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[Treatment of infectious diseases in al-Andalus].

The treatment used in Islamic Spain, al-Andalus, for a number of infectious diseases such as leprosy, tuberculosis, gonococcal disease, diarrhea, smallpox, measles, parasitic diseases, etc., is reviewed briefly. The different remedies of plant, animal and mineral extracts employed by renowned physicians of the time, such as Isaac, Arib ibn Said, Abulcasis, al-Gafiqi and Averroes among others, are analyzed briefly to provide an understanding of the approach to the treatment of infectious diseases nowadays known to be caused by microorganisms.

History, Medieval↗

Campylobacter: common cause of enteritis in an infectious diseases hospital.

Eleven patients were referred to the infectious diseases wards of the Prince Henry Hospital, Sydney, between August and December, 1979, with acute infectious diarrhoea acquired within Australia. Nine of the 11 had infection with Campylobacter species as the sole pathogens. In contrast, a variety of pathogens was isolated from the stools of 13 patients referred to the hospital with enteritis acquired during overseas travel, including three Shigella species, but only one Campylobacter species. The patients with campylobacter enteritis suffered fever, abdominal discomfort and diarrhoea, often with some blood. Complications of campylobacter enteritis included colitis, severe abdominal pain, renal failure, severe muscle cramps, headache with meningism, myalgias and arthralgias. Campylobacter enteritis resolved with cessation of solid food intake, together with intravenous or oral fluid therapy. Some patients were treated with erythromycin, with prompt improvement, though a role for antibiotic therapy has not yet been established.

Adolescent↗

Delayed-impact infectious disease after a natural disaster.

Most recent studies of natural disasters have shown little increase in post-disaster infectious disease. The result has been a de-emphasis of the disease control portion of many disaster relief programs. This study demonstrates a significant increase in four out of the five diseases studied following two hurricanes in the Dominican Republic, with the major impact of the increases coming several months after the disaster. Posited reasons for the increase in infectious diseases are: (a) overcrowding of makeshift refugee centers with insufficient sanitary facilities, and (b) flood-caused water transmission of pathogens.

Communicable Diseases↗

High serum hepatocyte growth factor levels in the acute stage of community-acquired infectious diseases.

Acute serum levels of hepatocyte growth factor (HGF) were studied in 6 clinical groups with (i) gastroenteritis, (ii) skin and soft tissue infection, (iii) urinary tract infection, (iv) septicemia, (v) influenza, and (vi) chronic hepatitis C in comparison with a normal control group using an enzyme-linked immunosorbent assay method. We found that serum HGF levels were significantly higher in patients with acute infectious diseases (p < 0.0001) compared to patients with chronic viral hepatitis and healthy controls. Serum HGF and CRP levels were correlated significantly (r=0.65, p < 10(-7)). We conclude that serum HGF levels are elevated in patients with acute infectious diseases.

Acute Disease↗

sispread: A software to simulate infectious diseases spreading on contact networks.

OBJECTIVES: We present a simulation software which allows studying the dynamics of a hypothetic infectious disease within a network of connected people. The software is aimed to facilitate the discrimination of stochastic factors governing the evolution of an infection in a network. In order to do this it provides simple tools to create networks of individuals and to set the epidemiological parameters of the outbreaks. METHODS: Three popular models of infectious disease can be used (SI, SIS, SIR). The simulated networks are either the algorithm-based included ones (scale free, small-world, and random homogeneous networks), or provided by third party software. RESULTS: It allows the simulation of a single or many outbreaks over a network, or outbreaks over multiple networks (with identical properties). Standard outputs are the evolution of the prevalence of the disease, on a single outbreak basis or by averaging many outbreaks. The user can also obtain customized outputs which address in detail different possible epidemiological questions about the spread of an infectious agent in a community. CONCLUSIONS: The presented software introduces sources of stochasticity present in real epidemics by simulating outbreaks on contact networks of individuals. This approach may help to understand the paths followed by outbreaks in a given community and to design new strategies for preventing and controlling them.

Algorithms↗

High prevalence of hypophosphataemia amongst patients with infectious diseases. A retrospective study.

OBJECTIVES: To describe the prevalence of hypophosphataemia amongst all patients treated during 1993 for infectious diseases. The associations between serum C-reactive protein, serum albumin and white blood cells in blood were studied amongst hypophosphataemic patients. Comparisons were made according to the severity of infection. DESIGN: A retrospective study of the prevalence of hypophosphataemia, and a case-control study amongst a subgroup of patients. SETTING: The Department of Infectious Diseases, University Hospital, Umeå, Sweden. SUBJECTS: For the prevalence study all 967 patients (449 women and 518 men) treated during 1993 were included. In the case-control study, 108 cases, with serum phosphate < or =0.64 mmol L(-1), 216 age-and sex-matched controls with serum phosphate >0.82 mmol L(-1) (men) and >0.86 mmol L(-1) (women), respectively, were included. RESULTS: In 402 of 967 patients (42%) at least one serum phosphate value was below the reference level. Hypophosphataemia was found in 573 of 1966 blood samples (29%). Severe hypophosphataemia (<0.30 mmol L(-1)) was seen in 1.2% of the patients (0.9% of blood samples). The prevalence of hypophosphataemia was higher amongst women than amongst men. In the case-control study, the serum C-reactive protein and the number of white blood cells was higher amongst the cases compared with the controls (124 vs. 94 mg L(-1) and 11.4 vs. 9.3 cells/L x10(9), respectively). The multiple logistic regression showed a 4-fold higher risk of having low serum phosphate in patients with severe infection, compared with mild infections. None of the other variables (albumin, days of hospital stay or white blood cells in blood) increased the risk for hypophosphataemia. CONCLUSIONS: The high prevalence of low serum phosphate levels and the increased risk of having low levels in severe infections shown in this study needs further attention.

Adolescent↗

[Immunoglobulin G avidity in infectious diseases].

The paper reviews results reached so far about avidity of immunoglobulins G in viral, parasitic and bacterial infectious diseases. The general introductory part begins with explanation of immunologic basis in maturation of avidity of immunoglobulins G and proceeds up to a survey of methods used for the determination of avidity. It also deals with the modes of evaluation in these methods and comments on their advantages and disadvantages. The part devoted to individual infectious diseases brings the most important information about avidity of immunoglobulins G in specific infections, especially in view of their (even potential) practical medical application, mainly in determining the phase of infection in pregnant women and in patients after transplantation. The highest attention is paid to herpes virus infections, especially the cytomegalous virus and the infections with Epstein-Barr virus, rubella and toxoplasmosis, therefore those infections, which in the given situations clearly demonstrated the contribution of avidity analysis in the solution of interpretation-difficult conditions typical for serology, such as lasting levels of immunoglobulins M and cross-reactivity of antibodies.

Antibody Affinity↗

The U.S.-Mexico Border Infectious Disease Surveillance project: establishing bi-national border surveillance.

In 1997, the Centers for Disease Control and Prevention, the Mexican Secretariat of Health, and border health officials began the development of the Border Infectious Disease Surveillance (BIDS) project, a surveillance system for infectious diseases along the U.S.-Mexico border. During a 3-year period, a binational team implemented an active, sentinel surveillance system for hepatitis and febrile exanthems at 13 clinical sites. The network developed surveillance protocols, trained nine surveillance coordinators, established serologic testing at four Mexican border laboratories, and created agreements for data sharing and notification of selected diseases and outbreaks. BIDS facilitated investigations of dengue fever in Texas-Tamaulipas and measles in California-Baja California. BIDS demonstrates that a binational effort with local, state, and federal participation can create a regional surveillance system that crosses an international border. Reducing administrative, infrastructure, and political barriers to cross-border public health collaboration will enhance the effectiveness of disease prevention projects such as BIDS.

Communicable Disease Control↗

Statistical inference for infectious diseases. Risk-specific household and community transmission parameters.

A statistical model is presented for the analysis of infectious disease data from family studies in the community. The model partitions the sources of infection into those from within the household and those from the community at large. The parameters reflecting these sources of infection are estimated as functions of the risk factors. This new model is used to overcome problems associated with the lack of independence of observations in infectious disease data and negative confounding due to the association of unmeasured exposures and immunity. An example of how this new statistical model is used to provide a clearer and less confounded description of risk factor effects is presented for data from influenza A(H3N2) epidemic seasons in the Tecumseh Respiratory Illness Study. The risk factors examined are age and pre-epidemic season antibody level as measured by the hemagglutination-inhibition test, while the outcome is the infection rate. A standard analysis of the data indicates that the efficacy of protective antibodies is 70% in children and only 47% in adults. However, such an efficacy measurement is negatively confounded by past exposure which is age dependent. By means of the model, the true, unconfounded, efficacy of protective antibodies is shown to be 90% in both adults and children.

Adolescent↗

Quality perceptions of microbiology services. A survey of infectious diseases specialists.

Opinions about the quality of their primary microbiology laboratory were received from more than 500 practicing infectious diseases specialists by a nationally distributed questionnaire. Approximately 92% of the respondents' primary laboratories were hospital-based. These sophisticated users rated the quality of their microbiology laboratories to be generally high, with bacteriology receiving highest scores and parasitology the lowest scores. Fortunately, the serious problems, such as failing to call a critical result and culture mishandled in the laboratory, were experienced rarely. Laboratories directed by pathologists with specialty microbiology training, PHD microbiologists, and infectious diseases specialists were judged to be of highest quality. American Board of Medical Microbiology certification of the laboratory director was related to higher overall quality perceptions. Whereas physician-customer opinions may not directly measure a laboratory's analytic quality, they are an important performance measure on which laboratories can base quality improvement activities in both service and analytical aspects of performance.

Clinical Laboratory Techniques↗

Utilizing stochastic genetic epidemiological models to quantify the impact of selection for resistance to infectious diseases in domestic livestock.

This paper demonstrates the use of stochastic genetic epidemiological models for quantifying the consequences of selecting animals for resistance to a microparasitic infectious disease. The model is relevant for many classes of infectious diseases where sporadic epidemics occur, and it is a powerful tool for investigating the costs, benefits, and risks associated with breeding for resistance to specific diseases. The model is parameterized for transmissible gastroenteritis, a viral disease affecting pigs, and selection for resistance to this disease on a structured pig farm is simulated. Two genetic models are used, both of which involve selection of sires. The first involves selection with the assumption of continuous genetic variation (the continuous selection model). The second involves selection with the assumption of introgression of a major recessive gene that confers resistance (the gene introgression model). In the base population, the basic reproductive ratio, R0 (i.e., the expected number of secondary cases after the introduction of a single infected animal) was 2.24, in agreement with previous studies. The probabilities of no epidemic, a minor epidemic (one that dies out without intervention), and a major epidemic were 0.55, 0.20, and 0.25, respectively. Selection for resistance, under both genetic models, resulted in a nonlinear decline in the probability of a major epidemic and a decrease in the severity of the epidemic, should it occur, until R0 was less than 1.0, at which point the probability of a major epidemic was zero. For minor epidemics, the probability and severity of the epidemic increased until R0 reached 1.0, at which point the probabilities also fell to zero. The epidemic probabilities were critically dependent on the location on the farm where infected animals were situated, and the relative risks of different groups of animals changed with selection. The main difference between the two genetic models was in the time scale; the introgression results simply depended on how quickly the resistance allele could be introgressed into the population. For the introgression model, the probability of a major epidemic declined to zero when 0.6 of the animals were homozygous for the resistance allele.

Animal Husbandry↗

Fibrinolysis and coagulation in patients with infectious disease and sepsis.

Sepsis is often associated with hemostatic dysfunction. This study aimed to relate changes in fibrinolysis and coagulation parameters to sepsis and sepsis outcome. Urokinase-type plasminogen activator (u-PA) antigen, tissue-type plasminogen activator (t-PA) antigen and activity, plasminogen activator inhibitor (PAI) type 1 antigen, PAI activity, antithrombin (AT) III activity, and protein C activity were measured in 24 patients suffering from sepsis or septic shock and the results were compared with those observed in 30 non-sepsis patients with severe infectious disease. The u-PA level was markedly increased in plasma of sepsis patients as compared to non-sepsis patients (11.5 +/- 9.4 versus 1.6 +/- 1.5 ng/ml, p less than 0.0001). PAI-1 antigen and t-PA activity showed a significant increase in sepsis patients (320 +/- 390 ng/ml versus 120 +/- 200 ng/ml, and 3.0 +/- 3.6 IU/ml versus 1.0 +/- 0.7 IU/ml, respectively, p less than 0.01). AT III was decreased in sepsis patients (58 +/- 28% in sepsis versus 79 +/- 26% in severe infectious disease, p less than 0.01) as was protein C (30 +/- 18% versus 58 +/- 27%, p less than 0.001). No significant difference was found for t-PA antigen nor for PAI activity. Nonsurvivors of sepsis were distinguished mainly by a high u-PA antigen level and increased t-PA activity. It is concluded that plasma u-PA antigen showed the strongest significant difference, among the parameters evaluated, between sepsis and severe infection. u-PA antigen may be of prognostic value in patients admitted to the medical intensive care unit for severe infectious disease.

Adult↗

Automated laboratory reporting of infectious diseases in a climate of bioterrorism.

While newly available electronic transmission methods can increase timeliness and completeness of infectious disease reports, limitations of this technology may unintentionally compromise detection of, and response to, bioterrorism and other outbreaks. We reviewed implementation experiences for five electronic laboratory systems and identified problems with data transmission, sensitivity, specificity, and user interpretation. The results suggest a need for backup transmission methods, validation, standards, preserving human judgment in the process, and provider and end-user involvement. As illustrated, challenges encountered in deployment of existing electronic laboratory reporting systems could guide further refinement and advances in infectious disease surveillance.

Bioterrorism↗

Vaccine therapy for HIV: a historical review of the treatment of infectious diseases by active specific immunization with microbe-derived antigens.

A review of the history of 'vaccine therapy' for infectious diseases is presented. The concept originated when Auzias-Turenne introduced 'syphilitic vaccination' or 'syphilization' as a treatment for syphilis in Paris in the mid-1800s; his clinical studies probably influenced Pasteur's successful rabies postexposure vaccine trials. Robert Koch in Berlin in the 1890s observed that inoculation of tuberculin into patients with tuberculosis induced an inflammatory response in affected tissues, and advocated 'tuberculin therapy'. Sir Almroth Wright in London in the early 20th century devised methods to measure changes in serum 'opsonizing' activity in response to therapeutic inoculations with microbe-derived vaccines. Since the advent of antibiotics, active specific immunization with microbe-derived antigens (vaccine therapy) has been largely forgotten as a strategy for treatment of infectious diseases. Advances in antigen production and in molecular immunology now permit new tactics to probe, analyse and selectively alter in vivo human immune responses to infectious microbes. Our recent demonstration that vaccine therapy can boost natural immunity to HIV in infected patients should rekindle interest in this approach.

AIDS Vaccines↗

[Molecular diagnosis of infectious diseases].

Application of techniques originally developed for the analyses of nucleic acids to the diagnosis and characterization of infectious diseases is increasingly practiced. This tendency has been intensified after the introduction of the polymerase chain reaction (PCR). With the PCR, the molecular diagnostic assays have achieved a high sensitivity that parallels and often exceeds the sensitivity of various culture methods. This means that we are entering a new era in which a new gold standard is to be established. In this review, we summarized the basic principle of molecular diagnostic methods, presented, as an example, the application of such techniques to the study of rotaviruses, the single most important etiological agent of acute diarrhea in children, and finally discussed briefly possible future trends of molecular diagnostics for infectious diseases at large.

DNA, Viral↗

Climate-based health monitoring systems for eco-climatic conditions associated with infectious diseases.

Despite a century of confidence and optimism in modern medicine and technology inspired by their often successful prevention and control efforts, infectious diseases remain an omnipresent, conspicuous major challenge to public health. Effective detection and control of infectious diseases require predictive and proactive efficient methods that provide early warning of an epidemic activity. Of particular relevance to these efforts is linking information at the landscape and coarser scales to data at the scale of the epidemic activity. In recent years, landscape epidemiology has used satellite remote sensing and geographic information systems as the technology capable of providing, from local to global scales, spatial and temporal climatic patterns that may influence the intensity of a vector-borne disease and predicts risk conditions associated with an epidemic. This article provides a condensed, and selective look at classical material and recent research about remote sensing and GIS (geographic information system) applications in public health.

Africa, Central↗

Electronic laboratory reporting for the infectious diseases physician and clinical microbiologist.

BACKGROUND: One important benefit of electronic health information is the improved interface between infectious diseases practice and public health. Electronic communicable disease reporting (CDR), given its legal mandate and clear public health importance, is a significant early step in the sifting and pooling of health data for purposes beyond patient care and billing. Over the next 5-10 years, almost all CDR will move to the internet. METHODS: This paper reviews the components of electronic laboratory reporting (ELR), including sifting through data in a laboratory information management system for reportable results, controlled "vocabularies" (e.g., LOINC, Logical Observation Identifiers Names and Codes [Regenstrief Institute], and SNOMED, Systematized Nomenclature of Medicine [College of American Pathologists]), the "syntax" of an electronic message (e.g., health level 7 [HL7]), the implications of the Health Insurance Portability and Accountability Act for ELR, and the obstacles to and potential benefits of ELR. RESULTS: There are several ways that infectious diseases physicians, infection control professionals, and microbiology laboratorians will participate in electronic CDR, including web-based case reporting and ELR, the direct, automated messaging of communicable disease reports from clinical lab information management systems to the appropriate public health jurisdiction's information system. CONCLUSIONS: ELR has the potential to make a large impact on the timeliness and the completeness of communicable disease reporting, but it does not replace the clinician's responsibility to submit a case report with important demographic and epidemiologic information.

Clinical Laboratory Information Systems↗