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PubMed2005

[Global warming and spread of infectious diseases].

At the end of the twentieth century, tropical infectious diseases increased despite earlier successes of eradication campaigns. As a global warming of 1.4-5.8 degrees C is anticipated to occur by 2100, mainly the vector-borne tropical diseases that are particularly sensitive to climate are expected to spread. Although biological reasons seemingly support this hypothesis, ecological and socioeconomic factors have in the past proven to be stronger driving forces for the spread of infectious disease than climate.

Animals↗

PubMed1997

Infectious diseases mortality in central Serbia.

STUDY OBJECTIVE: To determine the influence and the effect of the war in the former Yugoslavia and of the United Nations economic sanctions on mortality from infectious diseases. DESIGN: This was a descriptive study analysing mortality data time series. SETTING: Central Serbia, Yugoslavia. PARTICIPANTS: The population of central Serbia was the subject of the study (about six million inhabitants). MEASUREMENTS: Mortality rates were standardised directly, using the "European population" as the standard. Regression analysis and analysis of covariance were undertaken. MAIN RESULTS: During the period 1973-93, mortality from infectious diseases showed a decreasing trend. From 1987-90, and infectious diseases was significantly higher than expected on the basis of the trend for the preceding period (p = 0.020 and p = 0.00). In addition, there was a statistically significant departure from the preceding trend (p = 0.036) in men between 1991 and 1993 (the period of the war and UN sanctions)--the main effect being in younger age groups. CONCLUSION: The economic crisis in the former Yugoslavia during the 1980s followed by the outbreak of the war and the damaging effects of UN economic sanctions had a distinctly adverse effect on mortality from infectious diseases.

Adolescent↗

PubMed2005

Infectious diseases treated in emergency departments: United States, 2001.

Emergency departments (EDs) are an important source of medical care in the United States. Information is limited concerning epidemiologic patterns of ED visits for infectious diseases. Data for 2001 from the National Hospital Ambulatory Medical Care Survey (NHAMCS) were analyzed for infectious disease visits. The NHAMCS is a national probability sample survey of visits to hospital EDs and outpatient departments of non-federal, short-stay, and general hospitals in the United States. Data are collected annually and are weighted to generate national estimates. In 2001, an estimated 19.8 million visits were made to hospital EDs for infectious diseases (rate=71 visits/1,000 persons). Children under 15 years old made 36% of these visits and had the highest rate of visits (rate=119 visits/1,000 persons). The rate of visits for females was 37% higher than for males (82 versus 60/1,000 persons). Although the white population had the highest volume of visits, the rate of visits for blacks was more than twice that of whites (130 versus 64 visits/1,000 persons). Laboratory tests were ordered in 84% of visits. An estimated 18% of visits to the EDs concern infectious diseases. The issue of health care access and ED use is complex and the reasons for the higher rate of visits for blacks than for whites are not fully understood.

Adolescent↗

PubMed1994

General practice awareness of notifiable infectious diseases.

The Acheson Report concluded that the process of infectious disease notification in England and Wales was unsatisfactory and recommended that it should be reviewed. However, the success of any notification system will depend on the knowledge and motivation of general practitioners, who are responsible for a large proportion of infectious disease notifications. A district-wide telephone survey was conducted in Croydon among general practitioners to assess the level of awareness of which diseases are on the statutory notification list. Respondents' opinions were also sought on the composition of the present list. Results indicated that a generally high level of awareness contrasted with a relative paucity in knowledge of certain of the more common diseases. Differences in knowledge were not associated with the sex, the length of time since the doctor qualified or the number of partners in the particular practice. Motivation may be a particularly important factor underlying the present incompleteness of notifications. A large proportion of doctors stated that legionellosis, AIDS, brucellosis and listeriosis merited statutory notification.

Communicable Disease Control↗

PubMed1995

Low birthweight as a determinant of infectious disease mortality: a methodological evaluation.

Low birthweight (LBW) is cited as an important determinant of infectious disease mortality during infancy, both in developed and developing countries. We applied methodological standards to evaluate the scientific validity and clinical applicability of epidemiological studies of this relationship. Three published studies, all reporting an elevation of the risk of infectious disease mortality in infants born with LBW, were identified. Noteworthy methodological deficiencies found in one or more studies included failure to obtain objective data about birthweight and gestational age for a high proportion of study subjects, lack of explicit criteria for assigning causes of death, failure to safeguard against biases in assessment of cause of death and inadequate control for potential confounding variables. In addition, clinical application of the results of these studies was limited by lack of exploration of the roles of preterm birth vs. small-for-gestational-age (SGA) birth, as well as by inattention to the role of congenital anomalies, in explaining the elevated risk. Although our evaluation does not necessarily negate the results of these studies, the failure of any of the studies to comply with all of the standards highlights the need for further research to provide credible evidence regarding the presence and strength of a relationship between LBW and infectious disease mortality in both developed and developing countries.

Communicable Diseases↗

PubMedDate not supplied

[Infectious diseases of animals and their prevention].

Infectious diseases of animals are the subject of continuous concern. On the one hand there are some diseases which have not yet been described and on the other hand the presence of microbial agents is proved also in diseases which have been considered non-infectious. Undoubtedly, microbes and parasites take part also in the development of malignant transformation of cells. The question of possible transfer of animal oncogenic microorganisms (retroviruses in particular) to humans remains open. The study points to the changes in the incidence of orthopoxviruses which occurred after eradication of human variola and the increasing importance of bartonelloses. Disease prevention in animals is affected to an increasing extent by DNA recombinant methods. So called "Gene farming" has developed, consisting in production of narrow-profile therapeutically important proteins via animal bioreactors. We enter a period in which the resistance of animal organism begins to affect the transfer of genes encoding non-specific and specific protective mechanisms of organisms. (Tab. 7, Ref. 39.)

Animals↗

PubMed1996

The influence of the opinion of an infectious disease consultant on the appropriateness of antibiotic treatment in a general hospital.

The antibiotics chosen in hospitals are not always the most appropriate. A comparative prospective study with sequential analysis was designed to assess how the opinion of an infectious disease consultant affected the clinical efficacy of antimicrobial treatment in a general hospital. We studied 250 patients who had microbiologically documented infections according to Center for Disease Control criteria. The patients were divided in two groups with similar initial characteristics. Group G1 comprised 100 patients without infectious disease consultation, and group G2 contained 150 patients with infectious disease consultation. The influence of the consultant's opinion was assessed as the percentage of initially appropriate treatments, and by the number of inappropriate ones that were changed after the microbiological results were known. The appropriateness of initial treatment was significantly higher in group G2 (66% vs 55%), as were the number of treatments changed on the basis of the microbiological results (57.6% vs 33.3%). This lead to higher rates of cure, fewer deaths, and fewer cases of persistent infection in group G2. In 42.4% of G2 patients, antibiotic treatment was not changed in spite of the microbiological results and the opinion of an infectious disease consultant. We conclude that antibiotic treatment for the most clinically significant infections can be optimized if it is dispensed according to carefully developed guidelines.

Anti-Bacterial Agents↗

PubMed2003

Airborne infectious diseases during infancy and mortality in later life in southern Sweden, 1766-1894.

BACKGROUND: The importance of early life conditions and current conditions for mortality in later life was assessed using historical data from four rural parishes in southern Sweden. Both demographic and economic data are valid. METHODS: Longitudinal demographic and socioeconomic data for individuals and household socioeconomic data from parish registers were combined with local area data on food costs and disease load using a Cox regression framework to analyse the 55-80 year age group mortality (number of deaths = 1398). RESULTS: In a previous paper, the disease load experienced during the birth year, measured as the infant mortality rate, was strongly associated with old-age mortality, particularly the outcome of airborne infectious diseases. In the present paper, this impact persisted after controlling for variations in food prices during pregnancy and the birth year, and the disease load on mothers during pregnancy. The impact on mortality in later life stems from both the short-term cycles and the long-term decline in infant mortality. An asymmetrical effect and strong threshold effects were found for the cycles. Years with very high infant mortality, dominated by smallpox and whooping cough, had a strong impact, while modest changes had almost no impact at all. The effects of the disease load during the year of birth were particularly strong for children born during the winter and summer. Children severely exposed to airborne infectious diseases during their birth year had a much higher risk of dying of airborne infectious diseases in their old age. CONCLUSIONS: This study suggests that exposure to airborne infectious diseases during the first year of life increases mortality at ages 55-80.

Aged↗

PubMed2004

Effect of antibacterial home cleaning and handwashing products on infectious disease symptoms: a randomized, double-blind trial.

BACKGROUND: Despite the widespread household use of cleaning and personal hygiene products containing antibacterial ingredients, their effects on the incidence of infectious disease symptoms have not been studied. OBJECTIVE: To evaluate the effect of antibacterial cleaning and handwashing products for consumers on the occurrence of infectious disease symptoms in households. DESIGN: Randomized, double-blind clinical trial. SETTING: Northern Manhattan inner-city neighborhood, New York. PARTICIPANTS: 238 primarily Hispanic households (1178 persons) that included at least one preschool-age child. INTERVENTIONS: Households were randomly assigned to use either antibacterial or nonantibacterial products for general cleaning, laundry, and handwashing. All products were commercially available, but the packaging was blinded and the products were provided free to participants. MEASUREMENTS: Hygiene practices and infectious disease symptoms were monitored by weekly telephone calls, monthly home visits, and quarterly interviews for 48 weeks. RESULTS: Symptoms were primarily respiratory: During 26.2% (717 of 2736) of household-months, 23.3% (640 of 2737) of household-months, and 10.2% (278 of 2737) of household-months, one or more members of the household had a runny nose, cough, or sore throat, respectively. Fever was present during 11% (301 of 2737) of household-months, vomiting was present in 2.2% (61 of 2737), diarrhea was present in 2.5% (69 of 2737), and boils or conjunctivitis were present in 0.77% (21 of 2737). Differences between intervention and control groups were not significant for any symptoms (all unadjusted and adjusted relative risks included 1.0) or for numbers of symptoms (overall incidence density ratio, 0.96 [95% CI, 0.82 to 1.12]). CONCLUSIONS: The tested antibacterial products did not reduce the risk for symptoms of viral infectious diseases in households that included essentially healthy persons. This does not preclude the potential contribution of these products to reducing symptoms of bacterial diseases in the home.

Adolescent↗

PubMed1993

[Importance of infectious diseases and role of the infection specialist in a non-university hospital].

More than 3000 infectious diseases treated in the past 10 years at the Department of Medicine of the Cadolles Hospital in Neuchâtel (Switzerland) have been gathered from a computer data base. The infectious disease specialist is directly involved in the diagnosis and treatment of the most severe or rare affections. However, he influences in a more general fashion the management of anti-infectious treatments by directing the treatment plan and helping to choose the proper antibiotics. He also is responsible for the prevention of nosocomial infections. The role and function of the infectious disease specialist as well as the importance of this specialty in a community hospital are discussed.

Consultants↗

PubMed1994

[Refractory infectious diseases in the elderly].

The elderly is usually recognized as an immunocompromised host. But physiologic age and chronologic age are not always concordant and there is the heterogeneity of older persons. Because of the atypical clinical presentation of infectious disease in the elderly, diagnosis is frequently difficult and treatment is delayed and the risk of developing or dying from most serious infectious diseases is usually increased in the elderly. The apparent risk factors associated with infectious diseases in the elderly are low nutrition, baseline diseases, swallowing disturbance and diminished cell mediated immunity. The primary objective in preventing and treating infectious diseases in the elderly are maintenance of the general condition and nutrition and to give rapid, short-term and adequate antibiotics treatment.

Aged↗

PubMed1995

Will pathologists play as important a role in the future as they have in the past against the challenge of infectious diseases.

Since the recognition less than 120 years ago that organisms visible only microscopically are capable of causing human diseases, pathologists have played a major role in identifying and characterizing the etiologic infectious agents and in elucidating the pathogenic mechanisms. In face of the opportunities and challenges presented by molecular technology, AIDS and other emerging infections, and the evolution of health care systems, it is worthwhile to question whether the field of pathology will continue in the future to make major contributions in the field of infectious diseases. The AIDS epidemic has awakened pathologists to the need to reemphasize infectious diseases in diagnostic anatomic and clinical pathology, basic and applied research, and medical and scientific education. The knowledge and skills of pathologists are uniquely critical to the achievement of efficient advances in infectious diseases, and will remain so provided that pathologists embrace molecular science and apply it as a principal component in their methodologic and conceptual armamentarium.

Forecasting↗

PubMed2002

Back to the future: antibody-based strategies for the treatment of infectious diseases.

Before antibiotics, sera from immune animals and humans were used to treat a variety of infectious diseases, often with successful results. After the discovery of antimicrobial agents, serum therapy for bacterial infections was rapidly forsaken. In the last two decades, problems with treatment of newly emerged, re-emerged, or persistent infectious diseases necessitated researchers to develop new and/or improved antibody-based therapeutic approaches. This article reviews some information on the use of antibodies for the treatment of infectious diseases, with special reference to the most seminal discoveries and current advances as well as available treatment approaches in this field.

Animals↗

PubMed1992

Therapy of bacterial sepsis, meningitis and otitis media in infants and children: 1992 poll of directors of programs in pediatric infectious diseases.

To determine current opinions among experts in pediatric infectious diseases for treatment of bacterial sepsis, meningitis and acute otitis media, we polled directors of training programs in January, 1992. Responses were received from 69 centers in the United States and Canada. For initial treatment of presumed bacterial meningitis, the third generation cephalosporins alone or combined with ampicillin have become drugs of choice in all age groups. Most infectious disease programs include dexamethasone in the management of presumed bacterial meningitis for children 2 months of age and older. Third generation cephalosporins are also drugs of choice for presumed sepsis: combined with ampicillin for infants 5 weeks of age; used alone for children 5 months and 12 years of age. Amoxicillin remains the preferred drug for initial treatment of acute otitis media. The combination of amoxicillin and clavulanic acid is favored in the setting of an increased proportion of beta-lactamase-producing bacterial pathogens. Comparison of these results with polls in 1987 and 1989 indicates a shift in recommendations of therapy of presumed bacterial sepsis and meningitis from ampicillin alone or combined with an aminoglycoside or chloramphenicol to use of a third generation cephalosporin alone or combined with ampicillin.

Age Factors↗

PubMed2000

Passive immunity in prevention and treatment of infectious diseases.

Antibodies have been used for over a century in the prevention and treatment of infectious disease. They are used most commonly for the prevention of measles, hepatitis A, hepatitis B, tetanus, varicella, rabies, and vaccinia. Although their use in the treatment of bacterial infection has largely been supplanted by antibiotics, antibodies remain a critical component of the treatment of diptheria, tetanus, and botulism. High-dose intravenous immunoglobulin can be used to treat certain viral infections in immunocompromised patients (e.g., cytomegalovirus, parvovirus B19, and enterovirus infections). Antibodies may also be of value in toxic shock syndrome, Ebola virus, and refractory staphylococcal infections. Palivizumab, the first monoclonal antibody licensed (in 1998) for an infectious disease, can prevent respiratory syncytial virus infection in high-risk infants. The development and use of additional monoclonal antibodies to key epitopes of microbial pathogens may further define protective humoral responses and lead to new approaches for the prevention and treatment of infectious diseases.

Animals↗

PubMed2002

The postmortem sociomedical interview: uncertainty in confirming infectious disease risks of young tattooed donors.

PURPOSE: To assess the reproducibility of relatives' replies to questions asked at the time of corneal donation and again 2 months later concerning infectious disease risk factors and to identify characteristics associated with inconsistent responses. METHODS: A reinterview study involving individuals who answered questions regarding an eye donor's sociomedical history within 1 day of the decedent's death and who consented to be recontacted 6 to 12 weeks later. The main outcome measures were frequency of answering differently on the same questions of infectious disease risk factors and the donors' and relatives' characteristics that predicted inconsistency. RESULTS: Of 368 individuals who agreed to a reinterview, 263 (71.5%) completed and returned the survey questionnaire. Thirty-eight (14.4%) respondents answered differently on at least one question concerning infectious disease risk factors. The family of donors with a trauma-related death was 2.9 [95% confidence interval (CI), 1.0-8.3] times more likely to give inconsistent responses. Different responses to behavioral questions occurred 22 (95% CI, 1.6-315) times more often by relatives of donors who were both younger than 40 years old and had a tattoo. CONCLUSION: The postmortem sociomedical interview cannot assure complete knowledge of the risk of potentially transmissible disease of all donors. Relatives of young, tattooed donors tend to give inconsistent responses about infectious disease risk factors.

Adolescent↗

PubMed1986

Prevalence of Legionnaires' disease in pneumonia patients admitted to a Danish department of infectious diseases.

During a 14-month study period, 92 patients admitted to the University Clinic for Infectious Diseases with pneumonia were investigated to determine the prevalence and severity of Legionnaires' disease (LD). The diagnosis of LD was based on positive serology. Antibodies to 10 different legionella antigens--Legionella pneumophila serogroups 1-6, Fluoribacter (Legionella) bozemanae, F. dumoffii, F. gormanii, and Tatlockia (Legionella) micdadei--were measured by the microagglutination (MA) and indirect fluorescent antibody (IFA) techniques. LD was diagnosed in 22 patients showing a 4-fold or greater rise of MA titers. 10 patients showed a 4-fold or greater rise of IFA titer, 2 had standing high titer. One patient died. Legionella infection was the second most common cause of pneumonia. However, in half of the cases legionella infection occurred concomitantly with Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia psittaci, or viral infections. All 22 LD cases were sporadic. LD had been contracted abroad by 6 patients. Two of the legionella pneumonias were hospital-acquired. Half of the LD patients were older than 60 years. The majority of cases occurred during the winter months. Neither clinical chemistry parameters nor clinical features could distinguish LD from other types of pneumonia.

Adolescent↗

PubMed1985

Vaccination against Marek's disease and infectious bursal disease III. Growth rate of both turkey herpesvirus and infectious bursal disease virus in coinfected cell cultures.

Titers of the turkey herpesvirus (HVT) and infectious bursal disease virus (IBDV) in coinfected cell cultures, used to produce a live bivalent HVT/IBDV vaccine, were determined daily. Based on the daily titers, cells harvested either 2 or 3 days after inoculating the second virus (IBDV) into HVT infected cell cultures yielded the maximum titers for both viruses. Harvesting coinfected cell cultures on either day provided the most suitable source of the live HVT/IBDV vaccine against Marek's disease and infectious bursal disease.

Animals↗