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  • Safety and Immunogenicity of Zoster Vaccine Live in Human Immunodeficiency Virus–Infected Adults With CD4+ Cell Counts >200 Cells/mL Virologically Suppressed on Antiretroviral Therapy
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-03-26
    Benson C, Andersen J, Macatangay B, et al.

    BackgroundHerpes zoster (HZ) risk is increased in human immunodeficiency virus (HIV)–infected persons. Live attenuated zoster vaccine (ZV) reduces HZ incidence and severity in adults; safety and immunogenicity data in HIV-infected adults are limited.MethodsWe conducted a randomized, double-blind, placebo-controlled trial in HIV-infected adults virally suppressed on antiretroviral therapy (ART). Participants, stratified by CD4+ count (200–349 or ≥350 cells/µL), were randomized 3:1 to receive ZV or placebo on day 0 and week 6. The primary endpoint was serious adverse event or grade 3/4 signs/symptoms within 6 weeks after each dose. Immunogenicity (varicella zoster virus [VZV]–specific glycoprotein enzyme-linked immunosorbent assay and interferon-γ enzyme-linked immunospot assay responses) was assessed at 6 and 12 weeks postvaccination.ResultsOf 395 participants (296 ZV vs 99 placebo), 84% were male, 47% white, 29% black, and 22% Hispanic; median age was 49 years. Safety endpoints occurred in 15 ZV and 2 placebo recipients (5.1% [95% confidence interval {CI}, 2.9%–8.2%] vs 2.1% [95% CI, .3%–7.3%]; P = .26). Injection site reactions occurred in 42% of ZV (95% CI, 36.3%–47.9%) vs 12.4% of placebo recipients (95% CI, 6.6%–20.6%) (P < .001). Week 12 median natural log VZV antibody titer was higher for ZV (6.30 [Q1, Q3, 5.64, 6.96]) vs placebo (5.48 [Q1, Q3, 4.63, 6.44]; P < .001) overall and in the high CD4+ stratum (P = .003). VZV antibody titers were similar after 1 or 2 ZV doses. Polymerase chain reaction–confirmed HZ occurred in 2 participants (1 ZV; 1 placebo); none was vaccine strain related.ConclusionsTwo doses of ZV in HIV-infected adults suppressed on ART with CD4+ counts ≥200 cells/µL were safe and immunogenic.Clinical Trials RegistrationNCT00851786.

    更新日期:2018-11-13
  • Urine Antigen Detection as an Aid to Diagnose Invasive Aspergillosis
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-04-19
    Marr K, Datta K, Mehta S, et al.

    BackgroundEstablishing rapid diagnoses of invasive aspergillosis (IA) is a priority tests that detect galactomannan and β-d-glucan are available, but are technically cumbersome and rely on invasive sampling (blood or bronchoalveolar lavage).MethodsWe optimized a lateral flow dipstick assay using the galactofuranose-specific monoclonal antibody (mAb476), which recognizes urine antigens after Aspergillus fumigatus pulmonary infection in animals. Urine samples were obtained from a cohort of 78 subjects undergoing evaluation for suspected invasive fungal infections, and stored frozen until testing. Urine was processed by centrifugation through desalting columns and exposed to dipsticks. Reviewers blinded to clinical diagnoses graded results. Western blots were performed on urine samples from 2 subjects to characterize mAb476-reactive antigens.ResultsPer-patient sensitivity and specificity for diagnosis of proven or probable IA in the overall cohort was 80% (95% confidence interval [CI], 61.4%–92.3%) and 92% (95% CI, 74%–99%), respectively. In the subgroup with cancer, sensitivity was 89.5% (95% CI, 66.7%–98.7%) and specificity was 90.9% (95% CI, 58.7%–99.8%); among all others, sensitivity and specificity were 63.6% (95% CI, 30.8%–89.1%) and 92.9% (95% CI, 66.1%–99.8%), respectively. Eliminating lung transplant recipients with airway disease increased sensitivity in the noncancer cohort (85.7% [95% CI, 42.1%–99.6%]). Semiquantitative urine assay results correlated with serum galactomannan indices. Western blots demonstrated mAb476-reactive antigens in urine from cases, ranging between 26 kDa and 35 kDa in size.ConclusionsUrine testing using mAb476 may be used as an aid to diagnose IA in high-risk patients.

    更新日期:2018-11-13
  • Multiple Class I and Class II Haemophilus ducreyi Strains Cause Cutaneous Ulcers in Children on an Endemic Island
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-04-20
    Grant J, González-Beiras C, Amick K, et al.

    BackgroundTogether with Treponema pallidum subspecies pertenue, Haemophilus ducreyi is a major cause of exudative cutaneous ulcers (CUs) in children. For H. ducreyi, both class I and class II strains, asymptomatic colonization, and environmental reservoirs have been found in endemic regions, but the epidemiology of this infection is unknown.MethodsBased on published whole-genome sequences of H. ducreyi CU strains, a single-locus typing system was developed and applied to H. ducreyi–positive CU samples obtained prior to, 1 year after, and 2 years after the initiation of a mass drug administration campaign to eradicate CU on Lihir Island in Papua New Guinea. DNA from the CU samples was amplified with class I and class II dsrA-specific primers and sequenced; the samples were classified into dsrA types, which were geospatially mapped. Selection pressure analysis was performed on the dsrA sequences.ResultsThirty-seven samples contained class I sequences, 27 contained class II sequences, and 13 contained both. There were 5 class I and 4 class II types circulating on the island; 3 types accounted for approximately 87% of the strains. The composition and geospatial distribution of the types varied little over time and there was no evidence of selection pressure.ConclusionsMultiple strains of H. ducreyi cause CU on an endemic island and coinfections are common. In contrast to recent findings with T. pallidum pertenue, strain composition is not affected by antibiotic pressure, consistent with environmental reservoirs of H. ducreyi. Such reservoirs must be addressed to achieve eradication of H. ducreyi.

    更新日期:2018-11-13
  • The Effect of Antibiotic Selection Pressure on the Nasopharyngeal Macrolide Resistome: A Cluster-randomized Trial
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-04-20
    Keenan J, Chin S, Amza A, et al.

    BackgroundFrequent use of antibiotics is thought to create selection pressure by clearing susceptible bacteria and allowing resistant bacteria to spread in a community. A cluster-randomized trial comparing 2 different frequencies of mass azithromycin distributions for trachoma provided a convenient experiment for determining the causal relationship between antibiotic consumption and antibiotic resistance.MethodsTwenty-four communities were randomized to either annual or biannual mass azithromycin distributions for trachoma. Randomization was stratified on health catchment area and trachoma prevalence. Swabs were processed for the genetic macrolide resistance determinants ermB and mefA/E in a masked fashion from a random sample of 120 preschool children before treatment and another 120 children after 2 years of mass antibiotics.ResultsMacrolide resistance determinants were similar in the 12 annually and 12 biannually treated communities before treatment, with a median prevalence among preschool children of 20% (interquartile range [IQR], 10%–40%) in each group. By 24 months, macrolide resistance determinants were found more commonly in the biannually treated communities (median, 60% [IQR, 50%–80%]) than the annually treated communities (median, 40% [IQR, 20%–40%]; P < .001). Adjusting for baseline, the 24-month prevalence of macrolide resistance determinants in the biannual group was 29.4% higher than that of the annual group (95% confidence interval, 10.5%–56.7%).ConclusionsThis randomized trial used direct genetic methods to confirm the causal relationship of community antibiotic consumption and antibiotic resistance. Communities randomized to less frequent use of antibiotics had a significantly lower prevalence of genetic antibiotic resistance determinants.Clinical Trials RegistrationNCT00792922.

    更新日期:2018-11-13
  • Risk Factors and Incidence of Syphilis in Human Immunodeficiency Virus (HIV)–Infected Persons: The HIV Outpatient Study, 1999–2015
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-04-24
    Novak R, Ghanem A, Hart R, et al.

    BackgroundSince 2000, the incidence of syphilis has been increasing, especially among gay, bisexual, and other men who have sex with men (MSM) in the United States. We assessed temporal trends and associated risk factors for newly diagnosed syphilis infections among human immunodeficiency virus (HIV)–infected patients during a 16-year period.MethodsWe analyzed data from the HIV Outpatient Study (HOPS) cohort participants at 10 US HIV clinics during 1999–2015. New syphilis cases were defined based on laboratory parameters and clinical diagnoses. We performed Cox proportional hazards regression analyses of sociodemographic, clinical, and behavioral risk factors for new syphilis infections.ResultsWe studied 6888 HIV-infected participants; 641 had 1 or more new syphilis diagnoses during a median follow-up of 5.2 years. Most participants were male (78%), aged 31–50 years, and 57% were MSM. The overall incidence was 1.8 (95% confidence interval [CI], 1.6–1.9) per 100 person-years (PY) and it increased from 0.4 (95% CI, .2–.8) to 2.2 (95% CI, 1.4–3.5) per 100 PY during 1999–2015. In multivariable analyses adjusting for calendar year, risk factors for syphilis included age 18–30 years (hazard ratio [HR], 1.3 [95% CI, 1.1–1.6]) vs 31–40 years, being MSM (HR, 3.1 [95% CI, 2.4–4.1]) vs heterosexual male, and being non-Hispanic black (HR, 1.6 [95% CI, 1.4–1.9]) vs non-Hispanic white.ConclusionsThe increases in the syphilis incidence rate through 2015 reflect ongoing sexual risk and highlight the need for enhanced prevention interventions among HIV-infected patients in care.

    更新日期:2018-11-13
  • Intermediate Susceptibility Dose-Dependent Breakpoints For High-Dose Rifampin, Isoniazid, and Pyrazinamide Treatment in Multidrug-Resistant Tuberculosis Programs
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-04-24
    Zuur M, Pasipanodya J, van Soolingen D, et al.

    BackgroundBacterial susceptibility is categorized as susceptible, intermediate-susceptible dose-dependent (ISDD), and resistant. The strategy is to use higher doses of first-line agents in the ISDD category, thereby preserving the use of these drugs. This system has not been applied to antituberculosis drugs. Pharmacokinetic/pharmacodynamic (PK/PD) target exposures, in tandem with Monte Carlo experiments, recently identified susceptibility breakpoints of 0.0312 mg/L for isoniazid, 0.0625 mg/L for rifampin, and 50 mg/L for pyrazinamide. These have been confirmed in clinical studies.MethodsTarget attainment studies were carried out using Monte Carlo experiments to investigate whether rifampin, isoniazid, and pyrazinamide dose increases would achieve the PK/PD target in >90% of 10000 patients with tuberculosis caused by bacteria, revealing minimum inhibitory concentrations (MICs) between the proposed and the traditional breakpoints.ResultsWe found that an isoniazid dose of 900 mg/day identified a new ISDD MIC range of 0.0312–0.25 mg/L and resistance at MIC ≥0.5 mg/L. Rifampin 1800 mg/day would result in an ISDD of 0.0625–0.25 mg/L and resistance at MIC ≥0.5 mg/L. At a dose of pyrazinamide 4 g/day, the ISDD MIC range was 37.5–50 mg/L and resistance at MIC ≥100 mg/L. Based on MIC distributions, 93% (isoniazid), 78% (rifampin), and 27% (pyrazinamide) of isolates would be within the ISDD range.ConclusionsDrug susceptibility testing at 2 concentrations delineating the ISDD range, and subsequently using higher doses, could prevent switching to a more toxic second-line treatment. Confirmatory clinical studies would provide evidence to change treatment guidelines.

    更新日期:2018-11-13
  • Spectrum of Enterovirus Serotypes Causing Uncomplicated Hand, Foot, and Mouth Disease and Enteroviral Diagnostic Yield of Different Clinical Samples
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-04-24
    Gao L, Zou G, Liao Q, et al.

    BackgroundHand, foot, and mouth disease (HFMD) represents a substantial disease burden in the Western Pacific region. We investigated the spectrum of causative enteroviruses of HFMD, and evaluated different clinical samples’ diagnostic yield for enteroviruses.MethodsWe enrolled pediatric patients hospitalized for HFMD among 6 hospitals in Anhua County, Hunan Province, China between October 2013 and September 2016. Throat swabs and stool samples (or rectal swabs) were collected to detect the enterovirus serotypes by real-time reverse-transcription polymerase chain reaction (PCR) or nested PCR.ResultsAmong the 2836 patients, only 1 developed severe illness. Seventeen serotypes were identified in 2401 patients (85%), with the most frequently detected being CV-A16 (29% [814]), CV-A6 (28% [784]), EV-A71 (17% [491]), CV-A10 (4% [114]), and CV-A4 (2% [53]). Children were younger in CV-A6, CV-A10, and CV-A4 infections (median, 12 months; interquartile range [IQR], 12–24 months) than EV-A71 and CV-A16 infections (median, 24 months; IQR, 12–36 months; P < .05). The predominant enterovirus serotype shifted between CV-A16 and CV-A6 during the 3 years. Stool had a higher diagnostic yield (89%) than rectal (77%) and throat swabs (74%). Detection rates reached 93% when testing stools followed by throat swabs if stools were negative, and 89% when testing rectal swabs followed by throat swabs if rectal swabs were negative.ConclusionsOur results provide a virological benchmark for future surveillance and diagnostics. Continuous comprehensive virological surveillance is essential, especially after implementation of the EV-A71 vaccine in China, to monitor serotype replacement and the vaccine’s impact.

    更新日期:2018-11-13
  • Longitudinal Trajectories of Brain Volume and Cortical Thickness in Treated and Untreated Primary Human Immunodeficiency Virus Infection
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-04-24
    Sanford R, Ances B, Meyerhoff D, et al.

    BackgroundHuman immunodeficiency virus (HIV) penetrates the brain in early infection. We used neuroimaging to longitudinally examine the impact of HIV and combination antiretroviral therapy (cART) on the brain in treated and untreated HIV-infected participants, starting in primary HIV infection (PHI).MethodsSixty-five participants, enrolled during PHI, underwent longitudinal magnetic resonance imaging, 30 of whom commenced cART during follow-up. Cross-sectional data from 16 patients with chronic HIV infection (CHI) and 19 HIV-uninfected participants were included for comparison. Brain volume and cortical thickness were estimated using tensor-based morphometry and cortical modeling, respectively. Mixed-effects models longitudinally mapped structural brain changes before and after cART. The relationship between brain morphometry estimates and blood and cerebrospinal fluid (CSF) biomarkers were also tested. Region-of-interest analyses were performed to compare brain morphometry estimates between the groups.ResultsPrior to cART, longer duration of untreated infection in PHI correlated with volume loss in the thalamus, caudate, and cerebellum, and with cortical thinning in the frontal and temporal lobes and cingulate cortex. After cART, no further volume loss was observed. However, small increases of cortical thickness in the frontal and temporal lobe correlated with longer cART duration. No correlations were observed with blood or CSF measures. The PHI group did not have different brain morphometric measures compared to the HIV-uninfected group, but had larger volumes in the thalamus, caudate, putamen, and cortical gray matter compared with CHI participants.ConclusionsSubcortical atrophy and cortical thinning occur during untreated infection but may be arrested by cART. These findings emphasize the importance of early cART.

    更新日期:2018-11-13
  • Benchmarking Inpatient Antimicrobial Use: A Comparison of Risk-Adjusted Observed-to-Expected Ratios
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-04-24
    Yu K, Moisan E, Tartof S, et al.

    BackgroundIncreasing antibiotic resistance has made benchmarking appropriate inpatient antibiotic use a worldwide priority supported by expert societies and regulatory bodies; however, standard risk adjustment for fair interfacility comparison has been elusive. We describe a risk-adjusted antibiotic exposure ratio that may help facilitate assessment of antimicrobial use.MethodsThis was a retrospective cohort study of 2.7 million admissions evaluating a wide array of potential explanatory variables for correlation with expected antibiotic consumption in a 2-step approach using recursive partitioning and Poisson regression. Observed-to-expected ratios of risk-adjusted antibiotic use were calculated. Three models of varying complexity were compared: (1) a complex ratio consisting of all available antibiotic use risk factors in a hierarchical model; (2) a simplified antimicrobial stewardship program (ASP) ratio using common facility and encounter factors in a single-level model; and (3) a facility ratio using only broad hospital characteristics.ResultsDiagnosis-related groups, infection present on admission, patient class, and unit type were the major predictors of expected antibiotic use. Aside from a history of gram-positive resistance in the prior 12 months for anti–methicillin-resistant Staphylococcus aureus drugs, additional clinical and comorbid history information did not improve the model. The simplified ASP ratio demonstrated higher Pearson correlation (R2 = 0.97–0.99) to the complex ratio than the facility ratio (R2 = 0.57–0.85) and provided clinical explanations when discordant.ConclusionsThe simplified ASP ratio is derived from a parsimonious model that incorporates disease burden through patient-level risk adjustment and better informs stewardship assessment. This may allow for improved comparison of antibiotic use between healthcare facilities.

    更新日期:2018-11-13
  • Large-scale Artemisinin–Piperaquine Mass Drug Administration With or Without Primaquine Dramatically Reduces Malaria in a Highly Endemic Region of Africa
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-04-24
    Deng C, Huang B, Wang Q, et al.

    BackgroundMass drug administration (MDA), with or without low-dose primaquine (PMQLD), is being considered for malaria elimination programs. The potential of PMQLD to block malaria transmission by mosquitoes must be balanced against liabilities of its use.MethodsArtemisinin–piperaquine (AP), with or without PMQLD, was administered in 3 monthly rounds across Anjouan Island, Union of Comoros. Plasmodium falciparum malaria rates, mortality, parasitemias, adverse events, and PfK13 Kelch-propeller gene polymorphisms were evaluated.ResultsCoverage of 85 to 93% of the Anjouan population was achieved with AP plus PMQLD (AP+PMQLD) in 2 districts (population 97164) and with AP alone in 5 districts (224471). Between the months of April–September in both 2012 and 2013, average monthly malaria hospital rates per 100000 people fell from 310.8 to 2.06 in the AP+PMQLD population (ratio 2.06/310.8 = 0.66%; 95% CI: 0.02%, 3.62%; P = .00007) and from 412.1 to 2.60 in the AP population (ratio 0.63%; 95% CI: 0.11%, 1.93%; P < .00001). Effectiveness of AP+PMQLD was 0.9908 (95% CI: 0.9053, 0.9991), while effectiveness of AP alone was 0.9913 (95% CI: 0.9657, 0.9978). Both regimens were well tolerated, without severe adverse events. Analysis of 52 malaria samples after MDA showed no evidence for selection of PfK13 Kelch-propeller mutations.ConclusionsSteep reductions of malaria cases were achieved by 3 monthly rounds of either AP+PMQLD or AP alone, suggesting potential for highly successful MDA without PMQLD in epidemiological settings such as those on Anjouan. A major challenge is to sustain and expand the public health benefits of malaria reductions by MDA.

    更新日期:2018-11-13
  • Transmission of Mycobacterium tuberculosis From Patients Who Are Nucleic Acid Amplification Test Negative
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-04-24
    Xie Y, Cronin W, Proschan M, et al.

    BackgroundAmong adults with signs and symptoms of pulmonary tuberculosis (TB), recognition of transmissible TB has implications for airborne infection isolation and public health activities. Sputum smear–negative TB patients account for around one-fifth of tuberculosis transmission. The tuberculosis transmission risk of TB patients with negative results on nucleic acid amplification test (NAAT) of respiratory specimens has not been established. We sought to estimate the tuberculosis transmission risk of NAAT-negative TB patients.MethodsWe retrospectively reviewed Maryland TB program data collected from 2004 to 2009, during which time NAAT using the Mycobacterium Tuberculosis Direct Test (MTD) was performed routinely. Patients with sputum Mycobacterium tuberculosis (M.tb) isolates having matching genotypes were assigned to clusters. Transmission sequence was approximated by collection order of individuals’ first culture-positive specimens. Minimum transmission risks of NAAT (MTD)-negative TB patients and of smear-negative TB patients were estimated based on individuals’ positions within clusters.ResultsAmong 809 patients with culture-confirmed TB, M.tb genotypes were available for 782 (96.7%). For NAA-negative TB patients, the minimum transmission risk estimate was 5.1% (95% CI 0–11.4). For smear-negative TB patients, the minimum transmission risk estimate was 11.2% (95% CI 7.2–15.3).ConclusionsMinimum transmission risk of NAAT-negative TB patients was lower than that of smear-negative TB patients. However, transmission risk of NAA-negative TB patients appears to not be negligible.

    更新日期:2018-11-13
  • The Fog May be Lifting Around Antibiotic Use Metrics and Interfacility Comparison
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-04-24
    Fridkin S.

    (See the Major Article by Yu et al on pages 1677–85.)

    更新日期:2018-11-13
  • Differences in Transmission and Disease Severity Between 2 Successive Waves of Chikungunya
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-04-25
    Gordon A, Gresh L, Ojeda S, et al.

    BackgroundChikungunya, an arboviral disease, caused massive epidemics in Central and South America in 2014–2016. In a prospective pediatric cohort study, we examined the introduction of chikungunya in a naive population and investigated transmission and clinical characteristics.MethodsChildren presenting to the study health center with a chikungunya-like illness or undifferentiated fever were tested for chikungunya virus (CHIKV) infection by reverse transcriptase-polymerase chain reaction (RT-PCR) and serological assays. Inapparent CHIKV infections in the intervening year were determined by seroconversion in healthy blood samples collected annually.ResultsA total of 4353 children participated in the cohort study from March 2014 to February 2016 during the 2 epidemic waves of chikungunya. A total of 539 cases of chikungunya were documented, for an incidence rate of 80.2 cases per 1000 person-years (95% confidence interval [CI]: 73.7, 87.2); and a total of 893 CHIKV infections were documented, for an incidence rate of 137.1 infections per 1000 person-years (95% CI: 128.4, 146.4). The seroprevalence of anti-CHIKV antibodies increased linearly with age, with seroprevalence of >45% in 14-year-old children at the end of Epidemic 2. Symptom presentation varied between the epidemics, with Epidemic 2 exhibiting both a higher symptomatic-to-inapparent ratio (1:1.20 in Epidemic 1 vs. 1:0.65 in Epidemic 2) and more severe clinical presentation among cases. The mean reproduction number was also greater in Epidemic 2 than in Epidemic 1.ConclusionsThe intensity of transmission and severity of clinical presentation varied between the 2 epidemics, with higher transmission intensity associated with greater disease severity.

    更新日期:2018-11-13
  • Clinical Impact of a Multiplex Gastrointestinal Polymerase Chain Reaction Panel in Patients With Acute Gastroenteritis
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-04-25
    Cybulski R, Jr, Bateman A, Bourassa L, et al.

    BackgroundMolecular syndromic diagnostic panels can enhance pathogen identification in the approximately 2–4 billion episodes of acute gastroenteritis that occur annually worldwide. However, the clinical utility of these panels has not been established.MethodsWe conducted a prospective, multi-center study to investigate the impact of the BioFire FilmArray Gastrointestinal polymerase chain reaction panel on clinical diagnosis and decision-making, and compared the clinical acuity of patients with positive results obtained exclusively with the FilmArray with those detected by conventional stool culture. A total of 1887 consecutive fecal specimens were tested in parallel by FilmArray and stool culture. Laboratory and medical records were reviewed to determine rates of detection, turnaround times, clinical features, and the nature and timing of clinical decisions.ResultsFilmArray detected pathogens in 35.3% of specimens, compared to 6.0% for culture. Median time from collection to result was 18 hours for FilmArray and 47 hours for culture. Median time from collection to initiation of antimicrobial therapy was 22 hours for FilmArray and 72 hours for culture. Patients diagnosed by FilmArray were more likely to receive targeted rather than empirical therapy, compared to those diagnosed by culture (P = .0148). Positive Shiga-like toxin-producing E. coli results were reported 47 hours faster with FilmArray and facilitated discontinuation of empirical antimicrobials. Patients diagnosed exclusively by FilmArray had clinical characteristics similar to those identified by culture.ConclusionsFilmArray markedly improved clinical sensitivity in patients with acute diarrhea, identified cases with clinical acuity comparable to those identified by culture, and enabled clinicians to make more timely and targeted therapeutic decisions.

    更新日期:2018-11-13
  • Colonization With Levofloxacin-resistant Extended-spectrum β-Lactamase-producing Enterobacteriaceae and Risk of Bacteremia in Hematopoietic Stem Cell Transplant Recipients
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-04-26
    Satlin M, Chavda K, Baker T, et al.

    BackgroundBacteremia caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) is associated with inadequate empirical therapy and substantial mortality in neutropenic patients. Strategies are needed to identify neutropenic patients at high risk of these infections.MethodsFrom April 2014 to September 2016, we collected perianal swabs, both at admission and weekly thereafter, from patients undergoing hematopoietic stem cell transplantation (HSCT). Patients received prophylactic levofloxacin while neutropenic. Swabs were plated onto selective agar, colonies were identified and underwent antimicrobial susceptibility testing, and phenotypic ESBL testing and polymerase chain reaction for β-lactamase genes were performed on ceftriaxone-resistant Enterobacteriaceae. We then determined the prevalence of pre-transplant ESBL-E colonization and risk of ESBL-E bacteremia. Colonizing and bloodstream isolates from patients with ESBL-E bacteremia underwent multilocus sequence typing and pulsed-field gel electrophoresis.ResultsWe analyzed 312 patients, including 212 allogeneic and 100 autologous HSCT recipients. Ten percent (31/312) of patients had pre-transplant ESBL-E colonization. Susceptibility rates of colonizing ESBL-E were: levofloxacin, 25%; cefepime, 9%; piperacillin-tazobactam, 84%; and meropenem, 97%. Of 31 patients colonized with ESBL-E pre-transplant, 10 (32%) developed ESBL-E bacteremia during their transplant admission, compared to 1 (0.4%) of 281 patients not colonized with ESBL-E (P < .001). All bloodstream ESBL-E were levofloxacin-resistant and colonizing and bloodstream isolates from individual patients had identical genotypic profiles.ConclusionsHSCT recipients who are colonized with levofloxacin-resistant ESBL-E pre-transplant and receive levofloxacin prophylaxis have high rates of bacteremia from their colonizing strain during neutropenia. Assessing for ESBL-E colonization in neutropenic patients could lead to optimization of empirical antibacterial therapy.

    更新日期:2018-11-13
  • Epidemiology and Risk Factors for Cryptosporidiosis in Children From 8 Low-income Sites: Results From the MAL-ED Study
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-04-26
    Korpe P, Valencia C, Haque R, et al.

    BackgroundCryptosporidium species are enteric protozoa that cause significant morbidity and mortality in children worldwide. We characterized the epidemiology of Cryptosporidium in children from 8 resource-limited sites in Africa, Asia, and South America.MethodsChildren were enrolled within 17 days of birth and followed twice weekly for 24 months. Diarrheal and monthly surveillance stool samples were tested for Cryptosporidium by enzyme-linked immunosorbent assay. Socioeconomic data were collected by survey, and anthropometry was measured monthly.ResultsSixty-five percent (962/1486) of children had a Cryptosporidium infection and 54% (802/1486) had at least 1 Cryptosporidium-associated diarrheal episode. Cryptosporidium diarrhea was more likely to be associated with dehydration (16.5% vs 8.3%, P < .01). Rates of Cryptosporidium diarrhea were highest in the Peru (10.9%) and Pakistan (9.2%) sites. In multivariable regression analysis, overcrowding at home was a significant risk factor for infection in the Bangladesh site (odds ratio, 2.3 [95% confidence interval {CI}, 1.2–4.6]). Multiple linear regression demonstrated a decreased length-for-age z score at 24 months in Cryptosporidium-positive children in the India (β = –.26 [95% CI, –.51 to –.01]) and Bangladesh (β = –.20 [95% CI, –.44 to .05]) sites.ConclusionsThis multicountry cohort study confirmed the association of Cryptosporidium infection with stunting in 2 South Asian sites, highlighting the significance of cryptosporidiosis as a risk factor for poor growth. We observed that the rate, age of onset, and number of repeat infections varied per site; future interventions should be targeted per region to maximize success.

    更新日期:2018-11-13
  • Detection and Isolation of Clostridium difficile Asymptomatic Carriers During Clostridium difficile Infection Outbreaks: An Exploratory Study
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-05-16
    Paquet-Bolduc B, Gervais P, Roussy J, et al.

    During 4 Clostridium difficile infection outbreaks, unit-wide screening of 114 patients led to detection and isolation of 15 (13%) C. difficile asymptomatic carriers. Carriage prevalence varied between outbreaks, from 0% to 29% (P = .004). Isolating carriers was not associated with significantly shorter outbreak durations, compared with historical controls.

    更新日期:2018-11-13
  • Clinical and Cardiac Safety of Long-term Levofloxacin in Children Treated for Multidrug-resistant Tuberculosis
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-05-16
    Garcia-Prats A, Draper H, Finlayson H, et al.

    Safety concerns persist for long-term pediatric fluoroquinolone use. Seventy children (median age, 2.1 years) treated with levofloxacin 10–20 mg/kg once daily for multidrug-resistant tuberculosis (median observation time, 11.8 months) had few musculoskeletal events, no levofloxacin-attributed serious adverse events, and no Fridericia-corrected QT interval >450 ms. Long-term levofloxacin was safe and well tolerated.

    更新日期:2018-11-13
  • Risk Factors for Group A Streptococcus Colonization During an Outbreak Among People Experiencing Homelessness in Anchorage, Alaska, 2017
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-05-18
    Adebanjo T, Mosites E, Van Beneden C, et al.

    We identified risk factors for any emm type group A streptococcal (GAS) colonization while investigating an invasive emm26.3 GAS outbreak among people experiencing homelessness in Alaska. Risk factors included upper extremity skin breakdown, sleeping outdoors, sharing blankets, and infrequent tooth brushing. Our results may help guide control efforts in future outbreaks.

    更新日期:2018-11-13
  • Reply to Garcia-Granja et al
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-05-21
    Ambrosioni J, Tellez A, Hernandez-Meneses M, et al.

    To the Editor—We thank Dr. García-Granja et al [1] for their interest in our work and for their review of the literature. Despite references not being provided in their letter, we were able to conclude that approximately 80% of cases are the same as we report in our article (provided as a Supplementary table) [2]. We would, however, like to point out that when referring to the 72.7% of periannular complications in our article, it is only the institutional cases (with a probable bias, because our institution is reference for cardiac surgery for infective endocarditis for 9 other smaller centers) and not the whole series (28.9%).

    更新日期:2018-11-13
  • Nutritionally Variant Streptococci Infective Endocarditis: A Different View
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-05-21
    García-Granja P, López J, Vilacosta I, et al.

    To the Editor—We have read with great interest the article by Tellez et al [1] regarding infective endocarditis (IE) due to Abiotrophia and Granulicatella species (GA-IE). Simultaneously, we did another systematic review of this entity from 2000 to 2017 and found 73 cases. Although the article by Tellez et al summarizes the main features of GA-IE, we think that it would be interesting for the readers to access the information of each individual case; therefore, we have built up a table with this information (Supplemental Table 1Supplemental Table 1).

    更新日期:2018-11-13
  • Hantavirus Cardiopulmonary Syndrome Due to Imported Andes Hantavirus Infection in Switzerland: A Multidisciplinary Challenge, Two Cases and a Literature Review
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-05-22
    Kuenzli A, Marschall J, Schefold J, et al.

    Two travellers returning from South America were diagnosed with Andes hantavirus infection, the only member of the Hantaviridae family known to be transmitted from person to person. We describe the clinical course and therapeutic and infection control measures. While both patients showed high viral load (VL) and shedding over several months, 1 patient recovered within 1 week from severe respiratory illness that required noninvasive ventilation, whereas the second patient developed severe hantavirus cardiopulmonary syndrome that required extracorporeal membrane oxygenation for 27 days. The clinical course in the latter patient was complicated by severe disseminated intravascular coagulopathy with diffuse hemorrhage that necessitated mass transfusions, as well as by multiple organ failure, including the need for renal replacement therapy. Results of VL in blood, respiratory secretions, and semen for the first 9 months of follow-up are reported. To our knowledge, these are the first cases of Andes hantavirus infection detected in Europe.

    更新日期:2018-11-13
  • Reply to Garg et al, Smith et al, and Persichino and Miller
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-05-22
    White A, Jr, Coyle C, Rajshekhar V, et al.

    To the Editor—We thank Garg and colleagues for their letter [1]. Two randomized trials compared albendazole and combination therapy with simultaneous praziquantel and albendazole [2, 3]. In both cases, the radiologic response was better with combination therapy only in patients with >2 viable parenchymal cysts but not in those with ≤2 cysts. These trials were the basis for the distinction in treatment of viable parenchymal disease distinguishing patients with 1 or 2 parenchymal cysts form those with ≥3 parenchymal cysts or viable parenchymal cysticercosis. However, neither of these trials included patients with >20 cysticerci.

    更新日期:2018-11-13
  • Pregnancy Screening and Monitoring of Albendazole Therapy for Neurocysticercosis
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-05-22
    Persichino J, Miller L.

    To the Editor—We read with great interest the first guidelines from the Infectious Diseases Society of America and the American Society of Tropical Medicine and Hygiene on the diagnosis and treatment of neurocysticercosis, by White et al [1]. We applaud the authors’ obviously challenging efforts to develop recommendations for an infection that has few trial data from which to draw guidelines.

    更新日期:2018-11-13
  • Antiparasitic Dosing Discrepancy in the 2017 Neurocysticercosis Guidelines
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-05-22
    Smith E, Marks G, Hirai-Yang A, et al.

    To the Editor—With much anticipation, we have reviewed the recently published Infectious Diseases Society of America (IDSA) and American Society of Tropical Medicine and Hygiene 2017 guidelines for the diagnosis and treatment of neurocysticercosis [1]. We applaud the publication of the first IDSA guidelines dedicated to the management of this disease; however, we would like to note a dosing discrepancy encountered in one of the tables in that publication [1, p. e63].

    更新日期:2018-11-13
  • Diagnosis and Treatment of Neurocysticercosis: Issues That Need to Be Addressed
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-05-22
    Garg R, Malhotra H, Pandey S.

    To the Editor—We read with interest the guidelines on diagnosis and treatment of neurocysticercosis [1]. We wish to highlight few points that are lacking in these guidelines.

    更新日期:2018-11-13
  • Outcomes of Patients Lost to Follow-up in African Antiretroviral Therapy Programs: Individual Patient Data Meta-analysis
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-06-08
    Chammartin F, Zürcher K, Keiser O, et al.

    BackgroundLow retention on combination antiretroviral therapy (cART) has emerged as a threat to the Joint United Nations Programme on human immunodeficiency virus (HIV)/AIDS (UNAIDS) 90-90-90 targets. We examined outcomes of patients who started cART but were subsequently lost to follow-up (LTFU) in African treatment programs.MethodsThis was a systematic review and individual patient data meta-analysis of studies that traced patients who were LTFU. Outcomes were analyzed using cumulative incidence functions and proportional hazards models for the competing risks of (i) death, (ii) alive but stopped cART, (iii) silent transfer to other clinics, and (iv) retention on cART.ResultsNine studies contributed data on 7377 patients who started cART and were subsequently LTFU in sub-Saharan Africa. The median CD4 count at the start of cART was 129 cells/μL. At 4 years after the last clinic visit, 21.8% (95% confidence interval [CI], 20.8%–22.7%) were known to have died, 22.6% (95% CI, 21.6%–23.6%) were alive but had stopped cART, 14.8% (95% CI, 14.0%–15.6%) had transferred to another clinic, 9.2% (95% CI, 8.5%–9.8%) were retained on cART, and 31.6% (95% CI, 30.6%–32.7%) could not been found. Mortality was associated with male sex, more advanced disease, and shorter cART duration; stopping cART with less advanced disease andlonger cART duration; and silent transfer with female sex and less advanced disease.ConclusionsMortality in patients LTFU must be considered for unbiased assessments of program outcomes and UNAIDS targets in sub-Saharan Africa. Immediate start of cART and early tracing of patients LTFU should be priorities.

    更新日期:2018-11-13
  • Reply to Million et al
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-08-06
    Dubberke E, Blount K, Gerding D.

    To the Editor—We appreciate the comments by Million et al regarding the safety of RBX2660 [1]. We also agree Clostridium difficile infection (CDI) is associated with significant morbidity and mortality. CDI afflicts the sickest and frailest of our patients, with increases in hospital and nursing home admissions and mortality that persist at least 6 months after the initial episode [2]. This is especially true for patients with recurrent CDI. At 6 months after an initial episode of CDI, Olsen et al found that 36.3% of patients with recurrent CDI had died, compared to 25.7% of patients with a single episode, for a hazard ratio of 1.33 (95% confidence interval 1.12–1.58) on multivariable analysis [3]. As shocking as these objective data are, they only scratch the surface in regards to how devastating recurrent CDI can be to quality of life [2, 4].

    更新日期:2018-11-13
  • Bacterial Cocktail to Treat Clostridium difficile Infection: Primum Non Nocere
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-08-06
    Million M, Lagier J, Chaudet H, et al.

    To the Editor—We read with great interest the recent work of Dubberke et al evaluating—in a randomized, placebo-controlled clinical trial—the efficacy and safety of a cocktail of bacteria (RBX2660) to treat recurrent Clostridium difficile infections (CDI) [1]. However, we believe that the authors’ conclusion that “RBX2660 was safe” is not supported by the data presented.

    更新日期:2018-11-13
  • Two Birds, One Stone: Two Unusual Causes of Diarrhea in a Nonimmunocompromised Human Immunodeficiency Virus–Infected Patient
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-11-13
    Tornero C, Frutos J, Orta N, et al.

    A 46-year-old white homosexual man was diagnosed with human immunodeficiency virus (HIV) infection 6 years ago, following successfully treated secondary syphilis. Baseline blood tests showed a CD4&#x002B; count of 490 cells/mL (43%) and a plasma HIV RNA load of 43 000 copies/mL. Since then, correct antiretroviral therapy had been maintained (currently with Genvoya), with full virological suppression and a CD4&#x002B; count of >600 cells/mL.

    更新日期:2018-11-13
  • Reply to Collins and Riley
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-03-26
    McDonald L, Gerding D, Johnson S.

    To the Editor—We agree with Collins and Riley and thank them for their more accurate appraisal of the epidemiology of the epidemic Clostridium difficile ribotype (RT) 027 strain in Asia [1]. As noted, this strain has been linked to outbreaks of severe disease in North America and Europe, and fluoroquinolone use likely facilitated its dissemination [1, 2]. A targeted intervention including fluoroquinolone restriction resulted in a dramatic decrease in the prevalence of the RT027 strain by 2010 in England and is a reminder that antibiotic stewardship may be particularly helpful in the control of this highly fluoroquinolone-resistant strain [3]. Continued molecular surveillance of C. difficile strain prevalence worldwide remains important to detect trends in the prevalence and incidence of the RT027 strain, as well as other epidemic strains, including the RT017 strain commonly identified in Asian surveys.

    更新日期:2018-10-31
  • Clostridium difficile Guidelines
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-03-26
    Collins D, Riley T.

    To the Editor—The updated clinical practice guidelines on Clostridium difficile infection (CDI) [1] for the Infectious Diseases Society of America and Society for Healthcare Epidemiology of America is a valuable document for clinicians and researchers, summarizing the current evidence for diagnosis, surveillance, and management of CDI. Despite concerted efforts worldwide to control the spread of C. difficile, it not only remains the primary cause of healthcare-associated diarrhea, but it is also an important pathogen in the community. Thus, it is vital that we continuously monitor and improve our management and control of CDI.

    更新日期:2018-10-31
  • Cumulative Burden of Depression and All-Cause Mortality in Women Living With Human Immunodeficiency Virus
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-03-30
    Mills J, Pence B, Todd J, et al.

    Background Research linking depression to mortality among people living with human immunodeficiency virus (PLWH) has largely focused on binary “always vs never” characterizations of depression. However, depression is chronic and is likely to have cumulative effects on mortality over time. Quantifying depression as a cumulative exposure may provide a better indication of the clinical benefit of enhanced depression treatment protocols delivered in HIV care settings. Methods Women living with HIV (WLWH), naive to antiretroviral therapy, from the Women’s Interagency HIV Study were followed from their first visit in or after 1998 for up to 10 semiannual visits (5 years). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. An area-under-the-curve approach was used to translate CES-D scores into a time-updated measure of cumulative days with depression (CDWD). We estimated the effect of CDWD on all-cause mortality using marginal structural Cox proportional hazards models. Results Overall, 818 women contributed 3292 woman-years over a median of 4.8 years of follow-up, during which the median (interquartile range) CDWD was 366 (97–853). Ninety-four women died during follow-up (2.9 deaths/100 woman-years). A dose–response relationship was observed between CDWD and mortality. Each additional 365 days spent with depression increased mortality risk by 72% (hazard ratio, 1.72; 95% confidence interval, 1.34–2.20). Conclusions In this sample of WLWH, increased CDWD elevated mortality rates in a dose–response fashion. More frequent monitoring and enhanced depression treatment protocols designed to reduce CDWD may interrupt the accumulation of mortality risk among WLWH.

    更新日期:2018-10-31
  • A Statewide Antibiotic Stewardship Collaborative to Improve the Diagnosis and Treatment of Urinary Tract and Skin and Soft Tissue Infections
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-03-30
    Jenkins T, Hulett T, Knepper B, et al.

    Background Colorado hospitals participated in a statewide collaborative to improve the management of inpatient urinary tract infections (UTIs) and skin and soft tissue infections (SSTIs). We evaluated the effects of the intervention on diagnostic accuracy and antibiotic use. Methods The main collaborative outcomes were proportion of UTI diagnoses that met criteria for symptomatic UTI; exposure to fluoroquinolones (UTI only); duration of therapy (UTIs and SSTIs); and exposure to antibiotics with broad gram-negative activity (SSTIs only). Outcomes were compared between pre-intervention and intervention periods overall and by hospital. Secondary analyses were changes in outcome trends by time series analysis. Results Twenty-six hospitals, including 9 critical access hospitals, participated in the collaborative. Data were reported for 4060 UTIs and 1759 SSTIs. Between the pre-intervention and intervention periods, the proportion of diagnosed UTIs that met criteria for symptomatic UTI was similar (51% vs 54%, respectively; P = .10), exposure to fluoroquinolones declined (49% vs 41%; P < .001), and the median duration of therapy was unchanged (7 vs 7 days; P = .99). Among SSTIs, exposure to antibiotics with broad gram-negative activity declined (61% vs 53%; P = .001) and the median duration of therapy declined (11 vs 10 days; P = .03). There was substantial variation in performance among hospitals. By time series analysis, only the declining trend of fluoroquinolone use was significant (P = .03). Conclusions The collaborative model is a feasible approach to engage hospitals in a common antibiotic stewardship intervention. Performance improvement was observed for several outcomes but varied substantially by hospital.

    更新日期:2018-10-31
  • Burden, Etiology, and Risk Factors of Respiratory Virus Infections Among Symptomatic Preterm Infants in the Tropics: A Retrospective Single-Center Cohort Study
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-04-12
    Yeo K, de la Puerta R, Tee N, et al.

    BackgroundThe burden of respiratory viral infections (RVIs) among preterm infants in the first few years of life, especially those living in the tropics with year-long transmissions of respiratory viruses, remains unknown. We aimed to describe the clinical epidemiology and associated risk factors for RVIs among symptomatic preterm infants ≤32 weeks up to 2 years of life.MethodsWe performed a data linkage analysis of clinical and hospital laboratory databases for preterm infants born at KK Women’s and Children’s Hospital, Singapore, from 2005 to 2015. RVI episodes during initial admission and subsequent hospital readmissions were included.ResultsOf 1854 infants in the study, 270 (14.5%) infants were diagnosed with at least 1 RVI. A total of 285 (85.3%) episodes were diagnosed postdischarge, with the highest risk for RVIs being from 3 to 5 months of age. The incidence of RVI in this population was 116 per 1000 infant-years and respiratory syncytial virus was the main overall causative pathogen. Infants with RVIs were more likely to be born at ≤27 weeks’ gestational age (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.2–2.3), to have received postnatal steroids (OR, 1.5; 95% CI, 1.0–2.1), and to be diagnosed with bronchopulmonary dysplasia (OR, 1.7; 95% CI, 1.2–2.4).ConclusionsThe burden of RVIs is high in preterm infants in the tropics, affecting >1 of 10 infants born at ≤32 weeks’ gestation before 2 years of age. Respiratory syncytial virus was the main causative pathogen identified. Risk factors for RVI included extremely low gestational age, receipt of postnatal steroids, and bronchopulmonary dysplasia.

    更新日期:2018-10-31
  • Effects of Water, Sanitation, Handwashing, and Nutritional Interventions on Child Enteric Protozoan Infections in Rural Bangladesh: A Cluster-Randomized Controlled Trial
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-04-13
    Lin A, Ercumen A, Benjamin-Chung J, et al.

    BackgroundWe evaluated effects of individual and combined water, sanitation, handwashing (WSH), and nutritional interventions on protozoan infections in children.MethodsWe randomized geographical clusters of pregnant women in rural Bangladesh into chlorinated drinking water, hygienic sanitation, handwashing, nutrition, combined WSH, nutrition plus WSH (N+WSH), or control arms. Participants were not masked. After approximately 2.5 years of intervention, we measured Giardia, Cryptosporidium, and Entamoeba histolytica prevalence and infection intensity by multiplex real-time polymerase chain reaction of child stool. Analysis was intention-to-treat.ResultsBetween May 2012 and July 2013, we randomized 5551 pregnant women. At follow-up, among 4102 available women, we enrolled 6694 children into the protozoan assessment. We analyzed stool from 5933 children (aged ~31 months) for protozoan infections. Compared with 35.5% prevalence among controls, Giardia infection prevalence was lower in the sanitation (26.5%; prevalence ratio [PR], 0.75 [95% confidence interval {CI}, .64–.88]), handwashing (28.2%; PR, 0.80 [95% CI, .66–.96]), WSH (29.7%; PR, 0.83 [95% CI, .72–.96]), and N+WSH (26.7%; PR, 0.75 [95% CI, .64–.88]) arms. Water and nutrition interventions had no effect. Low prevalence of E. histolytica and Cryptosporidium (<2%) resulted in imprecise effect estimates.ConclusionsIndividual handwashing and hygienic sanitation interventions significantly reduced childhood Giardia infections, and there were no effects of chlorinated drinking water and nutrition improvements in this context. Combined WSH interventions provided no additional benefit. To reduce Giardia infection, individual WSH interventions may be more feasible and cost-effective than combined interventions in similar rural, low-income settings.Clinical Trials RegistrationNCT01590095.

    更新日期:2018-10-31
  • Continuous Invasion by Respiratory Viruses Observed in Rural Households During a Respiratory Syncytial Virus Seasonal Outbreak in Coastal Kenya
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-04-16
    Munywoki P, Koech D, Agoti C, et al.

    Background Households are high-intensity close-contact environments favorable for transmission of respiratory viruses, yet little is known for low-income settings. Methods Active surveillance was completed on 47 households in rural coastal Kenya over 6 months during a respiratory syncytial virus (RSV) season. Nasopharyngeal swabs (NPSs) were taken from 483 household members twice weekly irrespective of symptoms. Using molecular diagnostics, NPSs from 6 households were screened for 15 respiratory viruses and the remainder of households only for the most frequent viruses observed: rhinovirus (RV), human coronavirus (HCoV; comprising strains 229E, OC43, and NL63), adenovirus (AdV), and RSV (A and B). Results Of 16928 NPSs tested for the common viruses, 4259 (25.2%) were positive for ≥1 target; 596 (13.8%) had coinfections. Detection frequencies were 10.5% RV (1780), 7.5% HCoV (1274), 7.3% AdV (1232), and 3.2% RSV (537). On average, each household and individual had 6 and 3 different viruses detected over the study period, respectively. Rhinovirus and HCoV were detected in all the 47 households while AdV and RSV were detected in 45 (95.7%) and 40 (85.1%) households, respectively. The individual risk of infection over the 6-month period was 93.4%, 80.1%, 71.6%, 61.5%, and 37.1% for any virus, RV, HCoV, AdV, and RSV, respectively. NPSs collected during symptomatic days and from younger age groups had higher prevalence of virus detection relative to respective counterparts. RSV was underrepresented in households relative to hospital admission data. Conclusions In this household setting, respiratory virus infections and associated illness are ubiquitous. Future studies should address the health and economic implications of these observations.

    更新日期:2018-10-31
  • Seroprevalence of Herpes Simplex Virus Types 1 and 2 Among Pregnant Women and Sexually Active, Nonpregnant Women in the United States
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-04-16
    Patton M, Bernstein K, Liu G, et al.

    Background Neonatal herpes is a rare, devastating consequence of herpes simplex virus type 1 (HSV-1) or 2 (HSV-2) infection during pregnancy. The risk of neonatal infection is higher among pregnant women seronegative for HSV-1 or HSV-2 who acquire their first HSV infection near delivery. Methods We estimated HSV-1 and HSV-2 seroprevalence among pregnant women aged 20–39 years in 1999–2014, assessed HSV seroprevalence changes between 1999–2006 and 2007–2014, and compared HSV seroprevalence between pregnant women and sexually active, nonpregnant women aged 20–39 years in 2007–2014 using National Health and Nutrition Examination Survey data. Results Among pregnant women in 1999–2014, HSV-1 seroprevalence was 59.3%, HSV-2 seroprevalence was 21.1%, and HSV seronegativity was 30.6%. Between 1999–2006 and 2007–2014, HSV-1 and HSV-2 seroprevalence among pregnant women remained stable. However, among pregnant women with ≤3 sex partners (approximately 40% of all pregnant women), seronegativity for both HSV-1 and HSV-2 increased from 35.6% to 51.4% (P < .05). In 2007–2014, nonpregnant women who were (1) unmarried, (2) living below poverty level, or (3) had ≥4 sex partners were more likely than pregnant women to be seronegative for both HSV-1 and HSV-2 (P < .05). Conclusions HSV-1 and HSV-2 seroprevalence among US pregnant women remained stable between 1999 and 2014. However, pregnant women with fewer sex partners were increasingly seronegative for both HSV-1 and HSV-2, indicating an increasing proportion of pregnant women who are vulnerable to primary HSV acquisition in pregnancy, which confers an increased risk of transmitting HSV to their neonates.

    更新日期:2018-10-31
  • Burden and Risk Factors for Coronavirus Infections in Infants in Rural Nepal
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-04-16
    Uddin S, Englund J, Kuypers J, et al.

    Background Knowledge of risk factors for symptomatic human coronavirus (HCoV) infections in children in community settings is limited. We estimated the disease burden and impact of birth-related, maternal, household, and seasonal factors on HCoV infections among children from birth to 6 months old in rural Nepal. Methods Prospective, active, weekly surveillance for acute respiratory infections (ARIs) was conducted in infants over a period of 3 years during 2 consecutive, population-based randomized trials of maternal influenza immunization. Midnasal swabs were collected for acute respiratory symptoms and tested for HCoV and other viruses by reverse-transcription polymerase chain reaction. Association between HCoV incidence and potential risk factors was modeled using Poisson regression. Results Overall, 282 of 3505 (8%) infants experienced an HCoV ARI within the first 6 months of life. HCoV incidence overall was 255.6 (95% confidence interval [CI], 227.3–286.5) per 1000 person-years, and was more than twice as high among nonneonates than among neonates (incidence rate ratio [IRR], 2.53; 95% CI, 1.52–4.21). HCoV ARI incidence was also positively associated with the number of children <5 years of age per room in a household (IRR, 1.13; 95% CI, 1.01–1.28). Of the 296 HCoV infections detected, 46% were coinfections with other respiratory viruses. While HCoVs were detected throughout the study period, seasonal variation was also observed, with incidence peaking in 2 winters (December–February) and 1 autumn (September–November). Conclusions HCoV is associated with a substantial proportion of illnesses among young infants in rural Nepal. There is an increased risk of HCoV infection beyond the first month of life.

    更新日期:2018-10-31
  • Less Severe but Prolonged Course of Acute Hepatitis A in Human Immunodeficiency Virus (HIV)–Infected Patients Compared With HIV-Uninfected Patients During an Outbreak: A Multicenter Observational Study
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-04-17
    Lee Y, Chen G, Chen N, et al.

    Background This multicenter retrospective cohort study aimed to compare the clinical presentations and evolution of acute hepatitis A (AHA) between human immunodeficiency virus (HIV)–infected patients and HIV-uninfected counterparts during the AHA outbreak. Methods Clinical and laboratory data were collected from the medical records of the patients with AHA at the 14 hospitals around Taiwan between May 2015 and May 2017. Results A total of 297 adult patients with AHA were included during the study period. Their mean age was 31.4 years (range, 19.0–76.1 years); 93.4% were men and 58.6% were men who have sex with men. Of 265 patients with known HIV serostatus, 166 (62.6%) were HIV infected. Compared with HIV-uninfected patients, HIV-infected patients had a lower peak alanine aminotransferase (ALT) level (median, 1312 vs 2014 IU/L, P = .003), less coagulopathy (6.0% vs 16.2%, P = .007), and less hepatomegaly or splenomegaly on imaging studies, but a higher rate of delayed resolution of hepatitis (38.8% vs 21.3%, P = .009). HIV-infected patients with plasma RNA load <1000 copies/mL while receiving combination antiretroviral therapy (cART) had a higher peak ALT level (median, 1420 vs 978 IU/L, P = .006) and less delay in resolution of hepatitis (30.6% vs 48.8%, P = .047) than patients without cART or with plasma RNA load ≥1000 copies/mL. Conclusions During an AHA outbreak, HIV-infected patients had a lower severity, but delayed resolution, of AHA than HIV-uninfected patients. Better viral suppression by cART alleviated the impact of HIV infection on the disease course of AHA in HIV-infected patients.

    更新日期:2018-10-31
  • A Trial of a Single-tablet Regimen of Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir Disoproxil Fumarate for the Initial Treatment of Human Immunodeficiency Virus Type 2 Infection in a Resource-limited Setting: 48-Week Results From Senegal, West Africa
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-04-17
    Ba S, Raugi D, Smith R, et al.

    Background There is an urgent need for safe and effective antiretroviral therapy (ART) for human immunodeficiency virus type 2 (HIV-2) infection. We undertook the first clinical trial of a single-tablet regimen containing elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate (E/C/F/TDF) to assess its effectiveness in HIV-2–infected individuals in Senegal, West Africa. Methods HIV-2–infected, ART-naive adults with World Health Organization stage 3–4 disease or CD4 count <750 cells/μL were eligible for this 48-week, open-label trial. We analyzed HIV-2 viral loads (VL), CD4 counts, clinical and adverse events, mortality, and loss to follow-up. Results We enrolled 30 subjects who initiated E/C/F/TDF. Twenty-nine subjects completed 48 weeks of follow-up. The majority were female (80%). There were no deaths, no new AIDS-associated clinical events, and 1 loss to follow-up. The median baseline CD4 count was 408 (range, 34–747) cells/μL, which increased by a median 161 (range, 27–547) cells/μL at week 48. Twenty-five subjects had baseline HIV-2 VL of <50 copies/mL of plasma. In those with detectable HIV-2 VL, the median was 41 (range, 10–6135) copies/mL. Using a modified intent-to-treat analysis (US Food and Drug Administration Snapshot method), 28 of 30 (93.3%; 95% confidence interval, 77.9%–99.2%) had viral suppression at 48 weeks. The 1 subject with virologic failure had multidrug-resistant HIV-2 (reverse transcriptase mutation: K65R; integrase mutations: G140S and Q148R) detected at week 48. There were 8 grade 3–4 adverse events; none were deemed study related. Adherence and acceptability were good. Conclusions Our data suggest that E/C/F/TDF, a once-daily, single-tablet-regimen, is safe, effective, and well tolerated. Our findings support the use of integrase inhibitor–based regimens for HIV-2 treatment. Clinical Trials Registration NCT02180438.

    更新日期:2018-10-31
  • Adverse Events Associated With Antibiotics and Intravenous Therapies for Post–Lyme Disease Syndrome in a Commercially Insured Sample
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-04-17
    Goodlet K, Fairman K.

    Background Non-guideline-endorsed posttreatment courses of antibiotics for post–Lyme disease syndrome (PLDS) have been linked to adverse patient outcomes, but these findings have yet to be validated in large systematic evaluations. Methods A retrospective cohort analysis of medical and pharmacy claims derived from the Truven Health Market Scan Commercial Claims and Encounters Database assessed 90-day incidence rates of adverse events (AEs) associated with PLDS treatment (PLDS-Tx). Patients were diagnosed with PLDS ≥6 months after initial diagnosis and standard antibiotic treatment for Lyme disease. Comparison cohorts included intravenous (IV) PLDS-Tx with or without oral antibiotics; oral antibiotic–only PLDS-Tx; or neither. Results Composite AE incidence rates were higher for patients treated with IV or oral PLDS-Tx than for patients not receiving either treatment (18.7%, 16.8%, and 13.4%, respectively; P = .019). Significant between-group differences in AE incidence rates were noted for electrolyte imbalance (4.0%, 1.5%, and 0.7%, respectively; P = .001) and infection (14.0%, 12.7%, and 9.3%; P = .006). Infection prevalence increased by 22.0% in the IV treatment group and 17.7% in the oral group. Incidence rates for all-cause and AE-related hospital stays and emergency department visits were higher for treated than nontreated patients, particularly when treatment was IV (all P < .01). Of IV-treated patients, 7.3% experienced an incident all-cause inpatient stay and 11.3% an incident all-cause emergency department visit, compared with, respectively, 2.2% and 3.4% of those treated with oral antibiotics and 0.9% and 1.9% of nontreated patients. Conclusions Use of IV therapies or oral antibiotics for PLDS was associated with increased patient morbidity within 90 days.

    更新日期:2018-10-31
  • What Happens Next Depends on What Happened First
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-04-17
    Treanor J.

    (See the Major Article by Kosikova etal on pages 1523–32.)

    更新日期:2018-10-31
  • Factors Influencing Selection of Infectious Diseases Training for Military Internal Medicine Residents
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-04-18
    Barsoumian A, Hartzell J, Bonura E, et al.

    BackgroundApplications to infectious diseases fellowships have declined nationally; however, the military has not experienced this trend. In the past 6 years, 3 US military programs had 58 applicants for 52 positions. This study examines military resident perceptions to identify potential differences in factors influencing career choice, compared with published data from a nationwide cohort.MethodsAn existing survey tool was adapted to include questions unique to the training and practice of military medicine. Program directors from 11 military internal medicine residencies were asked to distribute survey links to their graduating residents from December 2016 to January 2017. Data were categorized by ID interest.ResultThe response rate was 51% (n = 68). Of respondents, 7% were ID applicants, 40% considered ID but reconsidered, and 53% were uninterested. Of those who considered ID, 73% changed their mind in their second and third postgraduate years and cited salary (22%), lack of procedures (18%), and training length (18%) as primary deterrents to choosing ID. Active learning styles were used more frequently by ID applicants to learn ID concepts than by those who considered or were uninterested in ID (P = .02).ConclusionsDespite differences in the context of training and practice among military trainees compared with civilian colleagues, residents cited similar factors affecting career choice. Interest in global health was higher in this cohort. Salary continues to be identified as a deterrent to choosing ID. Differences between military and civilian residents’ desire to pursue ID fellowship are likely explained by additional unmeasured factors deserving further study.

    更新日期:2018-10-31
  • Best Care for Patients Achieved Through Multidisciplinary Stewardship
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-05-15
    Dodds Ashley E, Davis S, Heil E, et al.

    To the Editor—The recent white paper from Ostrowsky et al [1] highlights the need for strengthening the role and support for infectious diseases (ID) physicians in antimicrobial stewardship programs. However, in identifying ID physicians as uniquely qualified for these functions, the authors fail to acknowledge the essential leadership and skill set of ID pharmacists in stewardship. Strong leadership is not limited to a single profession, and all leaders or coleaders of stewardship should be recognized and supported in their roles.

    更新日期:2018-10-31
  • Inhibition of Hepatitis C Virus Replication Induced by Chemotherapy: A Prospective Observational Study
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-05-15
    Hosry J, Angelidakis G, Kaseb A, et al.

    To the Editor—In patients with untreated chronic hepatitis C virus (HCV) infection, serum HCV-RNA levels are stable, varying within 0.5 log10 IU/mL [1]. We previously showed that 23% of HCV-infected patients receiving cancer treatment experienced HCV reactivation (increase in HCV-RNA level >1 log10 IU/mL), and of patients with HCV reactivation, 43% had hepatitis flare (alanine aminotransferase [ALT] increase to ≥3 times the upper limit of normal) and 26% required cancer treatment modification [2]. Herein, we report chemotherapy-induced inhibition of HCV replication (“HCV inhibition”) and clinical implications of this phenomenon.

    更新日期:2018-10-31
  • Use of Alternative Agents for Prevention of Opportunistic Infections in Heart and Lung Transplant Recipients
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-05-16
    Epstein D, Benamu E, Subramanian A.

    heart transplantlung transplantopportunistic infection prophylaxisnocardiosislisteriosis

    更新日期:2018-10-31
  • Effect of Antiretroviral Therapy on Plasma Concentrations of Chloroquine and Desethyl-chloroquine
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-05-16
    Ippolito M, Jacobson J, Lederman M, et al.

    The effect of antiretroviral therapy (ART) on chloroquine and desethyl-chloroquine plasma concentrations was evaluated in clinical trial participants. Concentrations did not differ among participants receiving protease inhibitor–based ART (n = 9), efavirenz-based ART (n = 15), or other ART (n = 8) and those not receiving ART (n = 31). Efavirenz seemed to inhibit chloroquine desethylation.

    更新日期:2018-10-31
  • Rotavirus Vaccination Is Associated With Reduced Seizure Hospitalization Risk Among Commercially Insured US Children
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-05-16
    Burke R, Tate J, Dahl R, et al.

    Rotavirus commonly causes diarrhea but can also cause seizures. Analysis of insurance claims for 1773295 US children with 2950 recorded seizures found that, compared to rotavirus-unvaccinated children, seizure hospitalization risk was reduced by 24% (95% confidence interval [CI], 13%–33%) and 14% (95% CI, 0%–26%) among fully and partially rotavirus-vaccinated children, respectively.

    更新日期:2018-10-31
  • Breakthrough Fungal Infections in Patients With Leukemia Receiving Isavuconazole
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-05-16
    Rausch C, DiPippo A, Bose P, et al.

    We retrospectively assessed breakthrough invasive fungal infections (b-IFIs) in 100 consecutive patients with leukemia receiving single-agent isavuconazole; 13 had documented b-IFIs (candidiasis in 6, mucormycosis in 4). All b-IFIs were observed in patients with prolonged neutropenia and active leukemia.

    更新日期:2018-10-31
  • Effectiveness of 13-Valent Pneumococcal Conjugate Vaccine Against Hospitalization for Community-Acquired Pneumonia in Older US Adults: A Test-Negative Design
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-05-21
    McLaughlin J, Jiang Q, Isturiz R, et al.

    Background Following universal recommendation for use of 13-valent pneumococcal conjugate vaccine (PCV13) in US adults aged ≥65 years in September 2014, we conducted the first real-world evaluation of PCV13 vaccine effectiveness (VE) against hospitalized vaccine-type community-acquired pneumonia (CAP) in this population. Methods Using a test-negative design, we identified cases and controls from a population-based surveillance study of adults in Louisville, Kentucky, who were hospitalized with CAP. We analyzed a subset of CAP patients enrolled 1 April 2015 through 30 April 2016 who were aged ≥65 years and consented to have their pneumococcal vaccination history confirmed by health insurance records. Cases were defined as hospitalized CAP patients with PCV13 serotypes identified via culture or serotype-specific urinary antigen detection assay. Remaining CAP patients served as test-negative controls. Results Of 2034 CAP hospitalizations, we identified PCV13 serotypes in 68 (3.3%) participants (ie, cases), of whom 6 of 68 (8.8%) had a positive blood culture. Cases were less likely to be immunocompromised (29.4% vs 46.4%, P = .02) and overweight or obese (41.2% vs 58.6%, P = .01) compared to controls, but were otherwise similar. Cases were less likely to have received PCV13 than controls (3/68 [4.4%] vs 285/1966 [14.5%]; unadjusted VE, 72.8% [95% confidence interval, 12.8%−91.5%]). No confounding was observed during adjustment for patient characteristics, including immunocompromised status, body mass index, and history of influenza and pneumococcal polysaccharide vaccination (adjusted VE range, 71.1%−73.3%). Conclusions Our study is the first to demonstrate real-world effectiveness of PCV13 against vaccine-type CAP in adults aged ≥65 years following introduction into a national immunization program.

    更新日期:2018-10-31
  • Breakthrough Invasive Mold Infections in the Hematology Patient: Current Concepts and Future Directions
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-05-31
    Lionakis M, Lewis R, Kontoyiannis D.

    Although the widespread use of mold-active agents (especially the new generation of triazoles) has resulted in reductions of documented invasive mold infections (IMIs) in patients with hematological malignancies and allogeneic hematopoietic stem cell transplantation (HSCT), a subset of such patients still develop breakthrough IMIs (bIMIs). There are no data from prospective randomized clinical trials to guide therapeutic decisions in the different scenarios of bIMIs. In this viewpoint, we present the current status of our understanding of the clinical, diagnostic, and treatment challenges of bIMIs in high-risk adult patients with hematological cancer and/or HSCT receiving mold-active antifungals and outline common clinical scenarios. As a rule, managing bIMIs demands an individualized treatment plan that takes into account the host, including comorbidities, certainty of diagnosis and site of bIMIs, local epidemiology, considerations for fungal resistance, and antifungal pharmacological properties. Finally, we highlight areas that require future investigation in this complex area of clinical mycology.

    更新日期:2018-10-31
  • Comparison of the Cumulative Efficacy and Safety of Chloroquine, Artesunate, and Chloroquine-Primaquine in Plasmodium vivax Malaria
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-06-08
    Chu C, Phyo A, Lwin K, et al.

    Background Chloroquine has been recommended for Plasmodium vivax infections for >60 years, but resistance is increasing. To guide future therapies, the cumulative benefits of using slowly eliminated (chloroquine) vs rapidly eliminated (artesunate) antimalarials, and the risks and benefits of adding radical cure (primaquine) were assessed in a 3-way randomized comparison conducted on the Thailand-Myanmar border. Methods Patients with uncomplicated P. vivax malaria were given artesunate (2 mg/kg/day for 5 days), chloroquine (25 mg base/kg over 3 days), or chloroquine-primaquine (0.5 mg/kg/day for 14 days) and were followed for 1 year. Recurrence rates and their effects on anemia were compared. Results Between May 2010 and October 2012, 644 patients were enrolled. Artesunate cleared parasitemia significantly faster than chloroquine. Day 28 recurrence rates were 50% with artesunate (112/224), 8% with chloroquine (18/222; P < .001), and 0.5% with chloroquine-primaquine (1/198; P < .001). Median times to first recurrence were 28 days (interquartile range [IQR], 21–42) with artesunate, 49 days (IQR, 35–74) with chloroquine, and 195 days (IQR, 82–281) with chloroquine-primaquine. Recurrence by day 28, was associated with a mean absolute reduction in hematocrit of 1% (95% confidence interval [CI], .3%–2.0%; P = .009). Primaquine radical cure reduced the total recurrences by 92.4%. One-year recurrence rates were 4.51 (95% CI, 4.19–4.85) per person-year with artesunate, 3.45 (95% CI, 3.18–3.75) with chloroquine (P = .002), and 0.26 (95% CI, .19–.36) with chloroquine-primaquine (P < .001). Conclusions Vivax malaria relapses are predominantly delayed by chloroquine but prevented by primaquine. Clinical Trials Registration NCT01074905.

    更新日期:2018-10-31
  • Imprinting of Repeated Influenza A/H3 Exposures on Antibody Quantity and Antibody Quality: Implications for Seasonal Vaccine Strain Selection and Vaccine Performance
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-08-31
    Kosikova M, Li L, Radvak P, et al.

    Background Reduced seasonal influenza vaccine effectiveness (VE) was observed in individuals who received repeated annual vaccinations. Preexisting influenza antibody levels were also found inversely correlated with postvaccination titers. These reports suggest that preexisting immunity may affect contemporary seasonal vaccine performance. Methods Influenza A/H3 specific cross-reactivity of postvaccination sera from humans with or without preexisting immunity was assessed by hemagglutination inhibition (HAI) assay. Ferret antisera induced by repeated H3 exposures were also subjected to HAI, antibody affinity, and antibody avidity analyses. Results Human postvaccination sera derived from subjects with or without preexisting immunity showed different cross-reactivity against H3 variant viruses. Similarly, the breadth of cross-reactive ferret antibodies induced by repeated H3 exposures was also broadened. Antigenic differences between H3 viruses characterized by ferret antisera became smaller as the number of exposures increased. Although repeated H3 exposures induced “original antigenic sin” phenomena in HAI titers against later exposed viruses, resultant ferret antibodies showed gradually enhanced avidity for different H3/hemagglutinin. Increased antibody avidity was found to be inversely correlated with decreased antigenic differences among H3 viruses characterized. Conclusions Our results suggest that repeated H3 exposures imprinted not only antibody quantity but also antibody quality. The “naive” ferret model currently used for vaccine strain selection does not recapitulate the complexity of human preexisting immunity. Vaccine strains identified hereby may not provide coverage sufficient for those who were frequently infected and/or vaccinated, leading to the reduced VE observed.

    更新日期:2018-10-31
  • Erratum
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-09-08

    An error appeared in the initial publication of this article [Serrano-Villar S, de Lagarde M, Vázquez-Castellanos J. Effects of Immunonutrition in Advanced Human Immunodeficiency Virus Disease: A Randomized Placebo-controlled Clinical Trial (Promaltia Study). Clin Infect Dis https://doi.org/10.1093/cid/ciy414]. This article was originally published with the following error:

    更新日期:2018-10-31
  • Hepatitis C Guidance 2018 Update: AASLD-IDSA Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-09-12
    , Chung R, Ghany M, et al.

    Recognizing the importance of timely guidance regarding the rapidly evolving field of hepatitis C management, the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) developed a web-based process for the expeditious formulation and dissemination of evidence-based recommendations. Launched in 2014, the hepatitis C virus (HCV) guidance website undergoes periodic updates as necessitated by availability of new therapeutic agents and/or research data. A major update was released electronically in September 2017, prompted primarily by approval of new direct-acting antiviral agents and expansion of the guidance’s scope. This update summarizes the latest release of the HCV guidance and focuses on new or amended recommendations since the previous September 2015 print publication. The recommendations herein were developed by volunteer hepatology and infectious disease experts representing AASLD and IDSA and have been peer reviewed and approved by each society’s governing board.

    更新日期:2018-10-31
  • Universal Screening of Pregnant Women for Hepatitis C: The Time Is Now
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-09-12
    Jhaveri R, Broder T, Bhattacharya D, et al.

    The epidemiology of hepatitis C virus (HCV) has changed significantly over the last decade. Once most prevalent among older adults, the current burden has disproportionately affected young adults including women of childbearing age (WOCA). The Society for Maternal-Fetal Medicine recently issued guidelines that made no change in the recommendation to screen pregnant women based on risk factors. The current burden in young adults including WOCA supports a change in strategy away from risk-based screening to universal HCV screening in pregnancy. Universal screening offers several advantages that position us for a future where HCV treatment in pregnancy can happen and offers us progress toward the elimination of HCV.

    更新日期:2018-10-31
  • Erratum
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-09-15

    An error appeared in the initial publication of this article [Cerrone M, Wang X, Neary M, et al. Pharmacokinetics of Efavirenz 400 mg Once Daily Coadministered With Isoniazid and Rifampicin in Human Immunodeficiency Virus–Infected Individuals. Clin Infect Dis https://doi.org/10.1093/cid/ciy491]. This article was originally published with the following error:

    更新日期:2018-10-31
  • Cavitary Pulmonary Nodules in an Immunocompromised Patient With Urothelial Carcinoma of the Bladder
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-10-30
    Morales A, Mathur-Wagh U, Tran A, et al.

    A 59-year-old Moroccan man with a history of metastatic urothelial cell carcinoma presented in May 2016 with fever, shortness of breath, and chest pain. Noninvasive urothelial carcinoma had been diagnosed in 2012 and treated with mitomycin. In 2014, the patient had received intravesicular Mycobacterium bovis BCG therapy, but invasive bladder carcinoma subsequently developed, requiring 4 cycles of chemotherapy with methotrexate, vinblastine, doxorubicin, and cisplatin. Nine months before the current admission, the patient underwent a radical cystoprostatectomy with creation of a neobladder. Nonetheless, brain metastases developed, for which he received dexamethasone (4 mg orally, twice daily), and underwent neurosurgical resection 3 months before presentation, followed by whole-brain irradiation. He continued receiving intermittent dexamethasone therapy until his admission to our hospital.

    更新日期:2018-10-31
  • Health Risks of Flood Disasters
    Clin. Infect. Dis. (IF 9.117) Pub Date : 2018-03-21
    Paterson D, Wright H, Harris P.

    Floods are the most common natural disaster occurring worldwide, with their impact expected to grow in the future due to the effects of climate change and population shift. Floodwaters pose immediate dangers to human health, but also long-term effects resulting from displacement and worsened living conditions. This review examines the health impact of flood disasters, including skin and soft-tissue infections, gastroenteritis, and zoonotic infections such as leptospirosis, and the impact on noncommunicable diseases and health infrastructure. Further work in the development of cost-efficient preparedness strategies may mitigate the morbidity and mortality associated with such natural disasters.

    更新日期:2018-10-15
Some contents have been Reproduced with permission of the American Chemical Society.
Some contents have been Reproduced by permission of The Royal Society of Chemistry.
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