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PubMed1996

Fever, famine, and war: William Osler as an infectious diseases specialist.

In 1896 William Osler addressed the American Medical Association on "The study of the Fevers of the the South", a lecture in which he showed his keen appreciation for the history, pathology, epidemiology, and management of infectious diseases. Osler can be claimed as an infectious diseases specialist not only because infections were the most common causes of death during his time but also because his perspectives and personal qualities typify the discipline as it has evolved during the twentieth century. Ten such desiderata are reviewed. A century later Osler's conclusion remains true for this specialty: "Fever in its varied forms is still with ... but it is of almost equal importance to know that the way has been opened, and that the united efforts of many workers in many lands are day by day disarming this great enemy of the race".

Communicable Diseases↗
PubMed2004

[Multi-drug-resistant tuberculosis in a Department of Infectious Diseases].

In Western Europe, Portugal has the highest incidence of tuberculosis (TB) as well as HIV infection. At the Department of Infectious Diseases, Hospital de Santa Maria, Lisbon, we have observed a steady increase in cases of drug resistant (DR) and multi-drug resistant (MDR) TB over the last few years. To identify the determinants of drug- resistant tuberculosis, clinical notes from all patients admitted to the Department of Infectious Diseases from 1995 to 2000, with DR- or MDR-TB were retrospectively reviewed. A total of 212 samples, from 190 patients with tuberculosis were tested for sensitivity to first line anti-TB drugs, using standard methods. Most patients (61%) were intravenous drugs users. Resistance to at least one drug was found in 44 patients (23%); notes were available for review in 39 (36 HIV infected) patients. The rate of DR-TB was 9% (n=16) and that of MDR-TB was 15% (n=28). Almost half of the MDR-TB cases (n=13) showed resistance to four drugs (HRSE). Thirteen patients (69%) were first diagnosed as fully sensitive tuberculosis, during their first admission to the Department; however, later on they developed MDR-TB or DR-TB. Non-compliance with therapy and the intravenous use of drugs were associated with MDR-TB. The large increase in MDR-TB in our Department is of great concern. The clustering of identical resistance patterns suggest transmission of TB from a single source patient that may well have occurred in a nosocomial context. Traditional tuberculosis control measures seem to be insufficient in settings were prevalence of HIV infection and tuberculosis are high. This becomes even more important when the incidence of intravenous substance abuse, and often non-compliance, are predominant factors. Appropriate isolation facilities for all suspected tuberculosis cases as well as rapid diagnostic and drug susceptibility tests will be required to prevent further spread of MDR-TB.

Adolescent↗
PubMed1983

Vaccination against Marek's disease and infectious bursal disease. I. Development of a bivalent live vaccine by co-cultivating turkey herpesvirus and infectious bursal disease vaccine viruses in chicken embryo fibroblast monolayers.

Vaccine viruses of Marek's disease (MD), the FC-126 strain of the herpesvirus of turkeys (HVT), and infectious bursal disease (IBD), the Bursa-Vac-M strain of IBD virus (IBDV), were propagated in the same chicken embryo fibroblast (CEF) monolayers by superinfection. Co-infection of the two viruses in the same CEF culture or in a single cell can be demonstrated by staining with acridine orange and by electron microscopy.l This study was conducted with a superinfected live bivalent vaccine (HVT/IBDV) in one-day-old specific pathogen-free (SPF) and conventional White Leghorn (CWL) chicks. Chickens vaccinated with HVT/IBDV produced persistent HVT viremia for at least 6 weeks postvaccination; significantly higher IBD virus neutralizing antibody levels were observed for the entire 8-week experimental period when compared to unvaccinated controls. Differences between virus neutralizing antibody titers stimulated by HVT/IBDV and IBDV alone were not statistically significant in SPF chickens; however, due to maternal antibody there were some significant differences in CWL chickens. Both the HVT/IBDV bivalent vaccine and the monovalent IBDV vaccine protected the chickens against challenge with virulent IBDV. Based on microscopic lesions and bursa: body weight indexes, challenge of vaccinated chickens with virulent IBDV caused no atrophy in the bursa of Fabricius, but severe tissue destruction was observed in unvaccinated challenged controls. Chickens vaccinated with HVT/IBDV vaccine or with HVT alone were effectively protected against MD when compared to the controls.

Animals↗
PubMed2001

[Microorganisms strike back--infectious diseases during the last 50 years].

In the first half of the 20th century, improved living conditions, preventive measures, vaccines and antibiotics led to a marked reduction in morbidity and mortality from infectious diseases. It was predicted that the conquest of all infectious diseases was imminent. However, 50 years later, in 1999, they were still the major cause of disease worldwide, and caused nearly one third of all deaths (a total of 55.9 million). The eradication of smallpox in the 1970s and the approaching eradication of poliomyelitis represent major achievements. The prevalence of measles, pertussis and tetanus neonatorum is also markedly reduced, but still 1.5 million children in developing countries die each year because of lack of vaccines. Malaria and tuberculosis are re-emerging. Tuberculosis and HIV/AIDS are the diseases with known aetiology that cause most deaths, altogether 5 million each year. Respiratory and gastrointestinal infections cause 6.5 million deaths annually. Infections in the immunocompromised host have become a "trade mark" of today's advanced medicine. Almost every year, new diseases related to new micro-organisms are described; over the last 30 years, approximately 40 new diseases/micro-organisms have been diagnosed. Among the best known are HIV/AIDS, peptic ulcer caused by Helicobacter pylori, Legionnaires' disease, borreliosis (Lyme disease), hepatitis C, gastroenteritis caused by rotavirus, and Ebola haemorrhagic fever. Antimicrobial resistance development of micro-organisms has become one of the major health problems worldwide; a number of preventive measures are being introduced.

Bacterial Infections↗
PubMed1989

Effects on the urinary level of gamma-carboxyglutamic acid caused by the administration of antibiotics with N-methyl thiotetrazole side chains to patients with infectious diseases.

A comparative study was conducted of the urinary level of gamma-carboxyglutamic acid (gamma-Gla) in patients with infectious diseases to investigate the mechanism of hemorrhagic diathesis occurrence resulting in post-administrative side effects of cephem-group antibiotics. The results showed that the group of administered antibiotics with N-methyl thiotetrazole (NMTT) side chains exhibited decreases in the urinary level of gamma-Gla. Especially, in the aged group of patients (over 65) with non-carcinoma infectious diseases, significant decreases in the urinary level of gamma-Gla were observed. From the above, it is considered that the administration of antibiotics with NMTT side chains has an effect of prohibiting the vitamin K function.

1-Carboxyglutamic Acid↗
PubMed1999

Infectious diseases in internationally adopted children: findings in children from China, Russia, and eastern Europe.

Conditions in many orphanages provide a fertile environment for infectious diseases uncommonly encountered in industrialized nations. Moreover, health care providers may be unfamiliar with the need to test for these conditions in internationally adopted children. Pediatric infectious disease specialists provide much-needed expertise for parents and providers alike.

Adolescent↗
PubMed1981

[Clinical evaluation of cefotiam in internal medicine, with special reference to infectious disease associated with hematological disorders (author's transl)].

Clinical evaluation of cefotiam (panspolin), a new cephem antibiotics, was performed in the infectious disease associated with hematological disorders and in the respiratory system. In hematological dis orders, 40% of good and 25% of fair results were obtained in clinical effects. In respiratory infections, however, 92% of good results were obtained. Opportunistic infection due to Gram-negative bacilli are often experienced in patients with leukemia. Since cefotiam has sufficient bacteriocidal effects in broad spectrum, it would be a good therapeutic agent against infectious diseases associated with hematological disorders.

Adolescent↗
PubMed2006

Emergency medicine and the public's health: emerging infectious diseases.

In recent years, multiple global forces have contributed to the emergence and widespread distribution of previously unknown disease entities. This article discusses Ebola virus, West Nile virus, and Hantavirus as representative emerging infectious diseases. Smallpox is discussed along with concerns about the safety of the smallpox vaccine, given the uncertain risk of bioterrorism and smallpox exposure. ED physicians must become familiar with the presentation, management, and public health impact of all of these entities, as well as understand the potential impact of other emerging infectious diseases.

Adult↗
PubMed2000

Foodborne and waterborne infectious diseases. Contributing factors and solutions to new and reemerging pathogens.

Demographic changes and complexities in food production, combined with complacency about the role of infectious diseases in general and the safety of the US food supply in particular, have brought about a resurgence in foodborne and waterborne infectious diseases and, with it, challenges that are unprecedented in recent times. A vigorous effort is already under way to ensure that food and water supplies are safe. This renewed attention to food and water safety must not be an interim response to a perceived short-term threat but, rather, a long-term effort to protect the population from pathogenic microorganisms whose wily adaptations will require constant vigilance.

Bacterial Infections↗
PubMed1985

Immunopotentiation in infectious disease, II. Effect of bestatin on experimental infection.

A two-stage protocol designed to evaluate putative immunomodulators for use in infectious disease has been proposed. In this report the effect of bestatin on a series of clinically relevant, and sub-lethal infections is described. Pyelonephritis, peritonitis and bacteremia were induced with Escherichia coli, while Klebsiella pneumoniae was used to produce a lung infection. Bestatin had no effect on the course of these infections. In a further experiment we assessed the effect of combined bestatin/antibiotic therapy on the course of renal infection. Again no effect was observed. These findings are consistent with the known immunomodulatory properties of bestatin. This methodology will be used to evaluate selected agents for their potential in infectious disease and should lead to useful clinical protocols.

Adjuvants, Immunologic↗
PubMed1996

Overcoming barriers and reaping the benefits of surveillance for infectious diseases: the New Mexico perspective.

Surveillance for disease is one of the cornerstones of public health practice in the United States. Surveillance, particularly for infectious diseases, has allowed the detection of outbreaks and provided for the long-term monitoring of disease incidence. In New Mexico, acquired immunodeficiency syndrome (AIDS) surveillance is characterized as one of the most comprehensive surveillance systems for an infectious disease to be found anywhere. The success of this system is largely a result of state and federal resources and a good partnership with the AIDS/human immunodeficiency virus health care providers. Surveillance for Haemophilus influenzae type b (Hib) has demonstrated a remarkable decline in disease incidence in the state especially since the use of second generation Hib capsular polysaccharide conjugate vaccine. In contrast, surveillance for hepatitis A has demonstrated a significant public health problem that is largely not being addressed by current control measures.

Disease Notification↗
PubMed1989

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

Therapeutic effects of cefodizime (CDZM, THR-221), a new cephalosporin having a methoxyimino group, were examined in various infectious diseases in children. Clinical efficacy rates were 100% (3/3) in pneumonia, 100% (5/5) in acute bronchitis, 75% (3/4) in upper respiratory infections and 100% (1/1) in each of a croup and a mixed infection with Streptococcus pyogenes and staphylococcal impetigo. Hence, the overall efficacy rate was 92.9% (13/14). Adverse effects were observed in 2 cases, i.e. exanthema provably due to drug allergy in 1 case and a slightly elevated GPT in another. Changes in serum concentrations and urinary excretion of CDZM were examined in a child with no infection. T 1/2 values obtained were 124.5 minutes (bioassay) and 143.4 minutes (high performance liquid chromatography (HPLC]. Eight hour recovery rates in urine were 62.9% (bioassay) and 65.4% (HPLC). CDZM was considered to be a safe and useful drug in treating various infectious diseases in children.

Adolescent↗
PubMed2004

Key references in infectious diseases pharmacotherapy.

Most health care practitioners are challenged to maintain knowledge of contemporary practice issues in many therapeutic disciplines. Like many other areas, infectious diseases pharmacotherapy continues to evolve because of new information regarding disease epidemiology and new treatment options. Emerging infections and resistance further compound the need for information. To assist clinicians in identifying such important new information, we compiled a list of key references on infectious diseases pharmacotherapy published over the last 2 years.

Anti-Bacterial Agents↗
PubMed2001

[Clinical aspects of the diagnosis and treatment of infectious mononucleosis in primary care and in departments of infectious diseases].

Medical documentation of the 342 patients hospitalised for infectious mononucleosis at the departments of infectious diseases of two county hospital was retrospectively reviewed between 1990 and 1996 and the most important clinical data were recorded. In order to document the effect of control measures, which were taken for the improvement diagnosis and therapy, data of the 105 infectious mononucleosis patients at one of the mentioned departments were also recorded in 1997 and 1998. The length of the time before the hospital admission (avg. 10.3 days), the length of the hospital stay (avg. 9.2 days) and the respectable amount of antibiotics taken for this indication show that this disease has great cost effect. High rate of classical clinical signs (fever, pharyngitis, lymphadenopathy, atypical cells) indicates, that the majority of the patients consulting their doctors presented the well-known signs of the disease. Only 43.6% of the patients were diagnosed as infectious mononucleosis by the G. P. s. Majority of the cases were treated for tonsillitis. 90.7% of the patients were given antibiotics before the hospital admission (avg. 1.6 antibiotics/person). 43.3% of the patients left the hospital without serologic diagnosis. After drowning lesson from the first part of this study, there was significant decrease in the rate of lack of serologic diagnosis and in the amount of consumption of antibiotics for this indication in the hospital, but there was no change at the level of G. P. s. The results of this paper demonstrate that the daily routine diagnosis and treatment of a well-known diseases differs remarkably from optimal practice. The fact is, that even if the physician has knowledge of a certain disease, does not necessarily mean that he uses it in his routine work. In order to reduce this failure, authors propose introduction of protocols and regular review of the practice.

Adolescent↗
PubMed2004

Evaluation of a method for issuing warnings pre-epidemics and epidemics in Japan by infectious diseases surveillance.

BACKGROUND: Simple methods have been developed to warn of pre-epidemics and epidemics in small areas using data of infectious diseases surveillance. Epidemic warnings are made if the index of cases per week per sentinel medical institution is greater than a defined value. A pre-epidemic warning means that an epidemic warning will be given in the following four weeks. While the methods are used routinely for surveillance in Japan, they remain to be validated. METHODS: Infectious diseases surveillance data of influenza-like illness and 12 pediatric diseases in the fiscal year between 1999 and 2001 were used in the analysis. We examined the frequency of warnings, temporal changes in the index before and after the onset of a warning, and the sensitivity, specificity, and positive predictive value of pre-epidemic warnings. RESULTS: For the majority of the diseases investigated, the proportion of weeks in which a warning was issued ranged between 0% and 10%. In several diseases including influenza-like illness, we observed a rapid increase and gradual decrease in the index before and after a warning. The sensitivity, specificity, and positive predictive value of a pre-epidemic warning were 90.4%, 93.7% and 23.9% for influenza-like illness, and ranged between 25.1-54.2%, 86.1-99.2%, and 2.5-20.8% for the pediatric diseases (chickenpox, rubella, measles, and mumps), respectively. CONCLUSIONS: The study showed that the methods used for determining whether or not to issue an epidemic warning were satisfactory in some diseases, including influenza-like illness, and may need to be improved in several other diseases.

Communicable Diseases↗
PubMed1989

[Infectious disease factors in swine--pathogenesis and control].

Infectious factorial diseases occur in all porcine age groups and are specially responsible for high mortality-rates in weaners and young feeder pigs affected by bronchopneumonia and enteritis. The pathogenesis of infectious factorial diseases is dominated by disease promoting factors of the pigs' environment as well as by false treatment with medicines and disinfectants. The control of infectious factorial diseases needs thorough examination as a basis for herd specific measures. Preventive measures should be completed in all pig herds by animal protective arrangements which are prescribed in the rules for prevention of cruelty to animals and contagious diseases.

Animals↗
PubMed1980

[Pathomorphosis of infectious diseases in children].

The general and therapeutically conditioned pathomorphosis was expressed in a significantly reduced number of autopsies predominantly due to reduced incidence of infectious diseases in children. Histological features of reactions in various organs in antibiotic therapy are examined. The necessity of continuous study of the clinical features and time course of infectious diseases in children is emphasized because the evolution of these processes continues.

Anti-Bacterial Agents↗