %). Malaria, filariasis and hepatitis were more frequent in Africans than in Americans (p < 0.05). Other helminthic infections (15 %) were more frequent in Americans. In both groups intestinal parasites and tuberculosis (6 %) were prevalent. Of the 36 (21 %) asymptomatic children, 53 % had at least one infectious disease. The most frequently diagnosed diseases in Africans were intestinal parasitosis (35 %), malaria (7 %), cured hepatitis B (15 %), filariasis (12 %) and superficial mycosis (4 %). The most frequent infectious diseases in Latin Americans were intestinal parasitosis (38 %) and visceral toxocariasis (25 %). CONCLUSIONS: Infectious diseases and co-infections are frequent in immigrant children, even in those who are asymptomatic. We propose screening of certain infectious diseases in these children according to their country of origin and their length of residence in Spain.

Adolescent↗
PubMed2003

Infectious disease hospitalizations among American Indian and Alaska native infants.

OBJECTIVE: To describe the burden and trends in hospitalizations associated with infectious diseases among American Indian and Alaska Native (AI/AN) infants. METHODS: First-listed infectious disease hospitalizations and hospitalization rates among AI/AN infants and infants in the general US population from 1988-1999 were analyzed by using Indian Health Service/tribal hospital discharge data and the National Hospital Discharge Survey data, respectively. RESULTS: Infectious disease hospitalizations accounted for 53% of all AI/AN infant hospitalizations and approximately 43% of all US infant hospitalizations during 1988-1999. The annual hospitalization rate for infectious diseases among AI/AN infants declined from 27,486 per 100,000 infants in 1988 to 14,178 per 100,000 infants in 1999. However, the rates for AI/AN infants within the Alaska, Southwest, and Northern Plains regions remained higher than that for the general US infant population at the end of the study period. Lower respiratory tract infection hospitalizations accounted for almost 75% of AI/AN infant infectious disease hospitalizations, and the lower respiratory tract infection hospitalization rate for AI/AN infants was twice that for US infants. CONCLUSIONS: Although infectious disease hospitalization rates for AI/AN infants have declined, AI/AN infants continue to have a higher infectious disease burden than the general US infant population.

Age Factors↗