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PubMedDate not supplied

Kinetic logic: a tool for describing the dynamics of infectious disease behavior.

Most of the infectious diseases imply biological regulations controlled by several feedback loops or circuits. Kinetic logic, which is a method easily accessible to biologists or physicians, and which takes time and thresholds of activity into account, seems a convenient method for building simplified models related to this field. This implies usually qualitative predictions concerning the dynamics of such biological systems, leading to a movement back and forth between experimentation or observation and logical description. Here, we illustrate this simple modelling method in building elementary models concerning prion infection to demonstrate how to proceed. We also discuss and summarize how this method has been used for studying several viral diseases. As an example, we show how predictions related to the rhabdovirus cycle, were experimentally verified.

Animals↗

PubMed1984

Aging and infectious diseases: state of the art.

Infectious diseases are major causes for morbidity and mortality in the elderly population. A variety of factors contribute to the elderly person's increased susceptibility to infection. Diagnosis of infections in the old individual is often difficult, and antimicrobial strategies may have to be altered in this patient population. Newer and innovative strategies in management are needed in the field of aging and infections.

Aged↗

PubMed1999

Treatment of community-acquired pneumonia--IDSA guidelines. Infectious Diseases Society of America.

The Infectious Diseases Society of America (IDSA) has published guidelines for the treatment of community-acquired pneumonia (CAP). Although Streptococcus pneumoniae remains the most common etiologic agent, Chlamydia pneumoniae and Legionella pneumophila are also important causes. For all suspected CAP patients, particularly those requiring hospitalization, chest radiographs are strongly recommended to confirm the diagnosis. The IDSA guidelines, in contrast to those published by the American Thoracic Society, emphasize the use of sputum Gram's stain and culture in all patients, whenever possible, to establish etiology. This information can be used not only to guide therapy but also to track trends in the etiologic pathogens for CAP and their antibiotic susceptibility. In light of the better outcomes with the earliest possible interventions, the IDSA recommends initial empiric antimicrobial therapy until laboratory results can be obtained to guide more specific therapy. Macrolides, doxycycline, and fluoroquinolones are suggested for primary empiric therapy, since each has activity against common bacterial pathogens and atypical agents. Detailed antibiotic recommendations are made for various pathogens. For inpatients, attempts should be made to cover Legionella and other common pathogenic bacteria. Alternative antibiotics are recommended for patients with structural diseases of the lung, penicillin allergy, or suspected aspiration pneumonia. Switch to an appropriate oral antibiotic is recommended as soon as the patient's condition is stable and he or she can tolerate oral therapy, often within 72 h.

Adult↗

PubMed1987

Delays in notification of infectious disease.

The delays in notifying infectious diseases can have implications on the efficiency of public health intervention, and allowance should be made when interpreting time trends. Data on notification delays of 15 diseases over 30 years in nine Health Authorities in England are presented. Measles is the most rapidly notified (a median delay of five days between onset and notification) and tuberculosis the slowest (median two months). The notification delay has varied between diseases, between Districts and also over time, and appears to have increased in recent years. The differences are attributed to the relative ratity, acuteness and difficulty of diagnosis of the disease, to administrative differences between Districts and to changes in incidence over time.

Communicable Disease Control↗

PubMed2004

Lessons from preventive infectious disease vaccines.

Preventive vaccines for infectious disease indications are regulated by the Office of Vaccines Research and Review, CBER, FDA. FDA-regulated biological products, including vaccines, must be safe, pure, potent, and manufactured consistently according to current Good Manufacturing Practices. Regulatory issues include common principles of vaccine production and quality control, lot release testing, vaccine preclinical data, and clinical development. For Phase 3 studies, the following should be addressed: the case definition of the disease that the vaccine is intended to prevent (piloted during Phase 2) and the sample size to support efficacy and safety considerations. Also during development, validation data for immunological and other critical assays, clinical lot consistency studies, and the possible need for bridging studies, e.g., to support manufacturing changes or extrapolation to different populations, should be addressed.

Bacterial Vaccines↗

PubMedDate not supplied

Management of dental caries as an infectious disease.

Dental caries is an infectious disease that demineralizes tooth structure as a consequence of bacterial metabolism. Chemical suppression of bacteria, especially using stannous fluoride, is gaining popularity because of its practicality and clinical efficacy.

Child, Preschool↗

PubMed2005

Postgraduate training in infectious diseases: investigating the current status in the international community.

International collaboration and understanding is becoming increasingly important as we face a soaring number of emerging and re-emerging infectious diseases. Management of these conditions calls for a cohesive international effort, with contributions from many infectious disease specialists. To optimise collaborative efforts, an international understanding of training, capabilities, and skills would be valuable. An investigation of postgraduate training programmes in the infectious disease specialties around the world was done. 33 countries contributed information. 26 of these countries had established training programmes--one of which was changing its duration and research component; three were in the process of setting up programmes, two provided specialist training that had no official recognition, and two had no specialist training. In addition to promoting international understanding and collaboration, this article should catalyse a global assessment of postgraduate training programmes within the field of infectious diseases.

Communicable Diseases↗

PubMed2001

Predicting tuberculosis among HIV-infected patients admitted to hospital: comparison of a model with clinical judgment of infectious disease specialists.

The aim of this prospective study was to compare a model based on clinical variables with the clinical judgment of infectious disease specialists to identify HIV-infected patients requiring isolation at admission in order to prevent the nosocomial transmission of tuberculosis. Clinical, epidemiological and radiological variables available at admission were recorded for 362 admissions of 274 HIV-infected patients. Using multiple logistic regression analysis, a model to identify patients with tuberculosis was developed based on four clinical variables (node enlargement, constitutional symptoms, intravenous drug use, history of previous correct therapy for tuberculosis) and a positive auramine sputum stain. This model was applied to each of the 362 admissions studied. The decision made by the infectious disease specialist at admission was also recorded. The results indicate that application of the model would have allowed physicians to correctly identify and isolate 24 of 27 patients with tuberculosis, while 5.4 patients without tuberculosis would have been unnecessarily isolated for every patient with tuberculosis. The results for the infectious disease specialists were slightly better, with 26 of 27 patients with tuberculosis being identified and isolated correctly and only 3.2 patients being isolated unnecessarily for every patient with tuberculosis. Thus, a simple model based on clinical variables may be useful in helping physicians identify tuberculosis carriers among HIV-infected patients, but infectious disease specialists are able to identify them more efficiently.

AIDS-Related Opportunistic Infections↗

PubMed2000

Emerging infectious diseases in the 21st century.

The emergence of novel infectious diseases, and the re-emergence of others, is not new. The global ecosystem is constantly changing, influencing the micro- and macroenvironments in which humans and their microbial companions reside and interact. Sometimes the environmental circumstances favour the pathogen and there is an unexpected increase in disease activity or emergence of a new infection. Alternatively, pathogenicity factors are acquired by the microbe, allowing new diseases to emerge or old diseases to increase in importance. The forces that drive the emergence, submergence and re-emergence of infectious diseases are varied, but the influence that humans have on the global ecosystem is often of central importance. This review considers infections that are of particular emerging importance.

Journal Article↗

PubMed1998

[The number of beds needed for patients with infectious diseases that require hospitalization by law].

PURPOSE: Using a statistical model, a study was conducted on the number of beds that are needed for patients with infectious diseases who are required by law to be hospitalized. METHODS: Based on 1995 data, the incidence of such infectious diseases and the average duration of isolation of these patients in Japan were obtained. Using a Poisson distribution, the probability that the number of patients that exceeds a specific number over an average duration of hospitalization was computed in a finite population. The observation period was then extended to one year and the probability that the number of patients did not exceed a specific number during one year was calculated. RESULTS: In 1995, the annual incidence of infectious diseases requiring isolation by hospitalization was 1.38 per 100,000 population and the average duration of hospital confinement was 13.8 days. The estimated patient numbers calculated based on the probability of less than 0.001 that the number of patients would not exceed a specific number were: 2 for 30,000 population, 3 for 50,000 through 100,000, 5 for 200,000 and 300,000, 5 for 400,000 and 500,000, 6 for 750,000 and 1,000,000, 8 for 2,000,000, and 10 for 3,000,000. CONCLUSION: By using a Poisson distribution, a method was developed for estimating the number of beds that are needed for patients with infectious diseases when hospitalization was mandatory.

Communicable Disease Control↗

PubMed1988

Secular trends of infectious disease mortality in The Netherlands, 1911-1978: quantitative estimates of changes coinciding with the introduction of antibiotics.

Secular trends of mortality from 21 infectious diseases in the Netherlands were studied by inspection of age/sex-standardized mortality curves and by log-linear regression analysis. An attempt was made to obtain quantitative estimates for changes coinciding with the introduction of antibiotics. Two possible types of effect were considered: a sharp reduction of mortality at the moment of the introduction of antibiotics, and a longer lasting (acceleration of) mortality decline after the introduction. Changes resembling the first type of effect were possibly present for many infectious diseases, but were difficult to measure exactly, due to late effects on mortality of World War II. Changes resembling the second type of effect were present in 16 infectious diseases and were sometimes quite large. For example, estimated differences in per cent per annum mortality change were 10% or larger for puerperal fever, scarlet fever, rheumatic fever, erysipelas, otitis media, tuberculosis, and bacillary dysentery. No acceleration of mortality decline after the introduction of antibiotics was present in mortality from 'all other diseases'. Although the exact contribution of antibiotics to the observed changes cannot be inferred from this time trend analysis, the quantitative estimates of the changes show that even a partial contribution would represent a substantial effect of antibiotics on mortality from infectious diseases in the Netherlands.

Adolescent↗

PubMedDate not supplied

[Emerging infections and infectious diseases as the cause of extreme situation].

Information on unexpectedly emerging and newly appearing infectious diseases in the world, based on materials contained in WHO weekly reviews for the period of 1991-2000, is presented. Opinions of researchers on the causes and factors giving rise to this complex situation in different regions and on different continents are cited. In cases of insufficient training of the medical personnel, the specialists of diagnostic laboratories and the antiepidemic service the outbreak of these infections may assume the character of emergency situations. The importance of the development, introduction and ensuring the availability of the methods for the rapid diagnostics of infectious diseases, as well as the improvement of the system of epidemiological surveillance and operative exchange in information on so-called "new" infectious diseases, is emphasized.

Communicable Disease Control↗

PubMed1995

Survey of knowledge of infectious disease and infection control practices of dental specialists.

A questionnaire was developed to assess the knowledge of clinical specialists regarding infectious disease as well as their infection control practices. The questionnaire was mailed to 202 dental specialists in British Columbia. Seventy per cent returned completed surveys. Their responses indicate that the mechanisms, route and risk of transmission of the viral pathogens of importance in dental practice are not clearly understood. However, infection control practices closely follow the guidelines set forth by the Canadian Dental Association and the licensing bodies, including immunization for hepatitis B (82 per cent), glove use (in 89 per cent of non-surgical and 95 per cent of surgical procedures), and sterilization/disinfection of dental handpieces (94 per cent). Compliance with infection control guidelines was similar to that reported in the United States, where strict enforcement has been instituted. The majority of dental specialists (84-88 per cent) were either treating or willing to provide treatment to patients with infectious disease. Continuing education in the area of infectious disease is needed to improve dentists' understanding of the risk of transmission to dental providers and patients. This will ensure that compliance with infection control recommendations and appropriate patient care practices continue.

Analysis of Variance↗

PubMed2005

Effectiveness of vaccination strategies for infectious diseases according to human contact networks.

Mathematical modeling of infectious disease transmission aims to predict the spread of infection and the effectiveness of containment strategies. For the case of infectious diseases that transmit between human, one key factor becomes the modeling of contacts between individuals through which the disease is potentially transmitted. We review several formulations of such contacts with emphasis on the recently investigated scale-free network, and also discuss the effectiveness of vaccination strategies.

Communicable Disease Control↗

PubMed1999

Evidence for a functional repeat polymorphism in the promoter of the human NRAMP1 gene that correlates with autoimmune versus infectious disease susceptibility.

A polymorphism in the promoter of human NRAMP1 encodes a Z-DNA forming dinucleotide repeat with four alleles: (1) t(gt)5ac(gt)5ac(gt)11g; (2) t(gt)5ac(gt)5 ac(gt)10g; (3) t(gt)5ac(gt) ac(gt)9g; and (4) t(gt)5ac(gt)9g. Alleles 1 and 4 are rare (gene frequencies approximately 0.001); alleles 2 and 3 occur at gene frequencies approximately 0.20-0.25 and approximately 0.75-0.80, respectively. Here, luciferase reporter gene constructs are used to show that the four alleles differ in their ability to drive gene expression. In the absence of exogenous stimuli, alleles 1, 2, and 4 are poor promoters; allele 3 drives high expression, indicating that the repeat itself has endogenous enhancer activity. All four alleles show a similar percentage enhancement of reporter gene expression in the presence of interferon-gamma, consistent with the multiple interferon-gamma response elements both 5' and 3' of the Z-DNA forming repeat. However, while the addition of bacterial lipopolysaccharide (LPS) has no effect on alleles 1 and 4, it causes significant reduction in expression driven by allele 2 and enhances expression driven by allele 3, suggesting that the juxtaposition of LPS related response elements (NFkappaB, AP-1, NF-IL6) may be differentially affected by the two commonly occurring alleles. These results are consistent with the hypothesis that chronic hyperactivation of macrophages associated with allele 3 is functionally linked to autoimmune disease susceptibility, while the poor level of NRAMP1 expression promoted by allele 2 contributes to infectious disease susceptibility. Conversely, allele 3 protects against infectious disease and allele 2 against autoimmune disease. Hence, alleles that are detrimental in relation to autoimmune disease susceptibility may be maintained in the population because they improve survival to reproductive age following infectious disease challenge.

Alleles↗

PubMed1998

Providing care in an infectious disease clinic. Why students volunteer.

This qualitative study explores the motivations of dental students who volunteered as care providers for patients identified as carriers of infectious diseases. The study involved 12 students, seven 4th year and five 3rd year students who worked 1-2.5 days per week in an infectious disease clinic in a dental school in the northeastern United States. 4 faculty members who also volunteered their time in the clinic supervised the students. Personal interviews were conducted with each student to determine their reasons for volunteering and to explore the perceived significance of their experiences in the clinic. Internal validity was established through group interviews wherein responses during the personal interviews were discussed with the students. All 12 students were interested in Oral Medicine and all 4th year students had completed a course on HIV-AIDS for their selective requirement. Students expressed willingness to care for patients who are medically compromised in anticipation of an increase of this type of patients in their future practice. Previous exposure to a family member or friend or patients (non-dental) who were terminally ill or to patients with HIV was another common reason. All 12 students preferred to work in the infectious disease clinic more than in other school clinics. They felt that there was more faculty-student interaction and a more stimulating learning atmosphere that the faculty created. The students felt that the patients treated in the clinic were more appreciative. Students also claim they experienced more team spirit among their fellow students and staff and that the clinic atmosphere was more relaxed and less competitive. Students got the most satisfaction from helping patients who were perceived to have had problems in accessing care prior to their visit to the clinic. Results of the study show that the students volunteered to treat patients who are known to have infectious diseases such as HIV/AIDS because they find personal and academic satisfaction from working in a clinic which provides care to individuals with specific medical needs.

Attitude of Health Personnel↗

PubMed2006

[Goal and task of integrated Chinese and Western medicine study on infectious disease].

It is suggested in this paper that the integrated Chinese and Western medicine (ICWM) study on infectious disease should be emphasized on fields of viral hepatitis, AIDS, bacillary phthisis and newly discovered infectious diseases, etc. clinically and theoretically, to unfold the studies of immune regulation on infectious diseases, treatment on bacteria and drug-resistant virus strain, and to promote functional and histological recovery, etc. in patients. Focusing on the weak links and shortages of modern medicine, the valuable experiences and theoretical advantages of TCM in clinical trials and mechanism studies should be brought to light so as to bring Chinese medicine into the frame of modern medicine and to contribute to the world medicine.

Anti-Bacterial Agents↗

PubMed2002

Systematic reviews of infectious diseases.

The World Wide Web provides ready access to a wealth of information on infectious diseases topics. Systematic reviews and practice guidelines help to focus that evidence with in-depth literature analysis of a specific question. These reviews are typically rigidly structured, often periodically updated, and include critical evaluation of available data. In this article, Web sites of organizations that publish systematic reviews and practice guidelines for infectious diseases are identified and reviewed with regard to ease of use, comprehensiveness, quality of information, and cost. Examples of information available in databases of practice guidelines and systematic reviews are provided. A hypothetical case is used to illustrate the use of electronic resources in evidence-based infectious diseases practice.

Anti-Bacterial Agents↗