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PubMedDate not supplied

Vaccination of adults against travel-related infectious diseases, and new developments in vaccines.

The number of people travelling to tropical or subtropical countries, whether for holidays or for business, is steadily increasing. Many of these travellers are at risk of acquiring an infectious disease. Protection against certain infectious diseases is possible by vaccination. Vaccinations required or recommended for adults are reviewed here. Progress in the refinement of available vaccines, as well as the development of new vaccines, is discussed.

Adult↗

PubMed2000

Infectious diseases in rugby players: incidence, treatment and prevention.

Participation in rugby football can expose individuals to a variety of infectious diseases both on and off the field of play. The close physical contact and trauma inherent in playing rugby facilitates the transmission of viral, bacterial and fungal pathogens between players and may also lead to the acquisition of potentially lethal infections from the environment, such as tetanus. In the past few years there have been a number of reported outbreaks of infection amongst rugby players in the medical literature. The appearance of HIV infection has focused attention on the potential for transmission of this and other blood-borne viruses such as hepatitis B and C viruses from bleeding wounds sustained on the rugby field. As a result, various expert bodies have produced guidelines on the management of players with bleeding wounds. Opportunities are now available to rugby players to play outside their own countries, including the third world. This can bring them into contact with a wide range of travel-associated infections, some of which may be life threatening. In view of the above it is clear that rugby players and those who coach and manage rugby teams require information and education on the subject of infection and its prevention, as well as access to appropriate medical care and expertise. Many of the infections seen in rugby players are preventable, e.g. by promoting hygienic facilities and conduct in changing rooms and on the field of play, by exclusion of infected players from contact with others and, in some cases, by immunisation or chemoprophylaxis. Players who present with infections should be assessed, correctly diagnosed (using laboratory investigations where appropriate) and treated, and measures should be taken to prevent spread to team-mates and other contacts while respecting the confidentiality of the individual. Any outbreaks of infection should be reported to the appropriate authorities. There is evidence to suggest that strenuous physical exercise such as playing rugby can make individuals susceptible to certain types of infection and prolong time to recovery. More information is required on the true frequency and effects of infection in rugby players.

Anti-Infective Agents↗

PubMed1985

Acute phase response in infectious disease.

In considering the pathology associated with infectious diseases, the most common host response to such infection is inflammation. The mechanism(s) whereby inflammation is initiated and the cell types involved will dictate the kinds of acute phase plasma changes that can be seen associated with the infection. Bacteria seem to initiate the classical type of inflammatory response and plasma protein changes similar to those seen in experimental inflammation induced by chemical means. Viruses, on the other hand, in the absence of cytopathology do not appear to induce the same kind of inflammatory changes and avoid the induction of the acute phase protein response since they may not initiate activation of monocytes and/or macrophages. Those viruses that do cause macrophage activation would be expected to have acute phase protein changes associated with that activation. Parasites, however, appear to initiate the acute phase plasma response only when their migration leads to tissue destruction and local inflammation such as caused by parasitemia with Trypanosoma cruzi in the mouse or with migration of Nippostrongylus brasiliensis in the rodent. Human parasitic diseases require much more investigation in order to clarify the role played by acute phase proteins in the subsequent establishment of the host-parasite relationship. We postulate that the macrophage or monocyte on interaction with the infectious pathogen becomes activated and secretes a number of factors, including interleukin 1 and hepatocyte-stimulating factor, which have a marked effect on the total acute phase reaction. In addition to an effect on phagocytic and immune systems, the mediators cause hepatocytes to markedly increase the secretion of plasma acute phase proteins. Some of these proteins return to the site of inflammation and interact with the infectious pathogen and/or cells and proteins of the host, thereby affecting the final outcome of inflammation. We also propose that the initial interaction of an organism such as a parasite and the mammalian host involves early recognition by the macrophage, thereby initiating both the humoral and cellular acute phase reactions and subsequently affects the immune response against the parasite. Variations in the acute phase reaction may help to explain differences in susceptibility to infectious organisms and the presence or lack of host killing mechanisms for the parasite.

Acute-Phase Proteins↗

PubMedDate not supplied

Travel and the emergence of infectious diseases.

Travel is a potent force in the emergence of disease. Migration of humans has been the pathway for disseminating infectious diseases throughout recorded history and will continue to shape the emergence, frequency, and spread of infections in geographic areas and populations. The current volume, speed, and reach of travel are unprecedented. The consequences of travel extend beyond the traveler to the population visited and the ecosystem. When they travel, humans carry their genetic makeup, immunologic sequelae of past infections, cultural preferences, customs, and behavioral patterns. Microbes, animals, and other biologic life also accompany them. Today's massive movement of humans and materials sets the stage for mixing diverse genetic pools at rates and in combinations previously unknown. Concomitant changes in the environment, climate, technology, land use, human behavior, and demographics converge to favor the emergence of infectious diseases caused by a broad range of organisms in humans, as well as in plants and animals.

Animal Diseases↗

PubMed2006

Learning to respect a patient's spiritual needs concerning an unknown infectious disease.

This article aims to help readers to learn about health care related cultural and religious beliefs and spiritual needs in Chinese communities. The recall diary of a severe acute respiratory syndrome (SARS)-infected intern working in Hoping Hospital in Taiwan during the 2003 SARS epidemic is presented and used to assist in understanding one patient's spiritual activities when personally confronted with this newly emerging infectious disease. The article also gives an overview of the 2003 SARS epidemic in Taiwan, and discusses people's general perceptions towards infectious diseases, their coping strategies concerning disease, and their spiritual beliefs, the psychological impact of the 2003 SARS outbreak in Chinese communities, Chinese myths about infectious disease, and the religious activities of a SARS-infected intern in Taiwan. Recommendations are given on how to achieve quality holistic nursing care.

Adaptation, Psychological↗

PubMed2005

Computer-assisted decision support for the diagnosis and treatment of infectious diseases in intensive care units.

Diagnosing nosocomial infections in critically ill patients admitted to intensive care units (ICUs) is a challenge because signs and symptoms are usually non-specific for a particular infection. In addition, the choice of treatment, or the decision not to treat, can be difficult. Models and computer-based decision-support systems have been developed to assist ICU physicians in the management of infectious diseases. We discuss the historical development, possibilities, and limitations of various computer-based decision-support models for infectious diseases, with special emphasis on Bayesian approaches. Although Bayesian decision-support systems are potentially useful for medical decision making in infectious disease management, clinical experience with them is limited and prospective evaluation is needed to determine whether their use can improve the quality of patient care.

Bayes Theorem↗

PubMed1995

[Evaluation of the National Notification System for infectious diseases during an outbreak of Shigella epidemic in Norway 1994].

The National Notification System for Infectious Diseases, in Norwegian abbreviated to MSIS, registered 110 cases of Shigella sonnei-infection in persons with debut of symptoms during weeks 21 to 25, 1994, and where we did not receive information that the patients had been abroad. We evaluated the notification system during this outbreak of infectious disease by looking at delays in the notification process and estimating the proportion of patients who received an etiological diagnosis. It took a median time of seven days from onset of illness until a faecal specimen was obtained and a further ten days (maximum 15 days) until the result was registered in MSIS. The time lapse between receiving the specimen until MSIS had registered the result varied from six to 15 days among the laboratories which sent more than four notifications. In the summarical notification system we registered an increase of 712 cases (86%) of acute gastroenteritis compared with the same week the previous two years.

Adult↗

PubMedDate not supplied

Wild primate populations in emerging infectious disease research: the missing link?

Wild primate populations, an unexplored source of information regarding emerging infectious disease, may hold valuable clues to the origins and evolution of some important pathogens. Primates can act as reservoirs for human pathogens. As members of biologically diverse habitats, they serve as sentinels for surveillance of emerging pathogens and provide models for basic research on natural transmission dynamics. Since emerging infectious diseases also pose serious threats to endangered and threatened primate species, studies of these diseases in primate populations can benefit conservation efforts and may provide the missing link between laboratory studies and the well-recognized needs of early disease detection, identification, and surveillance.

Animals↗

PubMed1980

[Modern antibiotics in the clinical picture of infectious diseases].

The number of various chemotherapeutics including antibiotics used in combined treatment of patients with various infectious diseases is rather significant. Recently some new valuable drugs have been recommended. Still, in spite of definite achievements in treatment of patients with infectious diseases there are some difficulties and problems mainly connected with therapy of patients with sepsis, chronic typhoid fever bacterial carriers and some other patients.

Anti-Bacterial Agents↗

PubMed2001

[Diagnosis and approaches to therapy of emotional disorders in patients with infectious diseases].

AIM: To examine psychological and emotional disorders in patients with infectious diseases, to specify indications for their pharmacological correction. MATERIAL AND METHODS: Clinicopsychological, clinicofunctional and laboratory tests were made to examine 30 patients with infectious mononucleosis (19 females and 11 males) and 30 patients with serous meningitis (16 females and 14 males) aged 16-35 admitted to hospital on the disease day 2-14. RESULTS: Shmishek's questionnaire revealed various types of personality accentuations with dominating hyperthymic (30%) and cyclothymic (20%). According to the data of the clinical scale SCL-90, the greatest number of cases with values over normal was in patients with serous meningitis. Beck's questionnaire revealed clinical depression in 12 patients (40%) with acute serous meningitis, subdepression in 14(46.7%) patients, severe depression in 6(20%) patients with infectious mononucleosis. In convalescence, emotional disorders persisted in 4 patients with serous meningitis. CONCLUSION: Affective disorders in the above patients require consultation of the psychiatrist to decide on psychopharmacotherapy inclusion in combined treatment of infectious diseases to prevent lingering course.

Acute Disease↗

PubMedDate not supplied

Emerging infectious diseases in an island ecosystem: the New Zealand perspective.

Several unique features characterize infectious disease epidemiology in New Zealand. Historically, well-organized, government-run control programs have eliminated several zoonoses. More recently, however, communicable disease control has been mixed. Rates of rheumatic fever, tuberculosis, and enteric infectious are high, and rates of meningococcal disease are increasing. These diseases are over-represented in New Zealanders of Polynesian descent, who generally live in more deprived and overcrowded conditions than do those of European descent. Measles and pertussis epidemics are recurring because of inadequate vaccine coverage, despite a well-developed childhood immunization program. A progressive response to the HIV epidemic has resulted in relatively low rates of infection, particularly among injecting drug users; however, the response to other sexually transmitted infections has been poor. A key challenge for the future is to build on successful strategies and apply them to persisting and emerging infectious disease threats in a small, geographically isolated country with limited economic resources.

Animals↗

PubMedDate not supplied

[The quest of quality in the field of infectious disease at the hospital].

The implementation of a quality program in the field of the infectious diseases requires the prior definition of criteria (efficacy, low toxicity, low cost, less emergence of resistant strains) but also the target (the patient it-self, his or her community, the health system as a whole). A lot of tools are questioned: antimicrobial policy (escalation/streamlining, restricted formularies, antibiotics rotation), guidelines, relational tools (booklets and CME, prescription's formularies, computer's help and the Web) but also the role of an infectious diseases specialist and an antimicrobial management team. Finally, we outline some processes of evaluation.

Anti-Bacterial Agents↗

PubMed1994

[Lyme borreliosis--an infectious disease with interdisciplinary demands].

Lyme borreliosis is an infectious disease with various clinical manifestations, caused by the bacterium Borrelia burgdorferi. Although symptoms of the disease have been described since more than 100 years ago, it was not until 1982 that the causative organism was discovered. In Europe, Lyme borreliosis is the most common tick-borne disease, and in endemic regions, a considerable number of clinical cases can be found. The course of the disease is in stages and involves various organ systems, such as skin, nervous system, heart, and joints. Laboratory diagnosis is considered to be difficult and relies mainly on the determination of antibodies. A vaccine for use in humans is not yet available, but experimental data support the feasibility of a vaccine development.

Animals↗

PubMed2002

[Infectious disease assessment in solid organ transplant candidates].

BACKGROUND: Infections are one of the leading causes of morbidity and mortality in solid organ transplant recipients. Many of these infections can be prevented or their effects reduced by accurate preoperative evaluation of risk in the transplantation candidate. The elaboration of guidelines using a multidisciplinary approach can help to establish more rational diagnostic, therapeutic, and preventive measures in this setting. OBJECTIVE: To elaborate guidelines for the assessment of infectious diseases in transplant candidates, based on consensus among professionals in this field and under the auspices of Spanish scientific societies. MATERIAL AND METHODS: The Infections in Transplant Patients Group (GESITRA), within the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), appointed a panel of four microbiologists and infectious disease specialists to elaborate a draft of the guidelines, which was subsequently approved by all the members of this Group. With the support of the National Transplant Organization, the GESITRA document was then presented to various professionals in this field so they could provide their comments and suggestions. RESULTS: The final document, after incorporation of all appropriate modifications and suggestions, is presented herein. The guidelines focus on the following: a) diagnosis of active and latent infections, and identification of risk factors in the candidate; b) recommended approach for infections diagnosed during the evaluation process and their corresponding treatment; c) definition of infections contraindicating transplantation; and d) prevention of post-transplantation infectious complications by systematic vaccination and instruction on preventive measures provided to patients, their relatives, and persons living with them. DISCUSSION: Using a multidisciplinary approach that included the efforts of experts in the field and the collaboration of scientific societies, a comprehensive document containing specific recommendations was elaborated. Systematic review of the guidelines in the future is considered worthwhile by both the authors and supporters of this document.

Biomarkers↗

PubMed1990

[The use of different statistical methods in epidemiological analysis to assess the seasonality and territorial spread of infectious diseases].

To solve the problems connected with the evaluation of the seasonal and territorial distribution of infectious diseases, indications and limitations for the use of the following statistical methods have been worked out: the calculation of the monthly morbidity level, the proportion of cases of infectious diseases falling on the months of seasonal morbidity rises, the proportion of such cases appearing due to the influence of seasonal factors, the total and partial indices, the average monthly rate of increase in seasonal morbidity, the complex evaluation of seasonal morbidity, the evaluation of the nonparallelism of two curves, the determination of the mean quadratic deviations and Shannon's entropy. The algorithms based on these methods lie in the foundation of 11 computer programs, forming the software complex "Epidanalysis" and provided with the service menu permitting an epidemiologist to proceed from the task via indications and limitations to the corresponding program. The programs are intended for different types of computers (IBM PC XT, EC-1640, Robotron 1715).

Algorithms↗

PubMedDate not supplied

[Trends of mortality caused by infectious diseases in Cartagena de Indias, Colombia, 1995-2000: a measure of the epidemiological transition].

OBJECTIVES: Mortality is a definition of, strictly populational nature, different from the concepts of death and decease which reflect the loss of an individ ual biological life. Therefore, mortality expresses the dynamics of deaths along time and space, and only allows for comparisons at this level. Th present study was aimed at describing the tendency of mortality caused b infectious diseases in Cartagena de Indias, Colombia, during the perio 1995-2000, with the purpose of evidencing the epidemiological transition. MATERIALS AND METHODS: The databases of the mortality registers of Cartagena de Indias between 1995 and 2000 were taken as reference. The im pact of mortality was measured by the sum of Years of Potential Life Lost (YPLL) for each group of death causes. To adjust for the temporal preference for the assessment of YPLL a discount rate of 3% was applied in this study. The computerized GESMOR application was used for estimating YPLL, analyzing the mortality reported in the registers using the 9th and 10th versions of the International Classification of Diseases (ICD) to establish the basic causes of death. RESULTS: A mean of 3,506 annual deaths occurred during the period studied, generating on average 60,311 YPLL, which gives a rate of 71.5 YPLL per 1000 inhabitants. This represents a 16% increase which can be explained by an increase in the number of deaths in the lower age groups. For 1995, there was a predominance of group II non-infectious diseases causes (41.9%), followed by group I (30.2%). For the year 2000, the proportional distribution of mortality between the different groups of causes changed, causes in group I constituting the main explanation for causes of YPLL (52.9%). Non-infectious diseases occupied the second place (31.2%). These changes can be explained by the importance of perinatal causes of death, which increased from 14.2% of YPLL in 1995 to 32.7% in 2000. DISCUSSION: It is evident that the greater weight of infectious, maternal, perinatal and nutritional diseases, the slower then the national average decrease in child mortality rates, the greater load of mortality in the male sex, the stability of the group of accidents and injuries at the expense of intentional injuries during the period studied, have caused a stagnation of the epidemiological transition and the instauration of the prolonged polarized model.

Adolescent↗

PubMed2001

Infectious disease pathology.

The anatomic pathologist performs an important role in the diagnosis or exclusion of infectious diseases. The morphologic interpretation of biopsies and cytologic preparations allows for the definitive establishment or exclusion of a wide variety of diseases. Once the pathologist has determined that a disease is likely to be due to an infection and has characterized the inflammatory response, associated microorganisms or viral-associated cytopathic effects should be recorded. Although some microorganisms or their cytopathic effects may be clearly visible on routine hematoxylin and eosin-stained sections, additional histochemical stains are often needed for their complete characterization. Highly specific molecular techniques, such as immunohistochemistry, in situ hybridization, and nucleic acid amplification, may be needed in certain instances to establish the diagnosis of infection. Through appropriate morphologic diagnoses and interlaboratory communication and collaboration, the anatomic pathologist contributes greatly to the diagnosis and treatment of infectious diseases.

Animals↗

PubMed2002

Infectious disease prophylaxis in renal transplant patients: a survey of US transplant centers.

Definitive approaches to most infectious diseases following renal transplantation have not been established, leading to different approaches at different transplant centers. To study the extent of these differences, we conducted a survey of the practices surrounding specific infectious diseases at US renal transplant centers. A survey containing 103 questions covering viral, bacterial, mycobacterial and protozoal infections was developed. Surveys were sent to program directors at all U.S. renal transplant centers. Responses were received from 147 of 245 (60%) transplant centers and were proportionately represented all centers with respect to program size and geographical location. Pre-transplant donor and recipient screening for hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV) and cytomegalovirus (CMV) is uniform, but great discrepancy exists in the testing for other agents. HCV seropositive donors are used in 49% of centers. HIV seropositivity remains a contraindication to transplantation, although 13% of centers indicated they have experience with such patients. Post-transplant, there is wide variety in approach to CMV and Pneumocystis carinii (PCP) prophylaxis. Similarly divergent practices affect post-transplant vaccinations, with 54% of centers routinely vaccinating all patients according to customary guidelines in non-transplant populations. In contrast, 22% of centers indicated they do not recommend vaccination in any patients. We believe an appreciation of the differences in approaches to post-transplant infectious complications may encourage individual centers to analyse the results of their own practices. Such analysis may assist in the design of studies to answer widespread and important questions regarding the care of patients following renal transplantation.

Humans↗