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. A cura del Dr. Giuseppe Giocoli
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>> aggiornato il 17/02/2010
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Riattivazioni e recidive TB: l'importanza dell'infezione HIV
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In India, a tuberculosis‐endemic country, most recurrences after successful treatment of tuberculosis are due to exogenous reinfection in HIV‐infected persons and endogenous reactivation in HIV‐uninfected persons. Strategies for prevention and treatment of tuberculosis infection must take these findings into consideration ... Tuberculosis recurrence rates, likely due to reinfection, were much higher than incidence rates. The findings suggest heterogeneity in susceptibility, implying that a vaccine could still provide useful protection in the population and strengthening the case for secondary preventive therapy.
Allegati il primo articolo e l'editoriale; il secondo articolo può essere scaricato mediante il link.
Impact of HIV Infection on the Recurrence of Tuberculosis in South India. Sujatha Narayanan et al. The Journal of Infectious Diseases 2010;201:691–703
High Rates of Recurrence in HIV‐Infected and HIV‐Uninfected Patients with Tuberculosis. Judith R. Glynn et al. The Journal of Infectious Diseases 2010;201:704–711
Recurrent Tuberculosis: Relapse, Reinfection, and HIV. Richard E. Chaisson and
Gavin J. Churchyard. The Journal of Infectious Diseases 2010;201:653–655
Link di approfondimento >>
http://www.journals.uchicago.edu/doi/pdf...
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>> aggiornato il 17/02/2010
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Un caso di leishmaniosi cutanea
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A 25-year-old man presented to our clinic with a 1-year history of skin lesions on his nose and arm. Physical examination was notable for painless erythematous papules and nodules with overlying scale and crust, some of which had central ulceration ... Cutaneous leishmaniasis typically begins as a painless papule that enlarges to a nodule with a central crust. The papules and nodules enlarge, may develop central ulceration, and take approximately 1 year to heal without treatment. Satellite lesions may also be present. The patient was treated successfully with injections of sodium stibogluconate.
Images in clinical medicine - Cutaneous Leishmaniasis. Mahdi Malekpour, Mohsen Esfandbod. NEJM Volume 362:e15 February 11, 2010 Number 6
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>> aggiornato il 16/02/2010
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Con il test della procicalcitonina si può ridurre l'uso degli antibiotici nelle terapie intensive ma ...
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A procalcitonin-guided strategy to treat suspected bacterial infections in non-surgical patients in intensive care units could reduce antibiotic exposure and selective pressure with no apparent adverse outcomes.
Commenta l'editorialista:
These investigators assessed the effect of a procalcitonin-guided algorithm on the duration of antimicrobial therapy in critically ill patients. The main findings were that patients in the procalcitonin group had significantly more antibiotic-free days than did those in the control group, who were managed according to present practices. Mortality, relapsing infection, and days free of mechanical ventilation days did not differ significantly between groups.
Use of procalcitonin to reduce patients' exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lila Bouadma et al. for the PRORATA trial group. The Lancet, Volume 375, Issue 9713, Pages 463 - 474, 6 February 2010
Will procalcitonin reduce antibiotic use in intensive care? Marin H Kollef. The Lancet, Volume 375, Issue 9713, Pages 435 - 436, 6 February 2010
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>> aggiornato il 15/02/2010
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HIV-1: stipiti resistenti possono avere gravi conseguenze, anche se poco frequenti
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Dall'editoriale: What are the implications of these studies? They both extend previous findings and demonstrate that minority nonnucleoside reverse‐transcriptase inhibitor (NNRTI) mutants increase the risk of virologic failure of efavirenz‐based regimens. Both studies indicate that the risk of virologic failure depends on both the individual NNRTI mutation and its frequency in the viral population.
Allegati l'art. di Paredes et al e l'editoriale di Heneine. All'articolo di Halvas et al si può accedere dal link.
Pre‐existing Minority Drug‐Resistant HIV‐1 Variants, Adherence, and Risk of Antiretroviral Treatment Failure. Roger Paredeset al.
for the AIDS Clinical Trials Group (ACTG) A5095 Study Team. The Journal of Infectious Diseases 2010;201:647–649
Low Frequency Nonnucleoside Reverse‐Transcriptase Inhibitor–Resistant Variants Contribute to Failure of Efavirenz‐Containing Regimens in Treatment‐Experienced Patients. Elias K. Halvas et al. The Journal of Infectious Diseases 2010;201:672–680
EDITORIAL COMMENTARY -When Do Minority Drug‐Resistant HIV‐1 Variants Have a Major Clinical Impact? Walid Heneine. The Journal of Infectious Diseases 2010;201:647–649
Link di approfondimento >>
http://www.journals.uchicago.edu/doi/pdf...
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>> aggiornato il 15/02/2010
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PCR per T.pallidum per la diagnosi di lue
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The diagnosis of syphilis can be complicated when it is based on diverse clinical manifestations, dark-field microscopy, and serology. In the present study, therefore, we examined the additional clinical value of a Treponema pallidum real-time TaqMan PCR for the detection of primary and secondary syphilis. The additional value of the T. pallidum real-time PCR for the diagnosis of primary syphilis was evaluated by the use of three different algorithms: (i) a head-to-head comparison of the dark-field microscopy result and the T. pallidum real-time PCR result, (ii) comparison of the clinical diagnosis made in a sexually transmitted infection clinic (STI) (including by dark-field microscopy) and the T. pallidum real-time PCR result, and (iii) comparison of the clinical diagnosis made in a general practitioner's office (without dark-field microscopy) and the T. pallidum real-time PCR result. A fourth algorithm was used to determine the performance of the T. pallidum real-time PCR regarding the detection of secondary syphilis. From December 2006 to April 2008, 716 patients with suspected cases of primary syphilis and 133 patients with suspected cases of secondary syphilis were included in the study. A kappa value of 0.601 was found for the agreement between dark-field microscopy and the T. pallidum real-time PCR. Good agreement was found between the T. pallidum real-time PCR and both the diagnosis of the general practitioner (kappa = 0.745) and the diagnosis of the STI clinic (kappa = 0.769). The sensitivity with respect to the STI clinic diagnosis was 72.8%, the specificity was 95.5%, the positive predictive value was 89.2%, and the negative predictive value was 95.0%. The T. pallidum real-time PCR is a fast, efficient, and reliable test for the diagnosis of primary syphilis in an STI outpatient clinic and a general practitioner setting, but it has no added diagnostic value for the diagnosis of secondary syphilis.
Clinical Value of Treponema pallidum Real-Time PCR for Diagnosis of Syphilis. R. Heymans, et al. J. Clin. Microbiol. 48: 497-502.
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