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PubMed1997

1997 guidelines for the use of antimicrobial agents in neutropenic patients with unexplained fever. Infectious Diseases Society of America.

This is the first in a series of practice guidelines commissioned by the Infectious Diseases Society of America through its Practice Guidelines Committee. The purpose of these guidelines is to provide assistance to clinicians when making decisions on treating the conditions specified in each guideline. The targeted providers are internists, pediatricians, and family practitioners. The targeted patients and setting for the fever and neutropenia guideline are hospitalized individuals with neutropenia secondary to cancer chemotherapy. Panel members represented experts in adult and pediatric infectious diseases and oncology. The guidelines are evidence-based. A standard ranking system was used for the strength of the recommendations and the quality of the evidence cited in the literature reviewed. The document has been subjected to external review by peer reviewers as well as by the Practice Guidelines Committee and was approved by the IDSA Council. An executive summary, algorithms, and tables highlight the major recommendations. The guideline will be listed on the IDSA home page at http://www.idsociety.org.

Adult↗

PubMed1997

Diagnosis and management of group A streptococcal pharyngitis: a practice guideline. Infectious Diseases Society of America.

This is the second in a series of practice guidelines commissioned by the Infectious Diseases Society of America through its Practice Guidelines Committee. The purpose of these guidelines is to provide assistance to clinicians when making decisions on treating the conditions specified in each guideline. The targeted providers are pediatricians, family practitioners, and internists. The targeted patients and setting for the acute pharyngitis guideline are pediatric, adolescent, and adult outpatients with a complaint of sore throat. Funding was provided by the IDSA. Panel members represented experts in adult and pediatric infectious diseases. The guidelines are evidence-based. A standard ranking system was used for the strength of the recommendations and the quality of the evidence cited in the literature reviewed. The document has been subjected to external review by peer reviewers as well as by the Practice Guidelines Committee and was approved by the IDSA Council. An executive summary, algorithms, and tables highlight the major recommendations. Indicators of quality will assist in guideline implementation. The guideline will be listed on the IDSA home page at http://www.idsociety.org.

Adolescent↗

PubMedDate not supplied

Infectious diseases fellowship training: another viewpoint.

According to some observers, an oversupply of physicians in general, and of infectious disease (ID) specialists in particular, already exists; if not, oversupply may be imminent. More stringent licensing requirements, mandatory accreditation for specialty programs, and legislation restricting Medicare expenditure on direct education may help to keep the numbers of specialists down. However, once saturation is reached, it will persist longer in ID than in other, older subspecialties. In the future, many ID specialists may spend much of their time evaluating conditions that have no obvious relation to an infectious disease. Rather than an unfortunate waste, however, ID training will be advantageous in these circumstances because of the excellent background acquired in evaluating histories and performing thorough physical examinations and the emphasis placed on cost-effective use of antimicrobial agents. Physicians well trained in ID are likely to be cost conscious in the use of the laboratory as well as parsimonious in the use of drugs. A further lowering of costs probably results from contributions of these physicians to hospital formulary committees and infection control programs. Thus, residents in internal medicine who wish ID training should be given the opportunity; they will be better internists for the experience.

Education, Medical, Graduate↗

PubMed1999

Vaccination against the major infectious diseases.

The reputation of vaccination rests on a 200-year-old history of success against major infectious diseases. That success has led to the doctrine of 'for each disease, a vaccine'. Although some diseases have proved frustrating, this doctrine carries considerable truth. However, when one reviews the vaccines now available it is apparent that most successes have been obtained when the microbe has a bacteremic or viremic phase during which it is susceptible to the action of neutralizing antibodies, and before replication in the particular organ to which it is tropic. Poliomyelitis and infections by capsulated bacteria are examples where vaccination has worked efficiently. However, some success has also been achieved against agents replicating on respiratory or gastrointestinal mucosae. Influenza, pertussis and rotavirus vaccines are examples of such agents, against which it has been possible to induce immune responses acting locally as well as systemically. In addition, when bacteria produce disease through exotoxins, purification and chemical or genetic inactivation of those toxins has yielded highly efficacious vaccines. Control of intracellular pathogens has not been achieved, except partly with the BCG vaccine against tuberculosis, and modern efforts are directed towards pathogens against which cellular immune responses are critical. In general, two achievements have been crucial to the success of vaccines: the induction of long-lasting immunological memory in individuals and the stimulation of a herd immunity that enhances control of infectious diseases in populations.

Animals↗

PubMed2005

Sphingolipids in infectious diseases.

Sphingolipids are ubiquitous constituents of membrane lipids in eukaryotes. Sphingolipid metabolites modulate various cellular events including proliferation, differentiation, and apoptosis. In addition, sphingolipids, along with cholesterol, form detergent-resistant membrane microdomains, so called 'lipid-rafts', which are implicated in signal transduction and membrane trafficking. Sphingolipids are also relevant to infectious diseases. Various types of pathogens exploit the sphingolipids of host cells as membrane receptors. Sphingolipid metabolites regulate pathogen infection and host defense: for instance, a specific glycosphingolipid acts as an endogenous ligand for activation of natural killer T cells. Lipid-rafts of host cells serve as platforms also for infection signaling and entry of intracellular parasites. Moreover, some post-infectious autoimmune diseases result from production of antibodies cross-reacting with mammalian sphingolipids. Differences in the pathways of sphingolipid metabolism between mammals and non-mammals are good clues for rational development of new anti-infectious disease drugs. This review summarizes recent advances in sphingolipid biology related to infectious diseases.

Bacterial Toxins↗

PubMed2005

Scaling properties of childhood infectious diseases epidemics before and after mass vaccination in Canada.

The goal of this paper is to analyse the scaling properties of childhood infectious disease time-series data. We present a scaling analysis of the distribution of epidemic sizes of measles, rubella, pertussis, and mumps outbreaks in Canada. This application provides a new approach in assessing infectious disease dynamics in a large vaccinated population. An inverse power-law (IPL) distribution function has been fit to the time series of epidemic sizes, and the results assessed against an exponential benchmark model. We have found that the rubella epidemic size distribution and that of measles in highly vaccinated periods follow an IPL. The IPL suggests the presence of a scale-invariant network for these diseases as a result of the heterogeneity of the individual contact rates. By contrast, it was found that pertussis and mumps were characterized by a uniform network of transmission of the exponential type, which suggests homogeneity in the contact rate or, more likely, boiled down heterogeneity by large intermixing in the population. We conclude that the topology of the network of infectious contacts depends on the disease type and its infection rate. It also appears that the socio-demographic structure of the population may play a part (e.g. pattern of contacts according to age) in the structuring of the topology of the network. The findings suggest that there is relevant information hidden in the variation of the common contagious disease time-series data, and that this information can have a bearing on the strategy of vaccination programs.

Canada↗

PubMed2001

[Development of intensive care for pediatric infectious diseases over the last 20 years].

Intensive care and especially pediatric intensive care originated in connection with fatal forms of infectious diseases, some forty years ago. It has come a long way during the last quarter of the past century. Several infectious diseases have disappeared in France during this period such as poliomyelitis, dipteria and tetanus. Many other are receding. Nevertheless problems remain: serious infections by pneumococcus or staphylococcus, maternofoetal infections, whooping cough in very young infant. Now, thanks to liver transplantations and intensive care, the fatal forms of infectious hepatitis can be overcome in more than 50% of the cases. Meanwhile HIV appeared involving intensivists participation. Toxic shock, and especially the purpura fulminans, remains a major difficulty. Great advances in understanding its mechanisms have been made and it seems today like the result of excessive and unsuitable defence reactions. In addition, intensive care takes charge of more and more vulnerable ill persons: immunosuppressed, extreme premature babies, children who had to undergo heavy operations. In those cases, intensive care faces superinfections, nosocomial infections, multi-resistant germs, related in part to the particular working and environmental conditions and an unsuitable use of antibiotics. To conclude, it is necessary to optimize the technical and working conditions in intensive care units, to strictly observe the well established regulations of hygienics and to develop vaccinations.

Child↗

PubMed2006

[Microarray-based transcriptome analyses in infectious diseases. A new diagnostic method].

The complex interaction between a pathogen and a host is the molecular basis of infectious diseases. Microarray technology is a powerful tool to investigate the crosstalk between pathogen and the host as it assesses whole genome expression profiles in response to disease. Deciphering the molecular details on both sides of the host-pathogen interaction will increase our understanding of the pathogenesis of infectious diseases and offer improvements in their diagnosis, treatment, prognosis, and prevention.

Biomarkers↗

PubMed1992

[Therapeutic effects of cefprozil in the treatment of various infectious diseases in children].

Therapeutic effects of cefprozil (CFPZ, BMY-28100), a new cephalosporin, were examined in various infectious diseases in children. Clinical efficacy rates were 50% (2/4) in acute bronchitis, 80% (4/5) in pharyngitis, 0% in laryngitis, 100% (7/7) in tonsillitis, 100% (8/8) in impetigo contagiosa, furuncle and posthitis. Hence, the overall efficacy rate was 84% (21/25). Adverse effects were observed in 1 case with slightly elevated serum GOT and GPT. Changes in serum concentrations and urinary excretion of CFPZ were examined in 4 and 2 children without infection, respectively. T 1/2 values obtained were between 1 hour to 2 hours (bioassay). Six hour recovery rates in urine were 51.8% and 77.8% (bioassay). CFPZ was considered to be a safe and useful drug in treating various infectious diseases in children.

Administration, Oral↗

PubMed1979

Catecholamine activity and infectious disease episodes.

The profile of 3-hydroxy-4-methoxy mandelic acid (VMA) excretion was studied in relation to reported acute infectious disease episodes. Daily VMA excretion levels and symptom reports were analyzed for a group of 47 volunteers over a four-week period. Results showed a tendency for elevated VMA levels to occur with greater frequency within three days prior to the onset of symptoms. These findings are interpreted as suggesting that elevated levels of catecholamine activity may increase susceptibility to disease by interfering with the immune response, and in the presence of an agent lead to an infectious disease episode.

Adolescent↗

PubMedDate not supplied

Global warming and infectious disease.

Global warming has serious implications for all aspects of human life, including infectious diseases. The effect of global warming depends on the complex interaction between the human host population and the causative infectious agent. From the human standpoint, changes in the environment may trigger human migration, causing disease patterns to shift. Crop failures and famine may reduce host resistance to infections. Disease transmission may be enhanced through the scarcity and contamination of potable water sources. Importantly, significant economic and political stresses may damage the existing public health infrastructure, leaving mankind poorly prepared for unexpected epidemics. Global warming will certainly affect the abundance and distribution of disease vectors. Altitudes that are currently too cool to sustain vectors will become more conducive to them. Some vector populations may expand into new geographic areas, whereas others may disappear. Malaria, dengue, plague, and viruses causing encephalitic syndromes are among the many vector-borne diseases likely to be affected. Some models suggest that vector-borne diseases will become more common as the earth warms, although caution is needed in interpreting these predictions. Clearly, global warming will cause changes in the epidemiology of infectious diseases. The ability of mankind to react or adapt is dependent upon the magnitude and speed of the change. The outcome will also depend on our ability to recognize epidemics early, to contain them effectively, to provide appropriate treatment, and to commit resources to prevention and research.

Animals↗

PubMed1985

Immunopotentiation in infectious disease, I. Effect of bestatin on the immune response.

Few immunomodulators are available for the control of infectious disease. One reason has been the lack of a suitable protocol for evaluating such agents. We have presented a series of assays of immune function that will allow a standardized approach to this problem. The value of this protocol has been established using long-term low dose, and short-term high dose, administration of bestatin, a small molecular weight microbial product. The experiments were done using both normal and immunocompromised animals. Bestatin had no effect on circulating leukocytes or the reticuloendothelial system. Leukocyte mobilization and T cell responsiveness in immunocompromised animals were enhanced following bestatin treatment. The antibody response to SRBC doubled in normal animals while the same treatment schedule resulted in a marked reduction in the response to Escherichia coli lipopolysaccharide. These results have established the value of the protocol and identified some new immunomodulating properties of bestatin which may be useful in the control of infectious disease.

Adjuvants, Immunologic↗

PubMed1995

Return to the past: the case for antibody-based therapies in infectious diseases.

In the preantibiotic era, passive antibody administration (serum therapy) was useful for the treatment of many infectious diseases. The introduction of antimicrobial chemotherapy in the 1940s led to the rapid abandonment of many forms of passive antibody therapy. Chemotherapy was more effective and less toxic than antibody therapy. In this last decade of the 20th century the efficacy of antimicrobial chemotherapy is diminishing because of the rapidly escalating number of immunocompromised individuals, the emergence of new pathogens, the reemergence of old pathogens, and widespread development of resistance to antimicrobial drugs. This diminishment in the effectiveness of chemotherapy has been paralleled by advances in monoclonal antibody technology that have made feasible the generation of human antibodies. This combination of factors makes passive antibody therapy an option worthy of serious consideration. We propose that for every pathogen there exists an antibody that will modify the infection to the benefit of the host. Such antibodies are potential antimicrobial agents. Antibody-based therapies have significant advantages and disadvantages relative to standard chemotherapy. The reintroduction of antibody-based therapy would require major changes in the practices of infectious disease specialists.

Anti-Bacterial Agents↗

PubMed1994

IL-12 regulates T helper type 1 cytokine responses in human infectious disease.

We investigated the role of IL-12 in regulating T cell and cytokine responses in human infectious disease by using the spectrum of leprosy as a model. Tuberculoid patients mount strong T cell responses to Mycobacterium leprae, with production of the type 1 cytokines IL-2 and IFN-gamma in lesions; whereas lepromatous patients manifest weak T cell responses to M. leprae, with production of the type 2 cytokines IL-4 and IL-10 in lesions. We found expression of IL-12 p40 mRNA, as measured by PCR amplification, and IL-12 p70, as measured by immunohistochemistry, to be 10-fold greater in tuberculoid lesions than in lepromatous lesions. The ability of M. leprae to stimulate release of IL-12 from monocytes was inhibited by rIL-4 and rIL-10. M. leprae-induced T cell proliferation in tuberculoid patients was blocked by the addition of neutralizing Abs to IL-12. Furthermore, rIL-12 stimulated proliferation of CD4+ type 1 T cell clones from tuberculoid lesions, but not CD8+ type 2 T cell clones from lepromatous lesions; however, both responded to rIL-2, rIL-12 augmented M. leprae-specific T cell proliferation in lepromatous patients, thereby causing the selective expansion of CD4+ T cells and increasing T cell IFN-gamma production. These data indicate that IL-12 is an important mediator in the generation of the type 1 cytokine response in human infectious disease.

Base Sequence↗

PubMed1995

Spatial heterogeneity, nonlinear dynamics and chaos in infectious diseases.

There is currently considerable interest in the role of nonlinear phenomena in the population dynamics of infectious diseases. Childhood diseases such as measles are particularly well documented dynamically, and have recently been the subject of analyses (of both models and notification data) to establish whether the pattern of epidemics is chaotic. Though the spatial dynamics of measles have also been extensively studied, spatial and nonlinear dynamics have only recently been brought together. The present review concentrates mainly on describing this synthesis. We begin with a general review of the nonlinear dynamics of measles models, in a spatially homogeneous environment. Simple compartmental models (specifically the SEIR model) can behave chaotically, under the influence of strong seasonal 'forcing' of infection rate associated with patterns of schooling. However, adding observed heterogeneities such as age structure can simplify the deterministic dynamics back to limit cycles. By contrast all current strongly seasonally forced stochastic models show large amplitude irregular fluctuations, with many more 'fadeouts' of infection that is observed in real communities of similar size. This indicates that (social and/or geographical) spatial heterogeneity is needed in the models. We review the exploration of this problem with nonlinear spatiotemporal models. The few studies to date indicate that spatial heterogeneity can help to increase the realism of models. However, a review of nonlinear analyses of spatially subdivided measles data show that more refinements of the models (particularly in representing the impact of human demographic changes on infection dynamics) are required. We conclude with a discussion of the implication of these results for the dynamics of infectious diseases in general and, in particular, the possibilities of cross fertilization between human disease epidemiology and the study of plant and animal diseases.

Communicable Diseases↗

PubMed1999

Infectious diseases and natural disasters: the effects of Hurricane Mitch over Villanueva municipal area, Nicaragua.

BACKGROUND: A three month relief operation for the 25,303 people living in the municipal area of Villanueva, Nicaragua, hit by Hurricane Mitch, was carried out jointly by the staff of an international non-government organization and an Italian Regional Hospital's staff. METHODS: Health Mobile Teams joined the local health facilities (Health Centers and Health Posts) in responding to the people's urgent health problems. From their files the thirty-day post-disaster incidence of acute diarrheas (AD), respiratory tract infectious diseases (ARD), and malaria were estimated and compared with off-crisis data. New cases of leptospirosis were searched, but no control group was available. RESULTS: The incidence of AD and ARD increased significantly in comparison with pre-disaster data (6,798 vs. 2,849 per 100,000 inhabitants (p < 0.01) and 1,205 vs. 295 per 100,000 inhabitants (p < 0.01)). The increase in incidence of malaria was not explicit. Only three cases of leptospirosis were ascertained. The relief operators used the gathered data to make decisions to allocate the poorly available resources. CONCLUSIONS: The feasibility of the infectious disease surveillance and the reliability of the results under such conditions may change according to the setting. In this case study the infectious disease surveillance was feasible, and the gathered data were reliable and of some help to the relief operators in order to allocate the resources efficiently.

Chi-Square Distribution↗

PubMed2001

Zinc and childhood infectious disease morbidity and mortality.

Zinc is an essential mineral and deficiency results in abnormal immune function and higher rates of infectious diseases. Randomized controlled trials of zinc supplementation have been conducted in children in developing countries to determine effects on infectious disease morbidity and mortality. Zinc-supplemented children have been found to have lower rates of diarrhea, pneumonia and malaria in comparison with children not given zinc. Zinc used as an adjunct to fluid and dietary management of acute and persistent diarrhea has been found to reduce diarrheal duration and severity. Preliminary evidence suggests that zinc supplementation in children in poor developing country settings may also reduce infant mortality, but larger trials are needed to address this important issue. Preventive and therapeutic interventions should be implemented in developing countries where zinc deficiency is likely to be prevalent.

Child, Preschool↗

PubMed2005

Infectious disease and the decline of Steller sea lions (Eumetopias jubatus) in Alaska, USA: insights from serologic data.

Serologic data were examined to determine whether infectious disease may have played a role in the decline of Steller sea lions (Eumetopias jubatus) in the Gulf of Alaska and Aleutian Islands, USA. Available published data, unpublished data, and recent collections (1997-2000) were compared and reviewed. Data were stratified by geography to compare the declining western Alaskan population in the Aleutian Islands through eastern Prince William Sound to the increasing population in southeastern Alaska. Prevalences of antibodies from the 1970s to the early 1990s were noted for Leptospira interrogans, Chlamydophila psittaci, Brucella spp., phocid herpesvirus-1, and calciviruses. Serum samples collected from 1997-2000 were tested for antibodies to these agents as well as to marine mammal morbilliviruses, canine parvovirus, and canine adenovirus-1 and -2. Conclusions could not be drawn about changes in antibody prevalence to these agents during the decline of Steller sea lions, however, because data were incomplete or not comparable as a result of inconsistencies in testing techniques. Despite these shortcomings, results provided no convincing evidence of significant exposure of Steller sea lions to morbilliviruses, Brucella spp., canine parvovirus, or L. interrogans. Steller sea lions have been exposed to phocid herpesviruses, caliciviruses, canine adenovirus, and C. psittaci or to cross-reactive organisms in regions of both increasing and decreasing sea lion abundance. Based on similar antibody prevalence estimates from the increasing and decreasing populations, these agents are unlikely to have been the primary cause of the population decline. They may have contributed to the decline or impeded population recovery, however, because of undetected mortality and morbidity or reductions of fecundity and body condition in animals under other stresses. Systematic monitoring for disease agents and their effects is needed to determine whether infectious disease currently plays a role in the decline and lack of recovery of Steller sea lions.

Alaska↗