Iron deficiency and susceptibility to infections: evaluation of the clinical evidence.

Iron is a fundamental nutrient for human and microbial life. We sought to examine the association of iron deficiency versus normal iron status with the susceptibility to infections. A systematic search in the PubMed and Scopus databases was performed to identify relevant clinical studies. Six studies (including a total of 1,422 participants) met the inclusion criteria: four prospective cohort (859 participants), one retrospective case-control (115 participants), and one retrospective cohort study (448 participants). Intensive care unit (ICU)-acquired and postoperative infections were more common in patients with iron deficiency than among those with normal iron status in two studies, while no difference was reported in another study. In one study examining pregnant women with normal mean iron values, higher soluble transferrin receptor values independently predicted vaginosis-like microflora. Iron deficiency anemia was an independent predictor of respiratory tract infections in one study, and postoperative urinary tract infections were more common in patients with iron deficiency anemia in another. The limited available evidence suggests that individuals with iron deficiency and those with iron deficiency anemia may be more susceptible to infections than patients with normal iron status. Future studies should elucidate further these findings.

Epidemiological aspects of 2009 H1N1 influenza: the accumulating experience from the Northern Hemisphere.

Preliminary data regarding the experience of countries of the Northern Hemisphere with pandemic 2009 A(H1N1) influenza have already appeared in the literature. We aimed to evaluate the available published literature describing the epidemiological features of pandemic influenza. We searched PubMed; 35 studies (14 referred to European countries, eight to the USA, five to Mexico, four to Canada, two to Japan, one to Colombia, and one reviewed relevant data reported worldwide) were included. Considerably high hospitalization, intensive care unit (ICU) admission, and fatality rates (up to 93.8, 36.4, and 38.5%, respectively) among the evaluated cases were reported across studies with available relevant data. Young and middle-aged adults constituted the majority of the evaluated pandemic cases, with different disease severity (as indicated by the level of care and outcome). Yet, substantial percentages of elderly individuals were reported among more severely afflicted cases. Otherwise healthy patients constituted substantial percentages among evaluated cases with different disease severity. Pregnant women, obese, and morbidly obese patients also constituted substantial percentages of the cases involved in the included studies. The evaluation of the currently available published evidence contributes to the clarification of the epidemiological features of pandemic 2009 A(H1N1) influenza, which is useful in terms of the individual and public health perspectives.

Short versus long duration of antibiotic therapy for bacterial meningitis: a meta-analysis of randomised controlled trials in children.

OBJECTIVE: To evaluate the effectiveness and safety of short-course antibiotic therapy for bacterial meningitis, by performing a meta-analysis of randomised controlled trials (RCT). REVIEW METHODS: PubMed and the Cochrane Central Register of Controlled Trials were searched for RCT on patients of all ages with community-acquired acute bacterial meningitis that compared treatment with the same antibiotics, in the same daily dosage, administered for a short course (up to 7 days) versus a longer course (2 days or more than corresponding short course). RESULTS: Five open-label RCT involving children (3 weeks to 16 years) were included. No difference was demonstrated between short-course (4-7 days) and long-course (7-14 days) treatment (intravenous ceftriaxone) regarding: end-of-therapy clinical success (five RCT, 383 patients, fixed effect model (FEM), odds ratio (OR) 1.24, 95% CI 0.73 to 2.11); long-term neurological complications (five RCT, 367 patients, FEM, OR 0.60, 95% CI 0.29 to 1.27); long-term hearing impairment (four RCT, 241 patients, FEM, OR 0.59, 95% CI 0.28 to 1.23); total adverse events (two RCT, 122 patients, FEM, OR 1.29, 95% CI 0.57 to 2.91); or secondary nosocomial infections (two RCT, 139 patients, random effects model, OR 0.45, 95% CI 0.05 to 3.71). The duration of hospitalisation was lower with short-course treatment (two RCT, 137 patients, FEM, weighted mean difference -2.17 days, 95% CI -3.85 to -0.50). The available data did not allow for analysis by causative organism. CONCLUSION: This meta-analysis of the rather limited available relevant data could not show differences between short and long-course antibiotic treatment for bacterial meningitis in children. Further research on this issue is required.

Concurrent M. tuberculosis, Klebsiella pneumoniae, and Candida albicans infection in liver metastasis of bowel carcinoma.

We describe the case of a 62-year-old patient with fever and abdominal pain of the right upper quadrant with a known history of adenocarcinoma of the colon and presence of hepatic metastases. One of the liver lesions underwent aspiration, and pus was sent for microbiological testing. Cultures of the pus were positive for Klebsiella pneumoniae and Candida albicans and polymerase chain reaction for Mycobacterium tuberculosis was concurrently positive; the patient received treatment for all three pathogens and improved clinically. One may consider searching not only for the usual pathogens of liver abscesses (gram-negative bacteria, anaerobic bacteria and gram-positive bacteria), but in special cases might consider pursuing a more detailed search for coexistence of fungi and mycobacteria in patients with cancer.

Characterisation of macrolide-non-susceptible Streptococcus pneumoniae colonising children attending day-care centres in Athens, Greece during 2000 and 2003.

Nasopharyngeal Streptococcus pneumoniae isolates colonising young children are representative of isolates causing clinical disease. This study determined the frequency of macrolide-non-susceptible pneumococci, as well as their phenotypic and genotypic characteristics, among pneumococci collected during two cross-sectional surveillance studies of the nasopharynx of 2847 children attending day-care centres in the Athens metropolitan area during 2000 and 2003. In total, 227 macrolide-non-susceptible pneumococcal isolates were studied. Increases in macrolide non-susceptibility, from 23% to 30.3% (p <0.05), and in macrolide and penicillin co-resistance, from 3.4% to 48.6% (p <0.001), were identified during the study period. The M resistance phenotype, associated with the presence of the mef(A)/(E) gene, predominated in both surveys, and isolates carrying both mef(A)/(E) and erm(AM) were identified, for the first time in Greece, among the isolates from the 2003 survey. Pulsed-field gel electrophoresis analysis of the isolates from the 2000 survey indicated the spread of a macrolide- and penicillin-resistant clone among day-care centres. The serogroups identified most commonly in the study were 19F, 6A, 6B, 14 and 23F, suggesting that the theoretical protection of the seven-valent conjugate vaccine against macrolide-non-susceptible isolates was c. 85% during both study periods.

Mesh-related infection after hernia repair: case report of an emerging type of foreign-body related infection.

The use of a mesh has been an advance in hernia repair and subsequently has become prevalent worldwide. However, the use of mesh may be associated with both non-infectious and infectious complications. We present here a representative case of a mesh-related infection due to Staphylococcus aureus and review the available data about the incidence, etiology, clinical manifestations, diagnosis, management, and prevention of this emerging type of foreign body infections.

Association between Wegener's granulomatosis and increased antithyroid antibodies: report of two cases and review of the literature.

We report two patients with severe manifestations of Wegener's granulomatosis, who also had significantly increased antithyroid antibodies. Auto-immune reaction against various human tissue antigens probably explains the association between increased anti-neutrophil cytoplasmic and antithyroid antibodies. The clinicians should include thyroid function and antithyroid antibody tests in the laboratory work up of the patients with Wegener's granulomatosis.