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PubMed2006

Next revolution in the molecular theranostics of infectious diseases: microfabricated systems for personalized medicine.

The molecular diagnosis of infectious diseases is currently going through a revolution sustained by the regulatory approval of amplification tests that have been shown to be equivalent or superior to existing gold standard methods. The recent approval of a microarray system for the pharmacogenomic profiling of cytochrome P450-mediated drug metabolism is paving the way to novel, rapid, sensitive, robust and economical microfabricated systems for point-of-care diagnostics, which are utilized closer and closer to the patient's bedside. These systems will enable the multiparametric genetic evaluation of several medical conditions, including infectious diseases. This forecoming revolution will position molecular theranostics in a broader integrated view of personalized medicine, which exploits genetic information from microbes and human hosts to optimize patient management and disease treatment.

Communicable Diseases↗

PubMed2005

[Infectious diseases risk management].

Surveillance activities first target health problems for which treatment, effective prevention or control measures are available. The data produced by surveillance systems allow prioritising public health actions and defining the objectives of infectious diseases control or prevention. The surveillance of infectious diseases relies on a large number of partners grouped in a public health network in which clinicians have a prominent role. In France, the surveillance of infectious diseases is based on mandatory notification of some diseases, national reference centers, networks of voluntary health professionals and repeated surveys, alerting health authorities in case of threats and identifying the determinants of changes in the population health's status. At hospital, the infectious risk is significant and the risk of epidemic outbreaks very high. A solid system for surveillance is mandatory. An educational program is needed to define the prevention program based on the use of hand disinfection and other standard precautions, antiviral and pneumococcal vaccination. A strong cooperation between general practitioners, healthcare team and relatives is necessary.

Anti-Bacterial Agents↗

PubMed2006

Experience of infectious diseases consultants with outpatient parenteral antimicrobial therapy: results of an emerging infections network survey.

BACKGROUND: Despite the increasing use of outpatient parenteral antimicrobial therapy (OPAT), little is known about the role of infectious diseases consultants in the process or their perceptions of OPAT. METHODS: In May 2004, the Infectious Diseases Society of America Emerging Infections Network (EIN) surveyed its members to characterize their involvement and experiences with OPAT. RESULTS: Of the 454 respondents (54%) who completed the questionnaire, 426 (94%) indicated that patients in their primary inpatient facility were "frequently" discharged while receiving OPAT, estimating that, on average, 19 patients are discharged from their hospitals while receiving OPAT each month. Although 86% of EIN members stated that they personally order OPAT for some patients, 18% indicated that they have no involvement, and 37% stated they only rarely or occasionally oversee OPAT. EIN members involved in OPAT estimated that approximately 90% of their patients who take OPAT received therapy at home, and the members described variable monitoring and oversight methods. Of the respondents, 68% of providers collectively estimated that they encountered 1951 infectious and serious noninfectious complications of OPAT in the past year. The most frequently used antibiotics included vancomycin, ceftriaxone, and cefazolin, most commonly used for bone and joint infections. CONCLUSIONS: These results testify to the pervasive use of OPAT in today's health care system, the variable role of infectious diseases consultants, and the heterogeneity in oversight and management practices. The widespread use of OPAT and its frequent complications indicate the need for additional studies to establish optimal methods of delivery and management to insure the quality and safety of the process.

Anti-Infective Agents↗

PubMed2005

Influence of the factor V Leiden mutation on infectious disease susceptibility and outcome: a population-based study.

BACKGROUND: The effect of the coagulation factor V Leiden mutation on infectious disease susceptibility and outcome is controversial. METHODS: We genotyped 9253 individuals from the Copenhagen City Heart Study for the factor V Leiden mutation. The risk of hospitalization for any infectious disease during a follow-up period of 7.2 years and subsequent risk of disease progression to death were estimated by Cox proportional-hazards regression analysis. RESULTS: During 66,789 person-years of follow-up, 1093 persons were hospitalized because of infection. The risk of urinary-tract infection was decreased in factor V Leiden heterozygotes, compared with that in noncarriers (adjusted relative risk [aRR], 0.55 [95% confidence interval [CI], 0.31-0.99]), whereas the risk of skin infection was increased (aRR, 1.68 [95% CI, 1.07-2.66]). No associations between carrier status and risk of diarrheal disease, other viral infections, parasitic infections, pneumonia, sepsis, or upper respiratory-tract infection were detected. However, in subjects hospitalized for sepsis, factor V Leiden carriers were at an increased risk of mortality 28 days after admission, compared with noncarriers (aRR, 4.41; 95% CI, 1.42-13.67]). CONCLUSION: In the Danish general population, the factor V Leiden mutation may be associated with infectious disease susceptibility and an increased risk of mortality from sepsis.

Adult↗

PubMed1992

Microbiology, infection control, immunizations, and infectious disease exposure: education and practices in United States nursing schools.

BACKGROUND: Previous data suggest that nursing students in the United States are inadequately protected against hepatitis B. This survey focused on the immunization and education practices, infection control knowledge, and follow-up to infectious disease exposure by U.S. nursing schools. METHODS: To ascertain education requirements, immunization practices, and infectious disease postexposure follow up, a survey was sent to the director or dean of 1164 U.S. nursing schools. RESULTS: Seven hundred sixty-five schools (65.7%) responded to the survey. A microbiology course was required before clinical experience by 49% of schools. Clinical experience in the operating room was given by 16%, 65% of schools offered infectious and communicable disease courses, and 98% offered universal precaution instructions. The hepatitis B vaccine was required by 11%; 2% required yearly influenza vaccination. In a comparison of programs, the diploma schools were more likely to have written policies for infectious disease exposure follow-up and to use appropriate agencies for exposure follow-up (p = 0.0001). CONCLUSIONS: A microbiology course before clinical experience should be encouraged. Immunization policies and infectious disease exposure follow-up are currently inadequate in U.S. associate degree and baccalaureate nursing programs.

Curriculum↗

PubMedDate not supplied

Cost reduction after introduction of a multidisciplinary infectious disease service at a German university hospital.

BACKGROUND: In 1997 an infectious disease service (IDS) similar to those in the US was established at a university hospital in Munich, Germany. PATIENTS AND METHODS: We assessed the economic impact of the new policy by performing a cost comparison analysis. Inpatients with pneumonia, skin infections/cellulitis, urinary tract infections (UTI) and bacteremia/sepsis were assigned to two groups: patients from a 6-month period after the establishment of the IDS (post-IDS group) were compared with similar patients before the implementation of the ID-service (pre-IDS group). Costs of microbiological investigation (MB), antibiotic treatment (AB), clinical imaging (CI), total costs and length of antibiotic therapy were analyzed. RESULTS: Patients with UTIs in the post-IDS group had 39% fewer MBs (p<0.05) than patients in the pre-IDS group, resulting in a 33% decrease in average MB costs (p<0.05). In the total group, in which subgroups with pneumonia, skin infection and UTI were summarized, the post-IDS group had 37% fewer MBs (p<0.05) resulting in MB cost reductions of 34% (p<0.05). There were no significant differences in expenditures for AB and CI and in the average length of antibiotic therapy. CONCLUSION: This study shows that continuous consultation by an IDS does not increase diagnostic and treatment costs, but results in significant cost reductions.

Aged↗

PubMed1990

Infectious diseases of the upper respiratory tract: implications for toxicology studies.

The consequences of adventitious infectious agents upon the interpretation of toxicology studies performed in rats and mice are incompletely understood. Several prevalent murine pathogens cause alterations of the respiratory system that can confuse the assessment of chemically induced airway injury. In some instances the pathogenesis of infection with these agents has been relatively well studied in the lower respiratory tract. However, there are few well-controlled studies that have examined the upper respiratory region, which result in interpretive problems for toxicologic pathologists. The conduct and interpretation of both short-term and chronic rodent bioassays can be compromised by both the clinical and subclinical manifestations of infectious diseases. This paper reviews several important infectious diseases of the upper airway of rats and mice and discusses the potential influence of these conditions on the results of toxicology studies.

Administration, Inhalation↗

PubMed1996

[Infectious diseases as a cause and risk factor for cerebrovascular ischemia].

Cerebrovascular ischemia can be caused by infectious diseases which involve cerebral arteries or the heart, including infectious endocarditis, bacterial and fungal meningitis, neurosyphilis, neuroborreliosis, herpes zoster, the acquired immunodeficiency syndrome, cat scratch disease and other rare infectious diseases. Presently, there is increasing evidence that infection in general and mainly respiratory infection is a risk factor for ischemic stroke. Case reports and smaller case series reported an association of cerebrovascular ischemia and recent infection in children and younger adults. Two case control studies from Helsinki (54 patients under the age of 50) and from Heidelberg (197 patients aged 80 or less) identified recent infection as an important risk factor for ischemic stroke. Febrile, bacterial and respiratory infections were most important in this respect. In the study from Heidelberg, the neurological deficit was more severe and cardioembolism was more frequent in infection-associated stroke than in stroke without preceding infection. This review summarizes the association of infectious diseases and cerebrovascular ischemia and discusses potential pathogenetic mechanisms linking both diseases.

Adult↗

PubMed2000

[Temporal and geographical variation in epidemics determined from the results of an infectious disease surveillance system in Japan description of epidemic patterns by data-based criteria for epidemic periods].

OBJECTIVE: After developing criteria for epidemic periods for 16 infectious diseases, we investigated temporal (annual and monthly) and geographical (regional) variation in epidemics. METHODS: Data from an infectious disease surveillance system for the years 1993 to 1997 were used for the analysis. The weekly number of patients per monitoring station was calculated from the data and used in developing criteria for an epidemic period. Based on these latter, we calculated the average number of epidemics occurring at each public health center in a year, an average length of the epidemic period, and the average number of patients per monitoring station reported during an epidemic period. These figures were used to explore temporal (annual, monthly) and geographical (regional) variation. RESULTS: With most diseases, the average number of epidemics occurring at a public health center was 0.3-0.5 per year and the average length of an epidemic period was 6-12 weeks. The average number of patients per monitoring station reported during an epidemic period differed according to the diseases. These indices showed that there were few annual differences, but great monthly differences, in most diseases. The average number of epidemics occurring in a public health center showed regional differences with some diseases. CONCLUSION: Temporal and geographical variation in epidemics for 16 infectious diseases was established by developing criteria for an epidemic period.

Data Collection↗

PubMed2005

[Is breast-feeding a protective factor for infectious diseases? A case-control study].

AIM: To analyze if breast-feeding (BF) is a protective factor against infectious diseases. DESIGN: Case-control study. Retrospective study during 1998. SETTING: Primary care. Teaching health center. Population of 22,500 inhabitants. PATIENTS: We consider an alpha risk of .05 and a beta risk of .20, unilateral hypothesis. We estimated a sample of 48 children in the "case" group and 144 in the "control" group. Random sample. MEASURES: Cases were children with 3 or more acute respiratory or digestive infectious episodes during the first year of age. Controls were children with less than 3 episodes. We analyze exposure to breast feeding (BF) and we consider it if the child had at least 3 months of BF. In other case we define as a non-exposure child. We have calculated odds ratio (OR) and its 95% confidence intervals. RESULTS: 60.4% of the children were BF after birth. But only 28.5% lasted 3 months, and only 13.9% lasted 1 year. The median of BF was 3.3 months (SD 4.2). 79.2% of the children have a respiratory infectious disease in the first year and 14.6% diarrhea. In children less than 1 year old the OR was 0.81 (95% CI, 0.40-1.63). In the period 3-6 months old we have found an OR of 0.346 (95% CI 0.161-0.744). CONCLUSIONS: In children aged less than 1 year, we have not found protective effects of breast-feeding against acute respiratory infectious diseases. Only in the period 3-6 months old, we have found that BF protects against these diseases.

Age Factors↗

PubMed1999

Diagnosis and prevention of equine infectious diseases: present status, potential, and challenges for the future.

The frequent transfers of horses, whether on a permanent or temporary basis, make strict control of infectious diseases essential. Such control needs a reliable and rapid means to accurately diagnose the relevant diseases. Indirect diagnosis based on antibody detection remains certainly the best method to secure the epidemiologic surveillance of the diseases at regional, national, or even world level, while direct diagnosis is the only way to diagnose a new outbreak. New diagnostic methods resulting from advances in biochemistry, molecular biology, and immunology are now available. As far as antibody detection is concerned, the new methods are mainly based on immunoassays, especially ELISAs. Regarding the identification of the pathogens, while isolation is still of importance, much progress has been made with immunocapture tests including capture ELISA based on monoclonal antibodies. DNA probes and amplification tests such as PCR or RT-PCR are representing a real breakthrough. Factors common to all of these tests are specificity, sensitivity, rapid implementation, and quick results. Such tests are, however, often still at the development stage. They absolutely need to be validated under multicentric evaluations prior to being used on a larger scale. At the same time there is an obvious need for the standardization of the reagents used. The technical and economic impact of a false (either positive or negative) diagnosis justifies such an harmonization which could effectively be achieved worldwide under the aegis of the Office International des Epizooties (OIE), which is itself the primary source of disease information. Vaccines are also essential for the control of equine infectious diseases. Most vaccines used in the prevention of viral or bacterial diseases are inactivated adjuvanted vaccines, which may cause unacceptable side effects. Also, their efficacy can sometimes be questioned. Subunit vaccines, when available, represent significant advances especially with regards to safety. Greater progress is expected from the use of new technologies taking advantage of recent developments in molecular biology (recombinant DNA technology) and in immunology (immunomodulators). Significant results have been obtained with subunit vaccines or with live vectored vaccines using recombinant DNA technology. Good results are on the way to be achieved with genetic (or naked-DNA) vaccines. It is therefore possible to expect the availability of a new generation of vaccines in the rather short term. Such vaccines will not only be safer and more efficacious, but they will also make it possible to differentiate vaccinated from infected animals, which will contribute to better control of the infection. Whatever the quality of the vaccines of the future may be, vaccination alone will never be sufficient to control infectious diseases. It is therefore essential to keep on making the animal owners and their veterinarians aware of the importance of the management and the hygiene in the diseases control and to organize them under "Common Codes of Practice."

Animals↗

PubMedDate not supplied

[The discarding of blood units and the prevalence of infectious diseases in donors at the Pro-Blood Foundation/Blood Center of São Paulo, São Paulo, Brazil].

OBJECTIVES: To analyze the changes in the proportion of blood units discarded from 1991 through 2001 at the Pro-Blood Foundation/Blood Center of São Paulo (Fundação Pró-Sangue/Hemocentro de São Paulo), which is the largest blood bank in Latin America, and to determine the prevalence of infectious diseases among donors at the Blood Center in November 2001. METHODS: We compiled data concerning the discarding of blood units due to the presence of serological markers for communicable diseases at the Blood Center during the period from 1991 through 2001. To determine the prevalence of infectious diseases, 9 942 screened samples were analyzed in November 2001; all reactive samples underwent confirmatory tests. RESULTS: Over the study period there was a significant decrease in the percentage of units discarded, from 20% in 1991 to 9% in 2001. In November 2001 the prevalence of infectious diseases among donors was: 0.04% for human immunodeficiency virus (HIV), 0.21% for hepatitis C virus (HCV), 0.06% for human T-lymphotropic virus (HTLV), 0.14% for Chagas' disease, and 1.10% for syphilis. For hepatitis B virus, the prevalences found were: 0.14% for anti-HBc and HBsAg, 1.68% for anti-HBc and anti-HBs, and 1.67% for isolated anti-HBc. CONCLUSIONS: The decrease in the discarding of blood units and in infectious diseases among donors at the Blood Center of São Paulo reflects the increase in the Center's percentage of repeat donors.

Blood Banks↗

PubMed2003

[Audit on antibiotic prescriptions in a department of infectious diseases].

OBJECTIVES: France is one of the countries that prescribe the most antibiotics. The inappropriate use of antibiotics participates in the emergence of multi-resistant bacteria. This study was aimed at assessing the adequation of antibiotic prescriptions in a hospital department of internal medicine-infectious diseases. METHODS: Over a two-month period, all the antibiotics treatments were analysed prospectively. The adequation of the treatments was analysed at first with regard to the various consensus conferences of the French-speaking Society of infectious diseases (Société de pathologie infectieuse de langue française (Spilf)) and then with regard to the bacteriological results. RESULTS: One hundred and five prescriptions were analysed during the study period. Thirty-five percent of prescriptions were inadequate with regard to the criteria used. In 22 cases the prescription was excessive, in 8 cases it was unjustified and in 5 cases it was inappropriate. Moreover, in univariate analysis, 3 factors were correlated with inadequation: prescriptions drawn-up by a non-infectious disease practitioner (OR =3.45, IC 95% 1.34-9.09, p=0.008), prescriptions drawn-up by junior in the department (OR =4.10, IC 95% 1.54-11.08, p=0.003) and prescriptions pour respiratory infections (OR=2.58, IC 95% 1.03-6.48, p =0.04). CONCLUSION: This study conducted in a department of infectious diseases reveals the persisting high rate of inappropriate prescriptions, confirming the need to develop control and retro-control strategies regarding the prescription of antibiotics in order to control the diffusion of multi-resistant bacteria.

Adolescent↗

PubMed1998

Hospitalizations for infectious diseases in Jewish and Bedouin children in southern Israel.

Two different population groups reside in the Negev region of southern Israel and have equal, and free from financial barrier, access to tertiary care at a single regional hospital. The Jewish population has a largely urban and industrialized lifestyle, while the Moslem Bedouins are in transition from their traditional nomadic life to settlement. To examine the differences in morbidity patterns reflected in hospitalizations, the computerized hospitalization records of children <15 years of age, for 1989-1991 were used (n=15,947). Rates of hospitalizations for infectious diseases were significantly higher for Bedouins in comparison to Jews (250 and 121/10,000 child years, respectively, odds ratio (OR): 2.1, 95% confidence interval (CI): 2.0-2.2, p < 0.001). Rates of hospitalization per 10,000 child years in Bedouins and Jews for diarrhea were 114 and 32 (OR: 3.7, 95% CI: 3.3-4.0, p < 0.001), respectively, and for pneumonia 55 and 19 (OR: 2.9, 95% CI: 2.6-3.3, p < 0.001), respectively. In infants the differences were even more pronounced, especially for diarrheal diseases. In Bedouin children infectious diseases were associated with longer hospital stay, more pediatric Intensive Care hospitalizations (OR: 2.7, 95% CI: 1.7-4.5,p < 0.001), and higher in-hospital mortality (OR: 5.7, 95% CI: 2.8-12.2, p < 0.001). Thus, Bedouin children are at higher risks of hospitalizations for infectious diseases in early childhood, as compared to Jewish children. This may reflect the differences in lifestyle, environmental and social conditions of the two populations.

Adolescent↗

PubMed1976

The effect of antibiotics on mortality from infectious diseases in Sweden and Finland.

A study was carried out to determine whether the preexisting decline in mortality rates from infectious diseases accelerated after the introduction of antibiotic and chemotherapeutic drugs. Linear regression curves showed that in Sweden mortality rates declined faster in septicemia, syphilis, and non-memingococcal meningitis after the introduction of these drugs. By contrast, for the ten other infectious diseases studied, (scarlet fever, erysipelas, acute rheumatic fever, puerperal sepsis, meningococcal infection, bronchitis, pneumonia, tuberculosis, typhoid fever, and acute gastroenteritis) no such accelerated decline in mortality could be detected. The findings suggest that antibiotic and chemotherapeutic drugs have not had the dramatic effect of the mortality of infectious diseases popularly attributed to them.

Age Factors↗

PubMed2000

Tropical environments, human activities, and the transmission of infectious diseases.

Throughout recent history, the tropical regions of the world have been affected more severely by infectious diseases than the temperate world. Much of the success of infectious diseases in that region is due to both biological and environmental factors that encourage high levels of biodiversity in hosts, vectors, and pathogens, and social factors that compromise efforts to control diseases. Several of these factors are described. Discussion then shifts to specific types of host-pathogen relationships. The most important of these in the tropics is the relationship between humans, a pathogen, and a vector that carries the pathogen from one human to another. Mosquitoes are the vector responsible for the transmission of many vector-borne human diseases. Characteristics of mosquito-human interactions are described, including cultural behaviors humans have developed that both increase the chances of transmission and help to limit that transmission. The transmission of water-borne diseases, fecal-oral transmission, zoonotic diseases, respiratory illnesses, and sexually transmitted diseases are also discussed. Attention is paid to how diseases with these modes of transmission differ in characteristics and importance in tropical human populations compared to those in temperate regions. Following this general discussion, three case studies are presented in some detail. The diseases chosen for the case studies include cholera, lymphatic filariasis, and dracunculiasis (guinea worm). These three case studies taken together provide examples of the diversity of human host-pathogen interactions as well as ways that human activities have both promoted their spread and helped to control them. The transmission of all three diseases is related to the nature and quality of water sources. The transmission of cholera, a water-borne disease, is related to sanitation practices, physical characteristics of the environment such as temperature and humidity, and modern shipping practices. Lymphatic filariasis, a mosquito-borne disease, has increased in frequency in parts of Africa in recent decades as a consequence of large-scale agricultural development projects that have shifted the nature and quantity of water sources and potential mosquito breeding sites. Dracunculiasis is transmitted by a small crustacean that contaminates sources of drinking water. Because its transmission can be prevented by a simple change in human behavior, filtering all water with a small piece of cloth before using it, dracunculiasis has been the focus of a major eradication effort that is near success.

Agriculture↗

PubMed2002

[Mandatory disclosure and infectious disease. From "pestilential" disease to "emerging" diseases].

Due to the recent overhaul of the procedure on mandatory disclosure of infectious diseases (law relating to the reinforcement of sanitation quality control established in July 1998, and the May 1999 and May 2001 decrees on the application of this law), wishing to take advantage of this opportunity, the authors propose a chronological review retracing the history of these legal declarations. For over a century, they have represented the main instrument used for intervention and surveillance allowing for the fight against infectious diseases. The health options kept have varied over the years, as well as the precautions taken to respect secrecy (nominative or anonymous disclosure, modalities of transmission...). Procedures adopted to reconcile the principle of confidentiality along with the necessity to protect public health in the case where it would require an immediate and urgent intervention are examined throughout the chronology (determining the source of contamination, prevention of contagion).

Communicable Diseases, Emerging↗

PubMed2000

[Infectious diseases in Poland in 1998].

Epidemiological situation of majority of infectious diseases in Poland was in 1998 consecutively improved. Decrease of incidence of infectious hepatitis type A and B was noted as well as of tuberculosis and sexually transmitted diseases. Percentage of deaths caused by infectious diseases decreased to 0.6%. Sustaining of such positive trends will require first of all continuation of preventive immunizations at present level, improvement of laboratory diagnoses, but also an improvement of identification of diseased and infected peoples and also notification of cases.

Adolescent↗