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PubMed2004

Why don't they listen? Adherence to recommendations of infectious disease consultations.

The effectiveness of an infectious diseases (ID) consultation is dependent on adherence to the recommendations. To delineate the factors that affect adherence, we conducted a prospective cohort study of 465 consultations at 2 academic institutions in which we evaluated the consultation process, patient and consultant characteristics, types of recommendations, and compliance with recommendations. The overall compliance rate was 80%, with 85% adherence to crucial recommendations. Multivariate analysis revealed that adherence to ID recommendations was higher when the recommendations were therapeutic instead of diagnostic, when they related to a specific clinical question, when recommendations were deemed crucial by the ID service, if the primary service was medicine, and if the consultation note was legible and organized. Whether modification of consultant practice will lead to improved recommendation compliance and patient outcomes warrants further study.

Adolescent↗

PubMed2004

Hospital preparedness for severe acute respiratory syndrome in the United States: views from a national survey of infectious diseases consultants.

In this survey of infectious diseases consultants, 90% reported that their health care facilities have plans in place to address severe acute respiratory syndrome (SARS). Some plan elements exceed current recommendations, whereas others are less stringent. Resource issues associated with airborne isolation and respirators were reported. Sixty-one percent of the respondents expressed some concern about their facility's preparation and capacity for managing patients with SARS. Recent draft guidance on SARS preparedness from the Centers for Disease Control and Prevention may help address some of these issues.

Communicable Diseases, Emerging↗

PubMed1998

Inpatient emergencies encountered by an infectious disease consultative service.

The spectrum of infectious disease (ID) emergencies in hospitalized patients was assessed in a prospective study of 3,626 inpatient ID consultations in a 1,350-bed teaching hospital. ID emergencies, defined by a need or anticipated need for advanced life support or by irreversible organ damage leading to permanent functional loss, were encountered in 175 patients. Infections of the central nervous system (26.3%), cardiovascular system (14.9%), alimentary system (13.1%), and lower respiratory tract (7.4%) and adverse reactions to antimicrobial agents (7.4%) were most common. In 18.9% of the cases, the referring clinicians were unaware of the emergency at the time of referral. Drug reactions (46.1%), severe alimentary and peritoneal infections (32.0%), upper respiratory tract infections (28.6%), and skin and soft-tissue infections (27.3%) were most frequently missed. The emergency ID conditions were not recognized because they had an atypical presentation (51.5%), were not commonly seen in the referring specialty (24.2%), were due to rare organisms (15.2%), or had unusual anatomical sites of involvement (9.1%). A close liaison between clinicians and the ID team is crucial for recognition of ID emergencies at their early stages so that appropriate investigations and management can be instituted expediently, before the occurrence of irreversible damage.

Adult↗

PubMed2000

Genetic distances for the study of infectious disease epidemiology.

Molecular epidemiologic studies of infectious pathogens 1) generate genetic patterns from a collection of microorganisms, 2) compare the degree of similarity among these patterns, and 3) infer from these similarities infectious disease transmission patterns. The authors propose a quantitative approach using genetic distances to study the degree of similarity between patterns. Benefits of such genetic distance calculations are illustrated by an analysis of standard DNA fingerprints of Mycobacterium tuberculosis in San Francisco collected during the period 1991-1997. Graphical representation of genetic distances can assist in determining if the disappearance of a specific pattern in a community is due to interruption of transmission or ongoing evolution of the microorganism's fingerprint. Genetic distances can also compensate for varying information content derived by DNA fingerprints of contrasting pattern complexity. To study demographic and clinical correlates of transmission, the authors calculated the smallest genetic distance from each patient sample to all other samples. With correlation of genetic distances and nearest genetic distances with previously understood notions of the epidemiology of M. tuberculosis in San Francisco, factors influencing transmission are investigated.

DNA Fingerprinting↗

PubMed2002

[Characteristics of infectious diseases in the elderly].

IN GENERAL: Infectious diseases represent the third cause of mortality in patients aged over 65. Age-related immune deficiency and underlying diseases frequently favour infections. The symptoms are often fickle and misleading, delay diagnosis and worsen the prognosis. THE PRINCIPLE INFECTIONS: Broncho-pulmonary and urinary infections predominate in this context. More rare but severe complications specifically related to age are also possible, notably meningitis, tuberculosis, herpes zoster and septicemia in the elderly. PREVENTIVE MEASURES: Influenza and anti-pneumococcal vaccines have demonstrated their efficacy in limiting the broncho-pulmonary infections in these patients.

Adolescent↗

PubMed1978

Function of fever in infectious disease.

The survival of fever in infectious disease is a controversial subject. In favour of the hypothesis that the fever response is one of the defence mechanisms of the host aginst micro-organisms are several data ranging from determinations of optimal growth temperatures of micro-organisms in vitro to in vivo experiments on the course of infections in temperature-manipulated warm-blooded and poikilothermic animals. In spite of this, the beneficial effect of an elevated body temperature has only been documented in a few human infections, and antipyretic drugs are still used in enormous quantities in the fight against the symptom "fever", as if this were the enemy.

Animals↗

PubMed1993

Infectious disease emergencies in the geriatric population.

Infectious diseases continue to be a common cause for emergency department visits among the elderly population. This phenomenon may be due to the existence of comorbid diseases as well as alterations in immune function with senescence. Diagnosis and acute management of specific infections are discussed in this article, including meningitis, endocarditis, urinary tract and skin infections, septic shock, and fever of unknown origin.

Aged↗

PubMedDate not supplied

Infectious disease causes of lymphadenopathy: localized versus diffuse.

Lymphadenopathy is commonly associated with numerous infectious diseases. The evaluation of lymphadenopathy may reveal local (regional) node involvement or diffuse (generalized) node involvement. Additional assessment factors used to evaluate the lymphadenopathy include the anatomic location, node characteristics, associated symptoms, medical and social history, and comprehensive physical examination fundings. Infectious diseases that cause generalized lymphadenopathy include HIV disease, toxoplasmosis, secondary syphilis, and tuberculosis. This article discusses the evaluation of lymphadenopathy, infectious causes of generalized lymphadenopathy, as well as those infections that cause regional lymphadenopathy.

Biopsy↗

PubMed2003

[Epidemiologic analysis of infectious diseases identified as occupational diseases in Poland in the years 1998-2002].

BACKGROUND: In spite of some unquestionable positive tendencies observed over the last few years, occupational infectious diseases still pose a serious problem in Poland. During the last thirty years overall as many as 41,000 cases of occupational contagious and invasive diseases were identified. METHODS AND MATERIALS: The analysis covered all cases of occupational diseases, reported by sanitary and hygiene stations on a specially designed form, to the Register of Occupational Diseases in Poland over the years 1998-2002. The analyses were performed by the disease entities, the job name, and activity sections classified according to Polish Classification of the Economy, and also by voivodeships. Crude numbers of the diseases reported and rates are presented. For the calculation of incidence rates, the statistics of the national economy employees provided by the Central Statistical Office was applied. RESULTS: In total, 4153 cases of infectious diseases were reported to the Register in 1998-2002. Viral hepatitis, tuberculosis, brucellosis and Lyme borelliosis covered (94.3%) of all cases. The analyzed diseases were identified mostly in two economic activity sections: Health and Social Works and Agriculture, Forestry and Hunting. About 63% of all cases were recorded in health care personnel, mostly in nurses, 1372 cases (33%), physicians (9.9%), laboratory workers (8.1%), orderlies (6.5%), dentists, dental assistants and dental technicians (1.9%). A substantial number of infections diseases were recorded in forestry workers (16.2), mostly foresters (10.9%). The highest rates of occupational diseases were found in the Podlaskie, Mazowieckie, Wielkopolskie, Pomorskie and Slaskie voivodships. CONCLUSIONS: At present, Lyme borelliosis and viral hepatitis pose the most serious problem of all infectious occupational diseases in Poland. Despite extensive programs of vaccination against viral hepatitis B, implemented since 1989, this pathology has not as yet been fully eradicated. It can be predicted that in the near future, viral hepatitis C and Lyme borelliosis will mostly influence the epidemiology of infectious occupational diseases in Poland. This situation will continue until relevant vaccines are developed and used in high risk occupational groups.

Communicable Diseases↗

PubMed2000

[Rapid diagnosis for infectious diseases: the respective roles of physician and medical technologist].

The outcome of infectious disease greatly depends on the rapidity of making a definite diagnosis. For this, smooth and tight cooperation between physician and laboratory where medical technologists are working will become to the key. Rapid diagnosis for infectious diseases can contribute on the patient care, however the laboratory has a self-limitation. That is a seesaw phenomenon; rapidity vs accuracy, rapidity vs sensitivity, rapidity vs easygoing, rapidity vs carefulness, etc. From the laboratory aspect, medical technologists should function as the effective access-point in the evidence-based medicine (EBM), and should have a reasonable balance in judging seesaw phenomena, and should be keeping up their knowledge and technical skill.

Humans↗

PubMed1994

Probing for answers. Use of DNA probes in infectious diseases.

Diagnostic molecular biology is at the forefront in the diagnosis of infectious diseases. Through the use of deoxyribonucleic acid (DNA) probes in conjunction with other molecular techniques such as polymerase chain reaction (PCR), physicians will be able to more rapidly and accurately diagnose causative agents in a variety of infectious diseases. This article will focus on the molecular basis of these techniques, how they may aid the physician in patient diagnosis, and the shortcomings of this new and exciting technology.

Communicable Diseases↗

PubMed2006

Reasons for the increase in emerging and re-emerging viral infectious diseases.

In the past two decades, humans have faced many new viral infectious agents in emerging and re-emerging infectious diseases (EIDs). Many factors contribute to the appearance of EIDs. These factors are complex but can be classified into three different categories: virus factors, human factors, and ecological factors. The factors contributing to the cause of such viral infectious diseases will be systematically reviewed in this article.

Animals↗

PubMed2006

Male circumcision, religion, and infectious diseases: an ecologic analysis of 118 developing countries.

BACKGROUND: Both religious practices and male circumcision (MC) have been associated with HIV and other sexually-transmitted infectious diseases. Most studies have been limited in size and have not adequately controlled for religion, so these relationships remain unclear. METHODS: We evaluated relationships between MC prevalence, Muslim and Christian religion, and 7 infectious diseases using country-specific data among 118 developing countries. We used multivariate linear regression to describe associations between MC and cervical cancer incidence, and between MC and HIV prevalence among countries with primarily sexual HIV transmission. RESULTS: Fifty-three, 14, and 51 developing countries had a high (>80%), intermediate (20-80%), and low (<20%) MC prevalence, respectively. In univariate analyses, MC was associated with lower HIV prevalence and lower cervical cancer incidence, but not with HSV-2, syphilis, nor, as expected, with Hepatitis C, tuberculosis, or malaria. In multivariate analysis after stratifying the countries by religious groups, each categorical increase of MC prevalence was associated with a 3.65/100,000 women (95% CI 0.54-6.76, p = 0.02) decrease in annual cervical cancer incidence, and a 1.84-fold (95% CI 1.36-2.48, p < 0.001) decrease in the adult HIV prevalence among sub-Saharan African countries. In separate multivariate analyses among non-sub-Saharan African countries controlling for religion, higher MC prevalence was associated with a 8.94-fold (95% CI 4.30-18.60) decrease in the adult HIV prevalence among countries with primarily heterosexual HIV transmission, but not, as expected, among countries with primarily homosexual or injection drug use HIV transmission (p = 0.35). CONCLUSION: Male circumcision was significantly associated with lower cervical cancer incidence and lower HIV prevalence in sub-Saharan Africa, independent of Muslim and Christian religion. As predicted, male circumcision was also strongly associated with lower HIV prevalence among countries with primarily heterosexual HIV transmission, but not among countries with primarily homosexual or injection drug use HIV transmission. These findings strengthen the reported biological link between MC and some sexually transmitted infectious diseases, including HIV and cervical cancer.

Africa South of the Sahara↗

PubMed2004

Bacterial meningitis and brain abscesses secondary to infectious disease processes involving the head in horses: seven cases (1980-2001).

OBJECTIVE: To determine clinical features of horses with bacterial meningitis or brain abscesses secondary to infectious disease processes involving the head. DESIGN: Retrospective study. ANIMALS: 7 adult horses. PROCEDURE: Medical records of Tufts University, the University of Pennsylvania, and the Livestock Disease Diagnostic Center (Lexington, Ky) were reviewed to identify adult (> 12 months old) horses in which a postmortem diagnosis of bacterial meningitis or brain abscess had been made. Horses were included in the study if an intracranial infection was confirmed, the horse had a primary infectious disease process involving the head, and there were no signs of systemic infection. RESULTS: 23 adult horses with bacterial meningitis or a brain abscess were examined during the study period, but only 7 met the criteria for inclusion in the study. Primary sites of infection included the paranasal sinuses, nasal cavity, periocular tissues, and submandibular lymph nodes. Three horses died suddenly prior to hospitalization, and 1 horse was hospitalized but died 7 days after the onset of neurologic abnormalities. The remaining 3 horses were euthanatized because of a rapid deterioration in clinical status. CONCLUSIONS AND CLINICAL RELEVANCE: Although rare, fatal intracranial complications can develop in horses with infectious diseases involving the head.

Animals↗

PubMed1998

[Clinical and bacteriological studies on panipenem/betamipron in pediatrics. Kanagawa Research Group for Infectious Diseases of Children].

Following its introduction into the market, PAPM/BP (panipenem/betamipron) was clinically studied in 188 evaluable cases out of 207 cases primarily of respiratory infectious diseases treated at the pediatric departments of 15 hospitals. In the clinical evaluation, the drug proved effective in three of three cases of sepsis; three of three cases of suppurative meningitis; nine of ten cases of laryngopharyngitis, six of seven cases of tonsillitis, 56 of 63 cases of acute bronchitis, 90 of 98 cases of pneumonia, and one of one case of phyothorax, all of which are respiratory infectious diseases; one of one case of secondary infection of a chronic respiratory disease; and two of two cases of lymphadenitis, which is a disease of the soft dermal structure. The overall efficacy rate was 91.0% (171/188 cases). In the bacteriological study, Gram-positive bacteria were eliminated in five of five strains of S. aureus, 30 of 31 strains of S. pneumoniae (96.8%), and three of three strains of S. pyogenes. Gramnegative bacteria were eliminated in 15 of 17 strains of H. influenzae (88.2%), three of four strains of M. catarrhalis, and two of two strains of K. pneumoniae. The overall elimination rate was 92.1% (70/76 strains). In the 23 strains of S. pneumoniae that were examined, penicillin-resistant strains accounted for 56.5%, showing an elimination rate of 100%. No serious adverse effects were observed, and the incidence of adverse effects was 1.45%. As for abnormalities in laboratory tests, levels of GOT and GPT increased in eight cases (3.88%), LDH increased in one case (0.48%), and neutropenia occurred in one case (0.51%). These results suggest that PAMP/BP could be considered the first choice in the treatment of infectious diseases in pediatrics, due to its effectiveness and high level of safety.

Adolescent↗

PubMed2003

Anticardiolipin, anti-beta(2)-glycoprotein I and antiprothrombin antibodies in black South African patients with infectious disease.

OBJECTIVES: To investigate IgG, IgM, and IgA, antiphospholipid antibodies (aPL), against cardiolipin (aCL), beta(2)-glycoprotein I (anti-beta(2)GPI), and prothrombin (anti-PT), in black South African patients with infectious disease. Unlike patients with systemic lupus erythematosus (SLE) and the antiphospholipid syndrome (APS), raised levels of aPL in infectious diseases are not usually associated with thrombotic complications. PATIENTS AND METHODS: Serum samples from 272 patients with a variety of infectious diseases (100 HIV positive, 112 leprosy, 25 syphilis, 25 malaria, and 10 HCV patients) were studied and compared with autoantibody levels in 100 normal controls. All three aPL were measured using commercial enzyme linked immunosorbent assay (ELISA) kits. RESULTS: Raised levels of all three aPL were found in all patient groups studied: aCL in 7%, anti-beta(2)GPI in 6%, and aPT in 43% of 100 HIV patients, in 29%, 89%, and 21% of 112 patients with leprosy, in 8%, 8%, and 28% of 25 patients with syphilis, in 12%, 8%, and 28% of 25 patients with malaria, and in 20%, 30%, and 30% of 10 HCV patients studied, respectively. CONCLUSIONS: The prevalence of aCL and anti-beta(2)GPI in black South African HIV positive patients, or those with syphilis, malaria, or hepatitis C virus is lower than reported for mixed race or white populations. aPT were the most prevalent aPL detected in these patient groups, except in patients with leprosy, for whom anti-beta(2)GPI was the most prevalent, and where the spectrum of aPL was similar to that seen in patients with SLE and APS.

Adult↗

PubMed2003

Informal consultations in infectious diseases and clinical microbiology practice.

Informed consultation between physicians is an important part of medical practice. The aim of the study was to evaluate the nature and frequency of such consultations in infectious diseases and clinical microbiology practice. This study was done in five university hospitals. Twenty-one infectious diseases and clinical microbiology specialists participated in informal ('curbside') consultations. In a written questionnaire, physicians were asked to report the number and nature of the informal consultations (ICs) they were asked to provide. A total three hundred and sixty-two such consultations were carried out during a three-month period. The ICs occurred most frequently in the hospital (82.3%). Most of the ICs from outside the hospital were by telephone. Most of the ICs (54.4%) were requested by fellows of specialists. 78.7% of the ICs were requested during working hours. 58.8% of consultations took less than 5 min, 18.8% took 6-10 min, 15.2% took 11-20 min, and 7.2% took over 20 min. The four most common reasons for obtaining ICs were to: help to select an appropriate treatment plan (41.4%), help to select an appropriate prophylaxis (19.3%), interpret laboratory data (10.2%), and provide information about antibiotics (10.2%). 30.1% of ICs resulted in subsequent formal consultation and only four patients (1.1%) were transferred to the consultants' clinics. Informal consultations are a frequent occurrence in the practice of infectious diseases and clinical microbiology (ID&CM). Physicians use this sort of consultation to select an appropriate treatment plan and obtain medical information. This study confirms the importance of the ID&CM specialists as a resource for medical personnel.

Communicable Diseases↗

PubMed1996

[The role of the day-care nursery and early schooling on the incidence of infectious diseases].

OBJECTIVE: The purpose of this study was to study if early care away from home of infants and young children increases the incidence and severity of infectious disease episodes and to define the age group in which the infection risk is highest. MATERIAL AND METHODS: A prospective cohort study was conducted in three pediatric clinics of a primary health care center. RESULTS: The mean number of infectious disease episodes was 7.2 (< 2 years of age), 6.3 (2-3 years) and 5.05 (> 3 years) in children attending school for the first year and 4.0, 3.1 and 2.7 for children of the same age groups not attending school. For the first year of schooling, the relative risk (RR) and 95% confidence intervals (CI) for some specific diseases, in children between 6-24 months of age were 1.99 (1.03-3.83) for more than two episodes of otitis media and 4.59 (1.97-10.7) for more than three episodes of bronchial asthma. Children between 24 and 36 months of age had RR and CI of 4.63 (1.51-14.8) for more than two episodes of otitis media. CONCLUSION: Infants and small children cared for outside of the home environment have a greater number of acute infectious disease episodes than those cared for at home. The risk is higher during the first year of schooling, particularly in those less than two years of age.

Acute Disease↗