International Journal of Infectious Diseases

Editorial Board

2012-02-01

The role of combination antifungal therapy in the treatment of invasive aspergillosis: a systematic review

Musa A. Garbati, Faisal A. Alasmari, Mohammad A. Al-Tannir, Imad M. Tleyjeh — 2011-12-05

Summary: Background: Because treatment outcomes of invasive aspergillosis (IA) remain suboptimal, clinicians have resorted to the use of combination antifungal therapy. We therefore sought to systematically review the evidence that addresses the role of combination antifungal therapy in the treatment of invasive aspergillosis.Methods: We retrieved the literature from MEDLINE, EMBASE, Web of Science, Cochrane Controlled Trials Register, and Scopus from inception up to March 2011 for cohort and randomized controlled trial (RCT) studies that assessed the efficacy of combination antifungal therapy for IA and reported on clinical outcomes.Results: Eight studies (one RCT and seven cohort studies) that enrolled a total of 1071 patients met our inclusion criteria. Six cohort studies examined the role of combination therapy for the primary treatment of IA and two for salvage therapy. Various antifungal combinations were used, mainly azoles with either an echinocandin or a polyene. Of the seven cohort studies, four reported adjusted effect estimates, one of which showed a better outcome with combination antifungal therapy and one a trend towards a better outcome, while the remaining two revealed that there was no added advantage of combination antifungal therapy over monotherapy or a better response with monotherapy, respectively. The randomized controlled trial revealed that the use of combination therapy was associated with a better outcome.Conclusion: Cumulative evidence supporting the use of combination antifungal therapy in IA is conflicting and of moderate strength. Well-designed RCTs are required to adequately address the issue of the usefulness of this approach.

Impact of the implementation of a vaccination strategy on hepatitis B virus infections in China over a 20-year period

Zhuanbo Luo, Lanjuan Li, Bing Ruan — 2011-12-19

Summary: Hepatitis B virus (HBV) vaccination has been recommended for all neonates in China since 1992. This article reviews the impact of HBV vaccination throughout the past 20 years in China. Before the introduction of the HBV vaccination program, approximately 9.8% of the general Chinese population tested positive for hepatitis B virus surface antigen (HBsAg). Since 1992, vaccination coverage has increased each year. In 1999, a National Expanded Programme on Immunization (EPI) review showed that the immunization coverage with three doses of HBV vaccine was 70.7%, and reached 99.0% in Beijing. The HBsAg carrier rate in the general population decreased to 7.2% in 2006. In particular, the prevalence of HBsAg decreased to 2.3% among children aged 5–14 years and to 1.0% among children younger than 5 years. In addition, the administration of the HBV vaccine may have reduced the risk of hepatocellular carcinoma among adults. Despite the administration of hepatitis B immunoglobulin and the HBV vaccine to children with HBsAg-positive mothers, the failure rate of HBV immunoprophylaxis was 5–10%. In China, vaccine failure was related to HBV S gene mutation and inadequate administration of HBV vaccine. The prevalence of HBV carriers in China was markedly reduced after the introduction of the universal HBV vaccination program. If we immunize all susceptible individuals with the hepatitis B vaccine (especially children), interrupt transmission, and provide antiviral treatment for existing HBV carriers, the number of new cases may be reduced to close to zero in the future and this may eventually result in the eradication of HBV.

Evaluation of factors predictive of the prognosis in Crimean-Congo hemorrhagic fever: new suggestions

Baris Ozturk, Ediz Tutuncu, Ferit Kuscu, Yunus Gurbuz, Irfan Sencan, Hakan Tuzun — 2011-12-08

Summary: Background: Crimean-Congo hemorrhagic fever (CCHF) is one of the viral hemorrhagic fevers caused by tick bites. Common symptoms of the infection are fatigue, high fever, headache, and myalgia. In some patients hemorrhage may accompany these symptoms and is a sign of a poor prognosis. Typical laboratory changes are thrombocytopenia, leukopenia, elevation of aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatine phosphokinase (CPK), and lactate dehydrogenase (LDH), and prolongation of prothrombin time (PT) and activated partial thromboplastin time (aPTT). Mortality rates vary between 3% and 30%. The aim of this study was to determine the factors affecting the prognosis of CCHF.Methods: A total of 70 patients with a diagnosis of CCHF who were followed at our clinic between 2005 and 2008 were included in this study. As well as patient clinical history, biochemical parameters tested during the first 5 days and the prognosis were evaluated. Findings were compared between patients who died and those who recovered. Non-parametric statistical tests were used for the statistical analysis.Results: When the laboratory parameters of patients who died and recovered were compared, PT, aPTT, international normalized ratio (INR), AST, LDH, fibrinogen, C-reactive protein (CRP), high-sensitivity CRP (hs-CRP), D-dimer, IgM, IgG,C3 and C4 levels, and platelet count were found to be positively related with fatality. On the other hand, there was no significant difference between groups regarding ALT, CPK, prealbumin, ceruloplasmin, protein C, protein S, and antithrombin III levels, and white blood cell counts.Conclusions: It is essential to determine the possibility of a fatal prognosis in CCHF patients using clinical history and biochemical parameters so that the necessary precautions can be taken.

Impact of rotavirus vaccination on childhood gastroenteritis-related mortality and hospital discharges in Panama

2011-12-12

Summary: Background: Rotavirus vaccination was introduced in Panama in March 2006. This study was carried out in order to describe the trends in gastroenteritis-related (GER) hospitalizations and mortality in children <5 years of age during the pre- and post-vaccination periods.Methods: Data from the Expanded Program on Immunization (Ministry of Health) were used to calculate vaccine coverage. GER mortality and hospitalizations were obtained through database review of the Contraloría General de la República and hospital discharge databases of five sentinel hospitals, for the period 2000–2008. Mean rates of GER mortality and mean numbers of hospitalizations during the baseline pre-vaccination period (2000-2005) were compared to those of 2007 and 2008.Results: National coverage for the second rotavirus vaccine dose increased from 30% in 2006 to 62% in 2007 and 71% in 2008, varying from 62% in the West region to 77% in the Panama region. Overall, at 2-years post-vaccine introduction, the GER mortality rate in Panama had decreased by 50% (95% confidence interval (CI) 46–54). During 2000–2005, the GER mortality rate in children (<1 year) was 73/100 000, decreasing by 45% (95% CI 40–51) in 2008. In children aged 1–4 years, the GER mortality rate was 20.3/100 000 (2000–2005), decreasing by 54% (95% CI 48–60) in 2008. The Panama region registered the highest mortality rate reduction (69%; 95% CI 58–81) for 2008. During 2008, GER hospitalizations among children <5 years of age decreased by 30% (95% CI 21–37) from the mean number of hospitalizations during 2000–2005.Conclusions: A substantial reduction in GER mortality and hospitalizations was observed following the introduction of rotavirus vaccine in Panama.

Evaluation of the mass measles vaccination campaign in Guangdong Province, China

2011-11-28

Summary: Objective: To evaluate the mass measles vaccination campaign of 2009 in Guangdong Province, China.Methods: Data on the campaign implementation, measles surveillance, and serological surveillance were reviewed and analyzed by statistical methods.Results: Rapid coverage surveys showed that 98.09% of children were vaccinated during the campaign. The coverage of migrant children increased significantly from 67.10% to 97.32% (p<0.01). From May to December 2009, after the campaign, the number of measles cases was reduced by 93.04% compared with the same period of 2008. The antibody positive rate in children aged less than 15 years reached above 95%. More than 1 million migrant children were identified and vaccinated during the campaign. Flyers, notices of information from doctors, and television programs were the best methods to inform parents of the campaign. Awareness of the campaign by residents increased significantly from 91.86% to 97.10% (p<0.01) through the use of social mobilization materials.Conclusions: A massive vaccination campaign approach for controlling measles in a developing region like Guangdong Province with a vast migrant population has proved effective. Comprehensive mobilization, communication with the mass media, and support from government departments were critical to the success of the campaign.

First report of mefA and msrA/msrB multidrug efflux pumps associated with blaTEM-1 β-lactamase in Enterococcus faecalis

2011-12-02

Summary: Objectives: Enterococcus faecalis is thought to possess a great deal of intrinsic resistance to several antimicrobial agents. In this study we identified ampicillin- and erythromycin-resistant clinical isolates of E. faecalis and sought to identify the resistance mechanisms among these isolates.Methods: Twelve isolates of E. faecalis were collected from 12 different patients. Identification of the isolates and their susceptibility patterns were determined using the Phoenix automated phenotypic identification criteria. PCR amplification and sequencing were used to detect β-lactamase production. Colony blotting was performed in order to screen for multidrug efflux pump production. Extraction and N-terminal sequencing of the multidrug efflux pumps was carried out.Results: The E. faecalis isolates showed high resistance to erythromycin and ampicillin, with minimum inhibitory concentrations of >16μg/ml. PCR amplification and sequencing showed that isolates produced TEM-1 β-lactamase. Colony blotting showed that these isolates harbored multidrug efflux pump genes. Multidrug efflux pump extraction, purification, and sequencing showed the distribution of mefA and msrA/msrB efflux pumps.Conclusion: Two resistance mechanisms among E. faecalis are described – the production of TEM β-lactamase and mefA and msrA/msrB efflux pumps. These results are of great interest because this is the first report of the co-existence of these resistance mechanisms among E. faecalis strains.

Randomized controlled study of fractional doses of inactivated poliovirus vaccine administered intradermally with a needle in the Philippines

Josefina Cadorna-Carlos, Emmanuel Vidor, Marie-Claude Bonnet — 2011-12-07

Summary: Objective: Comparison of a fractional inactivated poliovirus vaccine (IPV) dose administered intradermally (ID) to a full dose administered intramuscularly (IM).Methods: Healthy Filipino infants were randomized to receive IPV as either a fractional (1/5th) dose ID by needle injection or a full dose IM at 6, 10, and 14 weeks and a booster at 15–18 months of age. Pre- and post-vaccination anti-polio 1, 2, and 3 titers were estimated. Adverse events were monitored throughout the study.Results: Following primary series vaccination, anti-polio 1, 2, and 3 titers were ≥8 (1/dil) in 99–100% of participants, and the ID route was non-inferior to the IM route. Depending on the study group, antibody persistence was detected in 83–100% of participants, and the booster dose resulted in a strong anamnestic response in all groups. The incidence of adverse events in each group was similar, except for injection-site erythema (higher in the ID group).Conclusions: Primary series and booster vaccination of a fractional IPV dose administered by the ID route was highly immunogenic and well tolerated. These data confirm the medical validity of using fractional ID doses of IPV. The programmatic feasibility of implementing affordable mass vaccination programs based on this delivery mode has yet to be established.

Epidemiology of scabies in the West Bank, Palestinian Territories (Occupied)

Ahmad Amro, Omar Hamarsheh — 2011-12-06

Summary: Background: Scabies is a disease that is considered a public health problem in the Palestinian Territories and in other countries around the world. Scabies causes skin lesions leading to substantial morbidity, and is also associated with social stigma. In this study we describe the epidemiology of scabies in the West Bank, Palestine during the years 2005–2010.Methods: We examined the records and profiles of a total of 1734 patients who were admitted to the dermatology clinics of the Palestinian Ministry of Health in 2005–2010.Results: The disease was found to be prevalent in all governorates. The average annual incidence of scabies in the West Bank for 2005–2010 was 17/100 000 population. The average number of scabies patients per year in the West Bank was 26.3 per governorate, with a significant increase in the years 2009 and 2010 (p<0.001). Disease occurrence was significantly higher among children aged ≤10 years than in the other age groups, in adult females in the age groups of 31–40 and 41–50 years compared to males in these age groups, and in males in the age group of 11–20 years compared to females in that age group.Conclusions: Scabies was found in all governorates of the Palestinian West Bank. Individuals under 20 years of age are particularly at risk. Compulsory reporting of scabies to the Palestinian Ministry of Health would be expected to increase awareness of the disease, which is crucial for the prevention and control of scabies in the Palestinian Territories.

Trends and risk factors for HIV infection among young pregnant women in rural India

Gerardo Alvarez-Uria, Manoranjan Midde, Praveen K. Naik — 2011-12-07

Summary: Objectives: To study the trends of the HIV epidemic and risk factors associated with HIV in a rural area of India. We utilized HIV prevalence among young pregnant women as an indicator of population trends in HIV infection.Methods: This was an observational study of pregnant women aged less than 25 years who were counseled and tested for HIV infection in a rural hospital between August 2007 and June 2011. Information on age, education, occupation, and community were collected prospectively from all of the women.Results: The HIV prevalence in young pregnant women decreased from 1.22% in 2007 to 0.35% in 2011. Comparing the periods 2007–2009 and 2010–2011, a reduction in HIV prevalence was seen in all subgroups except in women from forward castes. Women whose job was not related to agriculture and women who had only completed primary education were more likely to be HIV-infected.Conclusions: These results indirectly indicate that the incidence of HIV infection is decreasing in this rural setting. However, an increase in the HIV prevalence in women from forward castes was observed. In rural areas, HIV testing of pregnant women who have only completed primary education or who are working in a field not related to agriculture should be encouraged, because of their higher risk of HIV infection.

Human herpesvirus 6 in donor biopsies associated with the incidence of clinical cytomegalovirus disease and hepatitis C virus recurrence

2011-12-19

Summary: Background: Reactivation of cytomegalovirus (CMV) and human herpesvirus 6 (HHV-6), as well as the recurrence of hepatitis C virus (HCV), occurs in the post liver transplantation period. However, their correlations remain questionable. The objectives of this study were to analyze the presence of CMV DNA and HHV-6 DNA in pre-transplant and post-transplant liver graft biopsies and to determine any correlations with CMV disease and HCV recurrence.Methods: Forty-one liver transplant recipients were followed up in the post-transplant period. The presence of CMV DNA and HHV-6 DNA was detected by nested PCR.Results: Four patients (4/41, 9.8%) were positive for CMV DNA in pre-transplant biopsies and three of them remained positive after transplantation; 11 patients became positive in the post-transplant biopsies (p=0.06). Fifteen (15/41, 36.6%) patients were positive for HHV-6 DNA in pre-transplant biopsies and 11 of these remained positive after transplantation. Another 11 patients became positive after the surgery (p=0.05). CMV disease occurred in 17 recipients; 10 of these 17 (58.8%) patients were positive for HHV-6 DNA in pre-transplant biopsies and they continued positive after transplantation (p=0.0128). Twenty-eight patients were transplanted due to hepatitis C; 12 of these patients had recurrence of the virus, and HHV-6 was positive in nine of the 12 (75%) patients (p=0.049).Conclusions: Recipients with HHV-6 DNA in pre-transplant graft biopsies remained positive post transplantation, showing a possible risk for post-transplant allograft loss because there was an association between HHV-6 and recurrent HCV and CMV disease.

Tobacco consumption is a reversible risk factor associated with reduced successful treatment outcomes of anti-tuberculosis therapy

Yi-Chun Chiang, You-Meei Lin, Jen-Ai Lee, Chun-Nin Lee, Hsiang-Yin Chen — 2011-12-20

Summary: Objective: The aim of this study was to evaluate the reversible factors that could possibly affect outcomes of anti-tuberculosis (anti-TB) treatment.Methods: A retrospective observational nested case–control study was performed to evaluate the association of patient and clinical factors with anti-TB therapy outcomes as defined by the World Health Organization (WHO).Results: To examine the impact of a variety of factors on the outcomes of anti-TB treatment, a total of 302 TB patients were included in the study. Univariate analysis revealed that age, gender, concurrent hypertension, asthma/chronic obstructive pulmonary disease, or liver disease, worsened baseline blood urea nitrogen or creatinine, ethambutol <800mg/day, hepatitis or adverse skin reactions during therapy, smoking history, and current tobacco consumption were significant factors in decreasing both the cure rate and treatment completion rate. However, multivariate regression showed that only age, current daily tobacco consumption, baseline liver disease, and ethambutol dosage were independent factors. A high level of tobacco consumption (>20 cigarettes per day) was significantly associated with a decreased odds of cure or treatment completion (odds ratio 0.23, 95% confidence interval 0.05–0.98, p=0.047).Conclusions: As smoking significantly inhibits the effectiveness of TB treatment, the integration of smoking cessation into TB treatment programs is strongly advocated to reduce the dual global burden of smoking and TB.

Gender inequities, relationship power, and childhood immunization uptake in Nigeria: a population-based cross-sectional study

Diddy Antai — 2011-12-26

Summary: Background: This study aimed to simultaneously examine the association between multiple dimensions of gender inequities and full childhood immunization.Methods: A multilevel logistic regression analysis was performed on nationally representative sample data from the 2008 Nigeria Demographic and Health Survey, which included 33 385 women aged 15–49 years who had a total of 28 647 live-born children; 24 910 of these children were included in this study.Results: A total of 4283 (17%) children had received full immunization. Children of women whose spouse did not contribute to household earnings had a higher likelihood of receiving full childhood immunization (odds ratio (OR) 1.96, 95% confidence interval (95% CI) 1.02–3.77), and children of women who lacked decision-making autonomy had a lower likelihood of receiving full childhood immunization (OR 0.74, 95% CI 0.60–0.91). The likelihood of receiving full childhood immunization was higher among female children (OR 1.28, 95% CI 1.06–1.54), Yoruba children (OR 2.45, 95% CI 1.19–4.26), and children resident in communities with low illiteracy (OR 1.82, 95% CI 1.06–3.12), but lower for children of birth order 5 or above (OR 0.64, 95% CI 0.45–0.96), children of women aged ≤24 years (OR 0.66, 95% CI 0.50–0.87) and 25–34 years (OR 0.79, 95% CI 0.63–0.99), children of women with no education (OR 0.33, 95% CI 0.21–0.54) and primary education (OR 0.66, 95% CI 0.45–0.97), as well as children of women resident in communities with high unemployment (OR 0.34, 95% CI 0.20–0.57).Conclusions: The woman being the sole provider for her family (i.e., having a spouse who did not contribute to household earnings) was associated with a higher likelihood of fully immunizing the child, and the woman lacking decision-making autonomy was associated with a lower likelihood of fully immunizing the child. These findings draw attention to the need for interventions aimed at promoting women's employment and earning possibilities, whilst changing gender-discriminatory attitudes within relationships, communities, and society in general.

Tuberculoid leprosy and cytomegalovirus retinitis as immune restoration disease in a patient with AIDS

2011-12-12

Summary: Here we report a unique case of tuberculoid leprosy and cytomegalovirus retinitis in a 27-year-old female patient with AIDS, suggestive of highly active antiretroviral therapy (HAART)-induced immune restoration disease. After initiation of HAART, the patient presented with decreased visual acuity, hypoesthetic patch with local nerve thickening, and an increase in her CD4+ T cell count. On further investigations cytomegalovirus retinitis and tuberculoid leprosy were confirmed. To our knowledge no case with such a co-existence has previously been reported.

Menopause, and not age, is a critical factor associated with a worse response to antiviral therapy in women affected by chronic hepatitis C

Stefano Gitto, Aimilia Karampatou, Pietro Andreone, Erica Villa — 2012-01-03

We read with great interest the article entitled “Impact of sex on virologic response rates in genotype 1 chronic hepatitis C patients with peg-interferon alpha-2a and ribavirin treatment”. It was shown that in women affected by chronic hepatitis C and treated with antiviral therapy, the sustained virological response (SVR) rate decreases with age as a likely consequence of gradual estrogen decline. Moreover, it was reported that among young patients, SVR is higher in females than in males, while in older subjects the opposite occurs.