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PubMed2005

Screening for infectious diseases among patients in a state psychiatric hospital.

This cross-sectional retrospective study examined the frequency of positive tests for infectious diseases among 655 patients who were admitted to a state psychiatric hospital from 1997 to 1999. Not all patients who were admitted to the hospital were tested for each disease. Rates of positive tuberculin (20.2 percent), hepatitis B (23.9 percent), and hepatitis C (21.5 percent) tests were all significantly greater than estimates for the U.S. general population. A minority of patients were tested for HIV, and 29.0 percent were positive. The rate of hepatitis A was similar to that in the general population (33.2 percent). Independent risk factors for markers of disease included age, immigrant status, homelessness, and history of substance use. These results confirm the importance of screening for infectious diseases among individuals with severe and persistent mental illness.

Adult↗

PubMed2003

[High mortality due to infectious diseases and unnatural causes of death among asylum seekers in the Netherlands, 1998-1999].

OBJECTIVE: Description of causes of death among asylum seekers in the Netherlands compared to the Dutch standard population and identification of preventive measures to avoid preventable death. METHODS: An analysis of the causes of death of asylum seekers accommodated in housing facilities of the Central Organ Asylum seekers (COA) for the period 1998-1999 was performed. The primary cause of death was attributed using the International Classification of Diseases (ICD-10) and grouped according to the most important causes of death list issued by Statistics Netherlands. After stratification for gender and age standardised mortality ratios (SMR) were computed. RESULTS: In 82% of the observed deaths amongst asylum seekers a description of the cause and circumstances of death could be obtained. During the 2-year study period 156 asylum seekers died (of which 49 due to an unnatural cause of death and 15 due to infectious diseases). Fourteen stillbirths were registered in an index population of 37,688 in 1998 and 54,110 in 1999. The crude mortality rate was 1.95 per 1000 for male asylum seekers and 1.25 per 1000 for female asylum seekers. Compared to the Dutch standard population, the SMR was 1.23 (95%-CI: 1.01-1.42) for male asylum seekers and 0.85 (0.59-1.11) for female asylum seekers. The elevated mortality in male asylum seekers was due to the high mortality for infectious diseases with an SMR of 4.1 (1.3-6.9) and unnatural death with an SMR of 2.5 (1.7-3.2). More specifically, drowning had an SMR of 11.1 (2.3-20.7), murder and manslaughter 7.3 (2.5-12.0) and suicide 2.8 (1.5-4.1). AIDS accounted for half of the mortality due to infectious diseases. CONCLUSION: In 1998-1999, drowning, murder, manslaughter and suicide contributed significantly to an elevated mortality rate amongst male asylum seekers in the Netherlands. Some of these unnatural deaths could be avoided by implementing preventive measures.

Adolescent↗

PubMed2004

Microglia and chemokines in infectious diseases of the nervous system: views and reviews.

Microglia are one of the resident mononuclear phagocyte populations within the central nervous system (CNS). These cells share many phenotypical and functional characteristics with macrophages, suggesting that microglia participate in innate immune responses in the brain. As such, microglia are uniquely poised to provide an initial line of defense against invading pathogens into the CNS prior to peripheral leukocyte infiltration. Numerous studies have shown that microglia are capable of producing a wide array of chemokines that act to initiate or promote inflammatory processes in the CNS through facilitating the recruitment of peripheral immune cells into the CNS parenchyma. In addition, microglia also express numerous chemokine receptors that are involved in cell migration and serve as co-receptors for human immunodeficiency virus-1 (HIV-1) infection. The findings obtained from studies of chemokine expression in animal models of CNS infectious diseases as well as from patient populations highlight a marked promiscuity in cerebral chemokine expression patterns with simultaneous expression of multiple chemokines being the general rule. A detailed discussion regarding the profiles and implications of chemokine and chemokine receptor expression in the context of various CNS infectious diseases including HIV-1 encephalitis, other viral encephalitides, bacterial meningitis, and brain abscess is presented. Future studies dissecting the potential roles of individual chemokines and their receptors in the context of CNS infectious diseases may provide insights into the complex regulatory network dictating neuroinflammatory responses.

Animals↗

PubMedDate not supplied

Social inequalities and emerging infectious diseases.

Although many who study emerging infections subscribe to social-production-of-disease theories, few have examined the contribution of social inequalities to disease emergence. Yet such inequalities have powerfully sculpted not only the distribution of infectious diseases, but also the course of disease in those affected. Outbreaks of Ebola, AIDS, and tuberculosis suggest that models of disease emergence need to be dynamic, systemic, and critical. Such models--which strive to incorporate change and complexity, and are global yet alive to local variation--are critical of facile claims of causality, particularly those that scant the pathogenic roles of social inequalities. Critical perspectives on emerging infections ask how large-scale social forces influence unequally positioned individuals in increasingly interconnected populations; a critical epistemology of emerging infectious diseases asks what features of disease emergence are obscured by dominant analytic frameworks. Research questions stemming from such a reexamination of disease emergence would demand close collaboration between basic scientists, clinicians, and the social scientists and epidemiologists who adopt such perspectives.

Acquired Immunodeficiency Syndrome↗

PubMed2006

Contributions of Native Americans to the global control of infectious diseases.

For over a half of a century, Native American populations have participated in numerous studies regarding the epidemiology, prevention and treatment of infectious diseases. These studies have resulted in measures to prevent morbidity and mortality from many infectious diseases. The lessons learned from these studies and their resultant prevention or treatment interventions have been applied around the world, and have had a major impact in the reduction of global childhood morbidity and mortality.

Humans↗

PubMed1991

AIDS epidemiology: inconsistencies with human immunodeficiency virus and with infectious disease.

The newly defined syndrome AIDS includes 25 unrelated parasitic, neoplastic, and noninfectious indicator diseases. Based on epidemiological correlations, the syndrome is thought to be due to a new, sexually or parenterally transmitted retrovirus termed human immunodeficiency virus (HIV). The following epidemiological data conflict with this hypothesis. (i) Noncorrelations exist between HIV and AIDS; for example, the AIDS risks of infected subjects vary greater than 10-fold with their gender or country. Abnormal health risks that are never controlled as independent AIDS causes by AIDS statistics, such as drug addiction and hemophilia, correlate directly with an abnormal incidence of AIDS diseases. Above all, the AIDS diseases occur in all risk groups in the absence of HIV. (ii) American AIDS is incompatible with infectious disease, because it is almost exclusively restricted to males (91%), because if it occurs, then only on average 10 years after transfusion of HIV, because specific AIDS diseases are not transmissible among different risk groups, and because unlike a new infectious disease, AIDS has not spread exponentially since the AIDS test was established and AIDS received its current definition in 1987. (iii) Epidemiological evidence indicates that HIV is a long-established, perinatally transmitted retrovirus. HIV acts as a marker for American AIDS risks, because it is rare and not transmissible by horizontal contacts other than frequent transfusions, intravenous drugs, and repeated or promiscuous sex. It is concluded that American AIDS is not infectious, and suggested that unidentified, mostly noninfectious pathogens cause AIDS.

Acquired Immunodeficiency Syndrome↗

PubMed1983

[Therapeutic effect of T-1982 (cefbuperazone) on the gynecologic infectious diseases].

T-1982 (cefbuperazone), a new cephamycin antibiotic with broad spectrum against Gram-positive, negative aerobic and anaerobic organisms, was clinically and bacteriologically evaluated on the gynecologic infectious diseases. Fourteen cases hospitalized at Kanazawa Medical University Hospital and the affiliated hospitals from October 1981 to July 1982 were treated with T-1982. By clinical symptoms, signs and bacteriological examinations the patients were diagnosed as pelveoperitonitis (1), intrauterine infection (3), adnexitis (3), infectious diseases of external genitalia (4), infectious abortion (1), vulvar hematoma (1), and rectovaginal fistula (1). T-1982 was administered intravenously or by drip infusion at a dose of 0.5-2.0 g twice a day after dissolved in a saline solution or a 5% glucose solution. Based on the improvement of clinical findings and antibacterial effect of T-1982, results were evaluated as excellent, good, poor and unknown. Clinical effects more than good were shown in 9 of 11 cases which could be followed up exactly on the therapeutic of T-1982. Two cases showing poor response were pelveoperitonitis and pyometra under carcinoma colli uteri stage IIIb, respectively. In 8 of 11 cases, antibacterial effect of T-1982 could be evaluated. Thirteen strains of aerobic and anaerobic bacteria were disappeared by T-1982 therapy, while no effect was seen on 5 strains. On the side effect of T-1982, exanthema was observed in 1 case but disappeared soon after the cessation of administration.

Adult↗

PubMed1979

Population biology of infectious diseases: Part I.

If the host population is taken to be a dynamic variable (rather than constant, as conventionally assumed), a wider understanding of the population biology of infectious diseases emerges. In this first part of a two-part article, mathematical models are developed, shown to fit data from laboratory experiments, and used to explore the evolutionary relations among transmission parameters. In the second part of the article, to be published in next week's issue, the models are extended to include indirectly transmitted infections, and the general implications for infectious diseases are considered.

Animals↗

PubMed1998

[National reference centers for surveillance of infectious diseases in Switzerland: results of a delphi study].

The national reference laboratories are one of the tools used by public health authorities to control infectious diseases. The Swiss Confederation supports 9 national reference centers (NC), each dealing with a limited number of infectious agents. The purpose of this study was to evaluate if this network meets present day needs, whether it has to be redefined, and how it can be improved. Using the Delphi technique, 34 experts in the field of infectious diseases were questioned to establish a concept for NC in Switzerland. The main result of this study is that official reference laboratories are considered necessary. However, depending on the type of infectious agent, the following types of laboratories should be used: national reference centers, specialized laboratories and laboratories abroad. The study also defined criteria for the designation of NC, their field of action (general objectives, tasks, duration of the mandate, infectious agent to be monitored), evaluation criteria, and the type of funding. Furthermore, possible improvements in the present system were identified and the establishment of good collaborations with reference centers abroad was proposed.

Communicable Diseases↗

PubMed2002

Sixth annual conference on infectious diseases focuses on bioterrorism, as well as more familiar problems. Monday, Dec 3, to Wednesday, Dec 5, 2001.

The Sixth Annual Conference on Infectious Diseases provided attendees with an opportunity to hear presentations by leaders in the field of infectious diseases and epidemiology who provided evidence that supports changing practices. Information supports the need to maintain well-known practices and recognize appropriate changes that will prevent undue patient and health care worker risk.

Bioterrorism↗

PubMed2005

History of U.S. military contributions to the understanding, prevention, and treatment of infectious diseases: an overview.

The contributions of U.S. military and affiliated civilian personnel to the advancement of mankind's understanding, prevention, and treatment of infectious diseases are innumerable. This supplement of Military Medicine has been produced by the Armed Forces Infectious Diseases Society (AFIDS) to review and highlight the accomplishments of U.S. Department of Defense military and civilian researchers in this field of study. Contributions by U.S. Armed Forces investigators to better the health of the world are documented in the 11 articles that follow.

Communicable Disease Control↗

PubMed2002

[Splenic rupture in infectious disease: splenectomy or conservative treatment? Report of three cases].

INTRODUCTION: Spontaneous splenic ruptures are rare but life-threatening complications of infectious diseases. Splenectomy is still the treatment of choice but numerous recent reports have documented favorable outcome with conservative treatment. EXEGESIS: We report three cases of splenic rupture occurring respectively with infectious mononucleosis, P. vivax infection and dengue fever. Diagnosis, treatment and indications are reviewed, an approach to management is suggested. The study included three military men respectively aged 23, 24 and 35 years, admitted for acute abdominal pain in the left upper quadrant. The abdominal computed tomography confirmed partial rupture (splenic hematoma) in the first two cases, and an hemoperitoneum in the dengue case. Splenic ruptures can reveal or complicate an evolving infection. Rupture can happen spontaneously or as a result of trauma, which may be minor and unnoticed. The typical presentation is acute, but progressive forms are described. The diagnosis is made by ultrasound and CT scan. Splenectomy dogma tends to be supplanted by conservative treatment. Non-operative management can be successful if appropriate criteria and a long period of follow-up are applied in carefully selected cases. When an operative approach is selected, conservative surgical treatment is attractive. Splenectomy should be reserved for patients with uncontrollable rupture or with recurrent splenic bleeding. CONCLUSION: Spontaneous splenic rupture are uncommon in infectious diseases. A multidisciplinary management is necessary. A conservative treatment should be considered in selected, closely monitored patients.

Abdominal Pain↗

PubMed1998

Career opportunities for infectious diseases subspecialists.

Few data are available regarding trends in career opportunities for subspecialty physicians. A review of advertisements for infectious diseases physicians in the 1990, 1993, and 1995 issues of the New England Journal of Medicine revealed a significant decline in the number of openings between 1990 and 1995. In each year the number of private practice advertisements exceeded those in all other categories combined, and this ratio increased over time. Both private practice and academic advertisements commonly listed opportunities or requirements for teaching or research. Expertise in internal medicine, rarely mentioned in advertisements for academic infectious diseases physicians, became the most frequently cited private practice subclassification in 1995. Both private practice and academic settings offered numerous positions related to the care of patients with human immunodeficiency virus infection. The demand for expertise in epidemiology, intravenous therapy, travel medicine, transplantation, or sexually transmitted diseases remained low. Most positions were in heavily populated states or geographic areas.

Advertising↗

PubMed1993

The use of recombinant human interleukin-2 in treating infectious diseases.

Data from animal models indicate that interleukin-2 is potentially valuable in the treatment of a variety of infectious diseases of viral, fungal, protozoal, bacterial, and mycobacterial origin. The role of interleukin-2 in resistance to infection with human immunodeficiency virus or Mycobacterium leprae (the causative agent of leprosy) has recently been studied in detail. Data from animal models and clinical trials indicate that relatively low doses of interleukin-2 effectively stabilize or reverse the course of these infections. The recent characterization of Th1 and Th2 helper T cells, and their relationship to the control of infectious diseases, are revealing the mechanisms involved in producing disease. Increased understanding of these mechanisms may help extend interleukin-2 therapy to other clinical applications.

Animals↗

PubMed1993

Polymerase chain reaction from bench to bedside. Applications for infectious disease.

The past decade has seen the rapid advancement of molecular biology and its application in the field of infectious diseases. The polymerase chain reaction (PCR) is a technique which allows for the in vitro amplification of DNA. The ability of this method to recognize and amplify small quantities of foreign genome from unpurified samples will revolutionize the diagnoses of microbial diseases which have previously been cumbersome or impossible. It has already been widely applied in this area, and clinical labs will soon be offering this test for selected pathogens. There are ongoing studies evaluating its use in CNS infections and for the identification of viruses in the immunocompromised host. The PCR is not without problems, particularly false positive results from contamination. Because it is so sensitive, the significance of a positive result in patients with latent or chronic infections is yet to be determined. As our knowledge and familiarity with PCR expands, it will become a powerful tool for the clinician to use to identify various infectious diseases.

Communicable Diseases↗

PubMed1990

Immunoserology of infectious diseases.

The immune response to microorganisms not only participates in the elimination of unwanted organisms from the body, but also assists in diagnosis of infectious diseases. The nonspecific immune response is the first line of defense, assisting the body until the specific immune response can be mobilized to provide protective mechanisms. The specific immune response involves humoral or cell-mediated immunity or both, dependent on the nature of the organism and its site of sequestration. A variety of test systems have been developed to identify the causative organisms of infectious diseases. Test systems used in immunoserology have classically included methods of detecting antigen-antibody reactions which range from complement fixation to immunoassay methods. Relevant test systems for detecting antigens and antibodies are described. With numerous test systems available to detect antigens and antibodies, there can be confusion regarding selection of the appropriate system for each application. Methods for detecting antibody to verify immunity differ from immunologic methods to diagnose disease. Techniques to detect soluble antigens present in active infectious states may appear similar to those used to detect antibody, but their differences should be appreciated.

Animals↗

PubMed2003

Severe acute respiratory syndrome: management and reconfiguration of a radiology department in an infectious disease situation.

Severe acute respiratory syndrome, or SARS, is a new infectious disease pandemic with important public health concerns. The high infectivity rate by means of droplet transmission places health care workers at substantial risk of contracting the disease. Radiology departments are particularly affected, since imaging plays a vital role in both diagnosis and follow-up of this disease. The authors outline their experience in infection control and isolation procedures during this outbreak. Barrier precautions, reconfiguration of the department, separation of imaging equipment, cleaning procedures, personal protective equipment, and staff safety are discussed.

Cross Infection↗

PubMed1999

Direct comparison of time to AIDS and infectious disease death between HIV seroconverter injection drug users in Italy and the United States: results from the ALIVE and ISS studies. AIDS Link to Intravenous Experiences. Italian Seroconversion Study.

OBJECTIVE: To compare the rate of HIV disease progression in a sample of polydrug injectors (AIDS Link to Intravenous Experiences [ALIVE] study) with that in a sample of predominantly opiate injectors (Italian Seroconversion Study [ISS]). DESIGN: Prospective cohort studies of HIV-positive individuals whose date of seroconversion (SC) is known with a good degree of precision. The ALIVE study involves a community-based cohort of injection drug users (IDU) in the United States and the ISS reports on a clinic-based cohort of seroconverters in Italy with different exposure modalities to HIV. METHODS: Data from the two cohorts were combined. The date of SC was estimated as the midpoint in time between the last negative and the first positive HIV test. Time-to-event (i.e., AIDS or death from an infectious disease) statistical methods were used. Relative hazards (RH) of progression to event were adjusted by age at SC, gender, and year of SC. RESULTS: Of the 1003 IDUs (251 from ALIVE and 752 from ISS), 226 progressed to AIDS, and 146 died after AIDS or from an infectious disease; of these, 10 were without an AIDS diagnosis. The two groups of IDUs differed in terms of age at SC (median, 35 years for ALIVE and 25 years for ISS), proportion of women (24% versus 31%), race (7.6% versus 100% white), and year of seroconversion (i.e., ISS participants seroconverted, on average, earlier than ALIVE participants). Although the univariate analysis suggested possible differences for progression to AIDS, or to death from infectious disease between cohorts, multivariate analyses that adjusted for age showed no significant differences by cohort, gender, race, or time of seroconversion. The median time to AIDS for 25-year-old persons was 12.3 years for ALIVE and 11.8 years for ISS; for 35-year-old persons, it was 8.5 and 8.2 years, respectively. These estimates were similar to those for non-IDUs observed in the ISS and to those from large cohort of homosexual men. CONCLUSION: Our results confirm the importance of accounting for age when considering the incubation period for HIV infection. Despite differences in drug use characteristics, the similar median times to AIDS, for each age, between the two cohorts of IDUs and between the IDUs and the non-IDUs suggest a negligible effect of injection drug use on HIV progression.

Acquired Immunodeficiency Syndrome↗