ABSTRACT
OBJECTIVE: To report five new cases of Pneumocystis carinii pneumonia (PCP) and to review and analyze the existing reports on the subject. METHOD: Five new cases of PCP during pregnancy are described. The cases, case series, and related articles on the subject in the English language were identified through a comprehensive MEDLINE search and reviewed. RESULTS: More than 80% of women with AIDS are of reproductive age, and PCP is the most common cause of AIDS-related death in pregnant women in the United States. Among 22 reviewed cases, the mortality rate was 50% (11 of 22 patients), which is higher than that usually reported for HIV-infected individuals with PCP. Respiratory failure developed in 13 patients (59%), and mechanical ventilation was therefore required, and the survival rate in patients requiring mechanical ventilation was 31%. Maternal and fetal outcomes were better in cases of PCP during the third trimester of the pregnancy. A variety of treatment regimens were used, including sulfamethoxazole-trimethoprim (SXT) alone or in combination with pentamidine, steroids, and eflornithine. The survival rate in patients treated with SXT alone was 71% (5 of 7 patients) and for those treated with SXT and steroids was 60% (3 of 5 patients), with an overall survival rate in both groups of 66.6% (8 of 12 patients). CONCLUSION: PCP has a more aggressive course during pregnancy, with increased morbidity and mortality. Maternal and fetal outcomes remain dismal. Treatment with SXT, compared to other therapies, may result in an improved outcome. Withholding appropriate PCP prophylaxis may adversely affect maternal and fetal outcomes.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Pneumonia, Pneumocystis , Pregnancy Complications, Infectious , Adult , Female , Humans , Pneumonia, Pneumocystis/drug therapy , Pregnancy , Pregnancy Complications, Infectious/drug therapyABSTRACT
Lyme borreliosis, a tick-transmitted spirochetal disease, may begin with a characteristic expanding skin lesion at the site of the tick bite. Within several days to weeks, the infection can spread haematogenously to involve the heart, nervous system or the joints. After months to years, the spirochete may persist in these organs causing a chronic form of illness. All stages of this disease can be treatable with antimicrobial agents.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Antibiotic Prophylaxis , Bites and Stings/microbiology , Borrelia burgdorferi/isolation & purification , Lyme Disease Vaccines , Lyme Disease/drug therapy , Ticks , Adult , Animals , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/adverse effects , Child , Disease Progression , Humans , Lyme Disease/diagnosis , Lyme Disease/microbiology , Lyme Disease/prevention & control , Lyme Disease Vaccines/administration & dosage , Lyme Disease Vaccines/adverse effects , Lyme Disease Vaccines/therapeutic useABSTRACT
Vaccines are now available for the prevention of hepatitis A and hepatitis B. In this article, biologics are reviewed with special attention to their use in the pediatric patient. Special attention is paid to issues that developed in 1999. For hepatitis A vaccine, it is the change in US recommendations regarding increased use in higher-risk US locations. For hepatitis B vaccine, it is the concern about toxicity, real or imagined.
Subject(s)
Hepatitis A/prevention & control , Hepatitis B/prevention & control , Viral Vaccines , Antibodies, Viral , Child , Feces/virology , Hepatitis A/epidemiology , Hepatitis B virus/immunology , Hepatitis B virus/isolation & purification , Humans , Immunization , United States/epidemiologyABSTRACT
This article highlights some of the exciting new developments in pediatric immunization. Starting with the newly licensed Lyme disease vaccine, which is not yet approved for children younger than 15 years of age, the article discusses potential vaccines for severe allergy and cocaine abuse and stresses some of the new techniques in needleless vaccination, including the edible plant technology.
Subject(s)
Lyme Disease/prevention & control , Vaccination/trends , Viral Vaccines , Animals , Child , Cocaine-Related Disorders/immunology , Cocaine-Related Disorders/prevention & control , Forecasting , Humans , Hypersensitivity/prevention & control , Immunotherapy , Ixodes/drug effects , Lyme Disease/diagnosis , Plants, Genetically Modified , Viral Vaccines/pharmacologyABSTRACT
We performed a randomized prospective study of 5-day treatment with topical mupirocin or bacitracin for the elimination of Staphylococcus aureus nasal colonization in healthcare workers (HCWs). Nasal cultures were obtained from 141 HCWs, 37 (26%) of whom showed S. aureus. After 72 to 96 hours of treatment, the organism was eradicated in 15 (94%) of 16 by mupirocin and in 8 (44%) of 18 by bacitracin (P = .0031). Similar efficacy was demonstrated at 30 days. Mupirocin may be more effective than bacitracin for eradication of S. aureus in healthy HCWs.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacitracin/therapeutic use , Infection Control/methods , Mupirocin/therapeutic use , Staphylococcal Infections/prevention & control , Staphylococcus aureus/drug effects , Adult , Carrier State/drug therapy , Cross Infection/prevention & control , Female , Humans , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Male , Nasal Mucosa/microbiology , Prospective Studies , Single-Blind Method , Treatment OutcomeABSTRACT
This contribution highlights factors involved with maintaining and enhancing antigen delivery or immunogenicity. Areas discussed include the cold chain, adjuvants, recombinant vectors for antigen delivery, routes for antigen delivery, and edible plant vaccines. It is doubtless that the technological understanding that underlies these advances is about to revolutionize vaccinology in the near future.
Subject(s)
Drug Storage/standards , Vaccines/genetics , Vaccines/immunology , Adjuvants, Immunologic , Drug Delivery Systems/methodsABSTRACT
Vaccine technology can be applied to targets of intervention that currently have not been considered preventable by immunization. Targets include some diseases caused by, or related to, infectious agents, and other conditions clearly unassociated with disease pathogens. This article considers vaccines for pregnancy, peptic ulcer disease, gastric cancer, cocaine abuse and atherosclerosis.
Subject(s)
Arteriosclerosis/prevention & control , Cocaine-Related Disorders/prevention & control , Contraception, Immunologic , Peptic Ulcer/prevention & control , Stomach Neoplasms/prevention & control , Vaccines , Animals , Arteriosclerosis/immunology , Cocaine-Related Disorders/immunology , Female , Peptic Ulcer/immunology , Pregnancy , Stomach Neoplasms/immunologyABSTRACT
Although poliovirus vaccination is nto new, the recent changes in ACIP recommendations involving polio vaccinations are. Currently, wild type poliovirus has been eliminated in the Western hemisphere, but vaccine-associated cases (VAPP) still occur. The new recommendations are intended to continue providing protection and to eliminate VAPP cases from occurring in vaccinees or close contacts.
Subject(s)
Poliomyelitis/prevention & control , Poliovirus Vaccine, Inactivated/administration & dosage , Poliovirus Vaccine, Oral/administration & dosage , Adult , Child , Humans , Immunization Schedule , Poliovirus Vaccine, Inactivated/immunology , Poliovirus Vaccine, Oral/immunologyABSTRACT
Infections following cardiac surgery, although generally uncommon, are associated with difficult management decisions and significant morbidity and mortality. They often present while the patient is either in a critical care unit, or requires CCU management. This review analyzes infections related to median sternotomy wounds, prosthetic heart valves, transvenous permanent pacemakers, automatic implantable cardioverter-defibrillators, and left ventricular assist devices. The diagnosis, microbiology, treatment and outcome of each is also discussed.
Subject(s)
Cardiac Surgical Procedures/adverse effects , Endocarditis, Bacterial/etiology , Surgical Wound Infection/etiology , Defibrillators, Implantable/adverse effects , Endocarditis, Bacterial/microbiology , Heart Valve Prosthesis Implantation/adverse effects , Heart-Assist Devices/adverse effects , Humans , Pacemaker, Artificial/adverse effects , Prosthesis-Related Infections/etiology , Surgical Wound Infection/microbiologySubject(s)
Endocarditis, Bacterial/diagnostic imaging , Heart Septum/microbiology , Heart Ventricles/microbiology , Streptococcal Infections/diagnostic imaging , Streptococcus pyogenes , Diagnosis, Differential , Echocardiography , Endocarditis, Bacterial/microbiology , Female , Humans , Middle Aged , Streptococcal Infections/microbiologySubject(s)
Endocarditis, Bacterial , Lactobacillus/isolation & purification , Aged , Aged, 80 and over , Female , HumansABSTRACT
The timely facilitation of immunologic (immunoglobulin or vaccine) or antimicrobial prophylaxis is used in individuals who have been exposed to certain infectious diseases. Such methodology has been shown to be helpful in infections such as viral hepatitis types A and B, measles, varicella, rabies, and tuberculosis. The data supporting such use in rubella and mumps are not strong and information is still needed in hepatitis C, human immunodeficiency virus, and Lyme borreliosis. This article reviews postexposure prophylaxis in these situations. Preventive strategies for meningococcal disease, group A streptococcus, tetanus, diphtheria, and pertussis are discussed elsewhere in this issue.
Subject(s)
Bacterial Infections/prevention & control , Virus Diseases/prevention & control , Chickenpox/prevention & control , HIV Infections/prevention & control , Hepatitis, Viral, Human/prevention & control , Humans , Lyme Disease/prevention & control , Measles/prevention & control , Mumps/prevention & control , Rabies/prevention & control , Rubella/prevention & control , Tuberculosis/prevention & controlABSTRACT
The in vitro activities of bacitracin and mupirocin were compared for seven different strains of methicillin-resistant Staphylococcus aureus. Six of seven strains showed bacitracin minimum inhibitory concentrations (MICs) of 0.5 to 1.0 units/mL, and all seven had mupirocin MICs of 0.5 to 2 micrograms/mL. Time-kill studies revealed 2.6- to 4.5-log reduction in 24 hours with strains susceptible to bacitracin (4 units/mL) and 0 to 2.2 reduction with mupirocin (16 micrograms/mL). Bacitracin should be considered further for in vivo studies because of enhanced bacteriocidal effect and lower cost.
Subject(s)
Anti-Bacterial Agents/pharmacokinetics , Anti-Infective Agents, Local/pharmacokinetics , Bacitracin/pharmacokinetics , Methicillin Resistance , Mupirocin/pharmacokinetics , Staphylococcus aureus/drug effects , In Vitro Techniques , New York , Staphylococcus aureus/classification , Time FactorsSubject(s)
Cardiac Surgical Procedures , Staphylococcal Infections/physiopathology , Staphylococcus aureus , Surgical Wound Infection/microbiology , Surgical Wound Infection/physiopathology , Humans , Methicillin Resistance , Staphylococcus aureus/isolation & purification , Staphylococcus aureus/pathogenicityABSTRACT
Neurocysticercosis cases were identified in 1991 in an Orthodox Jewish community. Transmission was linked to tapeworm-infected immigrant housekeepers from countries where Taenia solium is endemic. To evaluate the extent of and risks for locally acquired cysticercosis, a seroprevalence survey was conducted in 9% of the households in this community. Cysticercosis antibodies were detected in 23 (1.3%) of 1,789 persons from 612 families. All 23 seropositive persons were asymptomatic, and no intracerebral lesions were found for the 21 seropositive persons who underwent brain imaging. Seropositivity was associated with female sex (relative risk [RR] = 2.45, P = 0.049), hiring a domestic worker for child care duties (RR = 3.79, P = 0.05), and with employees from Central America (RR = 2.70, P = 0.0001). Exposure to T. solium in this community is unexpectedly high. Widespread employment of domestic workers from endemic regions and high employee turnover contributes to exposure risk.
Subject(s)
Cysticercosis/epidemiology , Jews , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Child , Child, Preschool , Cysticercosis/ethnology , Female , Household Work , Humans , Infant , Latin America/ethnology , Male , Middle Aged , New York City/epidemiology , Pregnancy , Pregnancy Complications, Parasitic/epidemiology , Pregnancy Complications, Parasitic/ethnology , Prevalence , Sex FactorsABSTRACT
We present the case of an elderly man with chronic obstructive pulmonary disease who had a 4-month history of multiple fluctuant masses of the dorsum of the right hand, which began at the site of an intravenous catheter. Medications included inhaled and oral steroids. Fungal cultures of the fluid obtained grew a pigmented mold identified as Exophiala species after several routine cultures were reported as negative. The patient underwent radical excision of the masses and received a perioperative course of oral itraconazole. This is one of the first known cases of a possible nosocomially acquired phaeomycotic cyst. Unusual fungi should be considered in the differential diagnosis of skin lesions in immunocompromised patients.
Subject(s)
Abscess/surgery , Catheters, Indwelling , Cross Infection/surgery , Cysts/surgery , Exophiala , Mycoses/surgery , Aged , Combined Modality Therapy , Humans , Itraconazole/administration & dosage , Male , RecurrenceSubject(s)
Fetal Diseases/prevention & control , HIV Infections/diagnosis , Mandatory Testing , Pregnancy Complications, Infectious/diagnosis , Zidovudine/administration & dosage , Centers for Disease Control and Prevention, U.S. , Drug Administration Schedule , Female , HIV Infections/prevention & control , Humans , Injections, Intravenous , Pregnancy , United StatesABSTRACT
OBJECTIVE: To report a case of pancreatitis related to paromomycin administration. CASE SUMMARY: A 39-year-old man with AIDS developed pancreatitis concurrent with successful treatment of intestinal cryptosporidiosis with paromomycin. The hyperamylasemia resolved with discontinuation of the agent and recurred when paromomycin treatment was reinstituted. DISCUSSION: To our knowledge, this is the first reported case of pancreatitis believed to be induced by paromomycin. Although pancreatitis in HIV-infected patients has multiple causes, the nature of this case suggests the involvement of paromomycin. The mechanism of action is unclear. CONCLUSIONS: Pancreatitis should be considered in the differential diagnosis of abdominal pain in patients who are treated with paromomycin.