Advertisement
At a Glance: New IDSA guidelines for Aspergillosis

At a Glance: New IDSA guidelines for Aspergillosis

New therapies are improving care, but early diagnosis remains critical in the effective treatment of invasive aspergillosis, a potentially deadly fungal infection, according to new guidelines released by the Infectious Diseases Society of America (IDSA) and published in the journal Clinical Infectious Diseases. The updated guidelines focus on the diagnosis and treatment of the major forms of aspergillosis: allergic, chronic and invasive, the latter which kills 40 percent to 80 percent of those with widespread infection. An airborne mold, aspergillus often is found in air conditioning units, compost piles and damp or flood-damaged homes or buildings. While generally harmless, it can cause an allergic reaction or chronic lung problems in some people and serious, invasive disease in vulnerable patients. Those at highest risk are people whose immune systems are suppressed, such as those undergoing stem cell and lung and other organ transplants. The infection also can affect those with severe influenza or who are on long-term steroids, or patients in the intensive care unit. “Invasive aspergillosis often is overlooked, but early diagnosis and treatment are key,” said Thomas Patterson, MD, lead author of the guidelines and chief of the Division of Infectious Disease and professor of medicine at The University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System, San Antonio. “These are complicated infections with a number of treatment options. Patients really benefit from a multidisciplinary approach, including the expertise of an infectious disease specialist.” Updating the 2008 guidelines, the new guidelines for the diagnosis and treatment of aspergillosis highlight the increased evidence for antifungal therapy recommendations as well as diagnostic tests....
CME: Pathogen-Directed Respiratory Infection Care

CME: Pathogen-Directed Respiratory Infection Care

Antimicrobial resistance poses a serious public health threat and is an especially challenging issue when treating respiratory infections. Research shows that the number of pneumonia cases caused by antibiotic-resistant bacteria has risen substantially in recent years. These cases have been linked to higher mortality and morbidity, longer stays in intensive care, and increased costs due to inadequate therapy when compared with pneumonia caused by non-resistant pathogens. “We’re in the middle of an antimicrobial resistance crisis in the United States,” says Helen W. Boucher, MD, FACP, FIDSA. “One of the biggest contributors to this issue is the overuse of antibiotics. Some clinicians are treating infections too broadly and prescribing unwarranted antibiotics. Although many respiratory infections are caused by viruses, antibiotics are often prescribed inappropriately to treat these infections.”   The Challenge As with any infection, respiratory infections should be treated as narrowly as possible, according to Dr. Boucher, who co-authored a review article summarizing the current state of antimicrobial-resistant bacterial respiratory tract pathogens (Table) that was published in Current Opinion in Pulmonary Medicine. “The goal is to treat the exact pathogen that’s causing the infection, and nothing more. Treating beyond a specific pathogen can lead to overuse of antibiotics, resistance, and adverse effects for patients,” she says. Dr. Boucher says strong, accurate diagnostic testing is required in order to appropriately prescribe antibiotics. “For pneumonia,” she says, “there are several new tools that are highly accurate in diagnosing the pathogen causing the infection. This allows for appropriate, pathogen-directed therapy. Pathogen-directed therapy also includes recognizing if the bacterium is susceptible or resistant to certain antibiotics.” Even when these factors are known, targeting...
New research identifies flaws in LM-method for Lyme disease

New research identifies flaws in LM-method for Lyme disease

A new microscopy technique (LM-method) developed to detect Lyme disease is unable to distinguish infected patients from healthy controls, yielding false-positive results that could lead doctors to over-diagnose a patient, according to new research published in the journal Infectious Diseases. The new research follows up on a previous study suggesting that modified microscopy techniques (LM-method) could detect active cases of Lyme disease (caused by Borrelia bacteria) and Babesia (a tick-borne malaria-like parasite) in just one to two days. Despite considerable publicity and patient demand for this test in Norway, earlier studies did not include a control group and methods were not validated and ready for use in patients. To investigate the reliability of the new test, Dr Audun Aase, from the Norwegian Institute of Public Health, and his colleagues collected blood samples both from people who had been suffering from Lyme disease-like symptoms for several years and previously tested positive for Borrelia and/or Babesia by the LM-method (21 people), and healthy controls with no known history of tick bites (41 people). The samples were then masked and analyzed in independent laboratories using a range of diagnostic tests including the LM-method, conventional microscopy, genetic fingerprint testing (PCR), and serology. The results indicate that the new LM-method can trigger false positives, suggesting people have Lyme disease when they really don’t. Using the LM-method, 14 (66%) patient group blood samples and 35 (85%) control group samples were judged positive for Borrelia and/or Babesia. However, only one sample (5%) of the patient group and eight samples (20%) of the control group tested positive for Borrelia DNA by PCR. None of the samples were...
Grant to Understand Why Some with HIV+ Avoid the “Duet of Death”

Grant to Understand Why Some with HIV+ Avoid the “Duet of Death”

Findings Could Offer Hope for TB Prevention, Cure by testing the hypothesis that genetic variations, possibly producing unconventional T-cells, enable macrophages to resist or kill off Mtb infection. Case Western Reserve University School of Medicine experts and colleagues in the United States and Africa have received an $11 million, five-year NIH grant to understand why some people living with HIV in Africa avoid becoming infected with the bacterium that causes tuberculosis (TB) despite exposure to high-TB-risk circumstances. Learning what causes this resistance to infection with TB bacteria has a potentially significant global health impact since TB is the leading cause of death worldwide among people living with HIV, as well as a primary cause of death among all people in many developing nations. People who are infected with HIV are 20 to 30 times more likely to develop active TB and one in three HIV deaths globally are estimated to be due to TB. “Living with both HIV and TB bacterial infection has been called the ‘duet of death,’” said lead researcher W. Henry Boom, MD, director of the Tuberculosis Research Unit at Case Western Reserve University School of Medicine. “Becoming infected with TB bacteria can be highly lethal to people living with HIV. Yet earlier my colleagues and I found that some HIV positive people not only don’t get sick or die from TB; they don’t even become infected in the first place. Our aim is to find out why.” Tuberculosis is caused by a bacterium called Mycobacterium tuberculosis (Mtb). Most people who are heavily exposed to airborne Mtb become infected and develop latent Mtb infection as measured...
Scientists Stabilize HIV Structure, Design Potential AIDS Vaccine Candidates

Scientists Stabilize HIV Structure, Design Potential AIDS Vaccine Candidates

“We’ve figured out one of the fundamental reasons why HIV is metastable,” said Zhu. By tweaking HIV’s genetic sequence, they were able to shorten the HR1 region, preventing its transformation and keeping the rest of the structure stable. Findings represent ‘big accomplishment’ in biomedical engineering and design. Findings were published this week in the journal Nature Communications. Want to catch a criminal? Show a mugshot on the news. Want to stop HIV infections? Get the immune system to recognize and attack the virus’s tell-tale structure. That’s part of the basic approach behind efforts at The Scripps Research Institute (TSRI) to design an AIDS vaccine. This strategy may hinge on finding new ways to stabilize proteins called HIV-1 surface antigens and in designing HIV-like particles to prompt the body to fight the real virus. Now two new studies led by TSRI scientists advance these efforts. The first describes a strategy to stabilize an important HIV structure and potentially create HIV lookalikes for large-scale vaccine production. The second study engineers novel nanoparticles as vaccine candidates, using this new knowledge. “This is a big accomplishment in terms of engineering and design,” said TSRI biologist Jiang Zhu. Zhu co-led the first study with Ian Wilson, Hansen Professor of Structural Biology and chair of the Department of Integrative Structural and Computational Biology at TSRI, and co-led the second with TSRI Associate Professor Andrew Ward. The findings were published June 28, 2016 in the journal Nature Communications. Stabilizing HIV In the first publication, Zhu and researcher Leo Kong (a study first author now at the National Institutes of Health) built on previous structural studies from the...
Overestimating the effect of medical errors can be detrimental

Overestimating the effect of medical errors can be detrimental

An issue with inflated numbers like 251,000 and 440,000 is that they are repeated by naïve journalists… A musician’s cancer diagnosis could have been made 4 years sooner if a CT scan report of a suspicious lung nodule had been properly followed up. I feel for the patient and agree that if the details of the story are accurate, he and his family deserve some compensation for the mistake. However, the article on Philly.com contained this misleading statement. “His odyssey comes at a time when the health-care community is reckoning the full impact of medical error: In May, an analysis by Johns Hopkins University School of Medicine identified it as the third-leading cause of death in the nation, killing 251,000 people annually.” That analysis, by Makary and Daniel in the BMJ, has been questioned by many including me. A post of mine explained why the number was likely inaccurate due to flaws in the authors’ methodology such as extrapolation of data from papers with only a few deaths, and like other studies in this genre, failure to explain how preventability was determined. As I have written, deciding that adverse events are preventable is extremely difficult. In my post, I said, “about 715,000 people died in hospitals in 2010. Of those who died, 75% were age 65 and over, and 27% of in-hospital deaths were in patients 85 and over. The average age of patients who died in a hospital in the first decade of this century was 72 to 73.” The elderly often die of causes that are not preventable, and even if errors occur, they may not be...
FDA OKs Epclusa, First Drug for All Major Forms of HCV

FDA OKs Epclusa, First Drug for All Major Forms of HCV

The U.S. Food and Drug Administration approved Epclusa to treat adult patients with chronic hepatitis C virus (HCV) both with and without cirrhosis (advanced liver disease). For patients with moderate to severe cirrhosis (decompensated cirrhosis), Epclusa is approved for use in combination with the drug ribavirin. Epclusa is a fixed-dose combination tablet containing sofosbuvir, a drug approved in 2013, and velpatasvir, a new drug, and is the first to treat all six major forms of HCV. “This approval offers a management and treatment option for a wider scope of patients with chronic hepatitis C,” said Edward Cox, M.D., director of the Office of Antimicrobial Products in the FDA’s Center for Drug Evaluation and Research. Hepatitis C is a viral disease that causes inflammation of the liver that can lead to diminished liver function or liver failure. There are at least six distinct HCV genotypes, or strains, which are genetically distinct groups of the virus. Knowing the genotype helps inform treatment recommendations and the duration of treatment. Approximately 75 percent of Americans with HCV have genotype 1; 20-25 percent have genotypes 2 or 3; and a small numbers of patients are infected with genotypes 4, 5 or 6. According to the Centers for Disease Control and Prevention, HCV infection becomes chronic in approximately 75 to 85 percent of cases. Patients who suffer from chronic HCV infection over many years may have complications, such as bleeding, jaundice (yellowish eyes or skin), fluid accumulation in the abdomen, infections, liver cancer and death. The safety and efficacy of Epclusa for 12 weeks was evaluated in three Phase III clinical trials of 1,558 subjects...
New Research Shows Vaccine Protection Against Zika Virus

New Research Shows Vaccine Protection Against Zika Virus

Promising preclinical studies suggest human vaccine will likely be feasible. The rapid development of a safe and effective vaccine to prevent the Zika virus (ZIKV) is a global priority, as infection in pregnant women has been shown to lead to fetal microcephaly and other major birth defects. The World Health Organization declared the Zika virus epidemic a global public health emergency on February 1, 2016. In a paper published today in the journal Nature, a research team led by scientists at Beth Israel Deaconess Medical Center (BIDMC), in collaboration with scientists at Walter Reed Army Institute of Research (WRAIR) and the University of Sao Paulo, demonstrates that two different ZIKV vaccine candidates provided complete protection in mice against a ZIKV strain from Brazil and suggest that a ZIKV vaccine for humans will likely be feasible. ZIKV is a member of the flavivirus family of viruses. Transmitted by mosquitoes, ZIKV is responsible for an unprecedented epidemic in the Americas. This family of viruses also includes West Nile virus, yellow fever virus, Japanese encephalitis virus, tick-borne encephalitis virus, and dengue viruses, for which successful vaccines have been developed. “Our data demonstrate that a single dose of a DNA vaccine or a purified inactivated virus vaccine provides complete protection against the ZIKV challenge in mice,” said senior author Dan H. Barouch, MD, PhD, Director of the Center for Virology and Vaccine Research at BIDMC, Professor of Medicine at Harvard Medical School, and Steering Committee member at the Ragon Institute of MGH, MIT and Harvard. “Importantly, we showed that vaccine-induced antibodies provided protection, similar to existing vaccines for other flaviviruses.” The researchers tested...
Five new confirmed microcephaly cases in Colombia may be harbingers of epidemic

Five new confirmed microcephaly cases in Colombia may be harbingers of epidemic

Just when it seemed that missing cases of microcephaly in Colombia were straining the credibility of the Zika virus’ connection to the birth defects, the latest report from Colombia includes five new cases of microcephaly with Zika infections. Just when it seemed that missing cases of microcephaly in Colombia were straining the credibility of the Zika virus’ connection to the birth defects, the latest report from Colombia includes five new cases of microcephaly with Zika infections. A recent report by the New England Complex Systems Institute (NECSI) noted that, despite their supposed connection, cases of microcephaly were not rising in sync with Zika’s epidemic spread. Of all the countries reporting cases, only Brazil has reported a distinctively large number of birth defects. In Colombia, a study of 12,000 pregnant, Zika-infected women reported in the New England Journal of Medicine had not shown any cases of microcephaly. The cases of microcephaly reported from outside the study could be explained by the background rate of microcephaly from unrelated causes. The new report from Colombia states that there are a total of 11 confirmed cases of microcephaly with Zika infections until June 18, five more than the number confirmed as of the previous week. The previous confirmed case, the sixth, was confirmed four weeks earlier. According to the NECSI analysis, it and the five other reported cases of microcephaly with Zika infections were consistent with the random co-occurence of each of them separately, and therefore should not be attributed to Zika as the cause. The five new confirmed Zika and microcephaly cases provide the best evidence available for an impending microcephaly epidemic...
Researchers Discover the 2009 Swine Flu Pandemic Originated in Mexico

Researchers Discover the 2009 Swine Flu Pandemic Originated in Mexico

The 2009 swine H1N1 flu pandemic — responsible for more than 17,000 deaths worldwide — originated in pigs from a very small region in central Mexico, a research team headed by investigators at the Icahn School of Medicine at Mount Sinai is reporting. The scientists say their findings, published in the journal eLife, represent the first time that the origin of an influenza pandemic virus has been determined in such detail. Researchers used state-of-the-art genetic analysis to identify the precise location and the main molecular transformations that allowed a pig influenza virus to jump into humans. They found that the virus responsible was a mix of one North American swine virus that had jumped between birds, humans, and pigs, and a second Eurasian swine virus, that circulated for more than 10 years in pigs in Mexico before jumping into humans. Previously, the most closely related ancestor viruses to the 2009 H1N1 virus were identified in Asian swine, but they were not as close genetically to the human 2009 pandemic H1N1 virus as the swine Mexican isolates found in this study. The only other H1N1 pandemic flu known to date was the “Spanish” flu of 1918 that killed between 50 and 100 million people — 3 to 5 percent of the world’s population. Influenza viruses infect up to 500 million people annually. “Knowing where and how an animal influenza virus infects humans and spreads all over the world helps us understand how we can reduce risk of these pandemics,” says the study’s senior author, Adolfo García-Sastre, PhD, Director of the Global Health and Emerging Pathogens Institute, Irene and Dr. Arthur...
Some viruses could survive on children’s toys for hours and cause infection, study finds

Some viruses could survive on children’s toys for hours and cause infection, study finds

Certain viruses, such as influenza, could survive on children’s toys long enough to result in exposures, placing children at risk for getting infectious diseases, according to researchers at Georgia State University. The researchers tested how long an enveloped virus could survive on pieces of a flexible plastic children’s toy, a squeaking frog. They were able to recover infectious virions (complete viral particles) from the toy up to 24 hours after the toy’s contamination at 60 percent relative humidity, and up to 10 hours at 40 percent relative humidity. These findings show enveloped viruses could survive on toys long enough to result in exposures. Enveloped viruses have a protective outer layer that may help them survive and infect other cells. Examples of such viruses include influenza and Coronaviruses, such as severe acute respiratory syndrome (SARS) or Middle East Respiratory Syndrome (MERS). The study is published online in The Pediatric Infectious Disease Journal. “People don’t really think about getting viruses from inanimate objects,” said lead author Richard Bearden II, who holds a master of science degree in biology from Georgia State. “They think about getting them from other people. Children are vulnerable to contracting infectious disease because they put their hands and foreign objects in their mouths, and their immune systems aren’t fully developed.” Toys may be an important channel for the transmission of viral diseases among children. Previous studies have found viral contamination of shared toys in daycares, doctor’s offices and homes. In particular, toys in common play areas in healthcare settings have been implicated as vehicles for outbreaks of viral illness. However, it has remained unknown how long enveloped...
Teaching an Old Drug New Tricks to Fight Cytomegalovirus

Teaching an Old Drug New Tricks to Fight Cytomegalovirus

Researchers at Johns Hopkins have found that an old drug once mostly used to treat amebiasis and induce vomiting for poisoning also halts replication of cytomegalovirus (CMV), a herpesvirus that can cause serious disease in immunocompromised individuals, including those with HIV or organ transplant recipients. A report on the finding, made in test tube  and mice studies, is published in the June 23 PLOS Pathogens and could potentially offer a much-needed tool to inhibit  CMV, the investigators say. Most people worldwide permanently harbor CMV, which causes no symptoms in the healthy. However, for those with a challenged or compromised immune system, the virus can cause diseases affecting multiple organs, such as the liver gut, lungs and brain. CMV is also the most common congenital infection passed from mother to child, leading to significant birth defects, such as microcephaly, hearing loss and other neurodevelopmental problems. A few drugs exist to treat CMV by inhibiting its replication in cells, but Ravit Boger, M.D., associate professor of pediatrics and oncology at the Johns Hopkins University School of Medicine, says these medications are associated with problematic side effects, including toxicity to the bone marrow and kidneys. Additionally, resistant strains of CMV sometimes emerge during treatment, creating “a desperate need for other ways to control this virus,” says Boger. Recently, investigators started a strategic search for useful drugs by screening those already approved by the U.S. Food and Drug Administration for new uses. Collaborating with Marc Ferrer at the National Institutes of Health, Boger screened a library of 1,280 such pharmacologically active compounds to see if any of these might inhibit CMV replication in...
Page 1 of 2312345...Last »
[ HIDE/SHOW ]