Showing papers in "Current Opinion in Infectious Diseases in 2008"
TL;DR: Use of PZQ will increase in the foreseeable future, whether given alone or coadministered with other anthelminthics in integrated control programmes, as well as inhibitors of a schistosome-specific bifunctional enzyme, thioredoxin-glutathione reductase.
Abstract: Purpose of reviewPraziquantel (PZQ) is the only drug being used to treat human schistosomiasis on a large scale. This review focuses on current knowledge about the mechanisms of action of PZQ, prospects for PZQ resistance, possible future alternative drugs and on exhortations that control of schisto
694 citations
TL;DR: Patterns of resistance in Salmonella are constantly changing, and Continual surveillance of resistance levels is critical for clinicians to keep abreast of treatment options, but it is often lacking in resource-poor regions of the world with the highest disease burden.
Abstract: Purpose of reviewIncreasing occurrence of antimicrobial resistance in both typhoidal and nontyphoidal salmonellae is a major public health problem. Recent studies documenting the occurrence and types of resistance, with particular reference to quinolones and extended spectrum cephalosporins, and new
255 citations
TL;DR: Future research to develop cheap, point-of-care diagnostic tests will allow a greater understanding of T. vaginalis epidemiology and facilitate operational studies evaluating optimal control strategies and their impact on the complications of T., vaginalis.
Abstract: PURPOSE OF REVIEW: Trichomonas vaginalis is the most common curable sexually transmitted infection. Despite a number of serious health consequences including facilitation of HIV transmission, pelvic inflammatory disease and adverse outcomes of pregnancy it remains an under-recognized condition. This review aims to update the reader on the global epidemiology and control of T. vaginalis. RECENT FINDINGS: The burden of T. vaginalis infection is found in resource-limited settings and high-risk groups in industrialized settings. Utilization of polymerase chain reaction-based diagnostics has enhanced our understanding of the epidemiology of T. vaginalis both at the population level and in sexual partners. High rates of asymptomatic infection in male partners of infected females and subsequent re-infection have significant implications for control programmes. Further studies investigating the role of T. vaginalis in facilitating HIV transmission has highlighted its significance and the need to develop and implement control interventions. SUMMARY: Future research to develop cheap, point-of-care diagnostic tests will allow a greater understanding of T. vaginalis epidemiology. In addition, the effect of treatment on outcome of pregnancy and HIV acquisition requires further study. This will in turn facilitate operational studies evaluating optimal control strategies and their impact on the complications of T. vaginalis.
220 citations
TL;DR: Both iron chelators were shown to effectively treat mucormycosis in animal models, and one has been successfully used as salvage therapy for a patient with rhinocerebral mucormYcosis.
Abstract: Purpose of reviewMucormycosis is an increasingly common fungal infection with an unacceptably high mortality despite first-line antifungal therapy. Iron acquisition is a critical step in the causative organisms' pathogenetic mechanism. Therefore, abrogation of fungal iron acquisition is a promising
215 citations
TL;DR: This review provides an update on the consequences of chlamydial infection during pregnancy and summarizes current evidence suggesting that some Chlamydia-related organisms are probably emerging obstetrical pathogens.
Abstract: Purpose of the reviewThis review considers the roles of Chlamydia spp. and newly identified Chlamydia-like organisms in miscarriage, stillbirths and preterm labour in both animals and humans.Recent findingsThe cause of miscarriage, stillbirth and preterm labour often remains unexplained. Intracellul
209 citations
TL;DR: Chemotherapy against filarial Wolbachia endosymbionts with doxycycline showed higher antiparasitic efficacy in onchocerciasis and lymphatic filariasis and also improved disease.
Abstract: Purpose of reviewChemotherapy against onchocerciasis and lymphatic filariasis has been discussed mainly within the framework of mass drug administration with diethylcarbamazine, ivermectin and albendazole. Although strong reductions in infection prevalence were achieved, the regimes for these drugs
202 citations
TL;DR: Carbapenem resistance continues to increase both in number and into new species/strain types, but therapeutic options remain woefully inadequate – a dilemma that will not improve in the foreseeable future.
Abstract: Purpose of review: To provide a brief synopsis of studies which have extended our understanding of carbapenem resistance in clinical isolates in terms of epidemiology, mechanism of action and genetic factors affecting their carriage and spread.
Recent findings: Studies published in the last 18 months continue to confirm that VIM-2 is the dominant metallo-β-lactamase in Pseudomonas aeruginosa and that it has now moved into the cystic fibrosis P. aeruginosa population. Increased incidences of KPC and Guiana extended-spectrum serine carbapenemase would indicate that these are likely to dominate in Enterobacteriaceae and that KPC-2 has now been isolated from P. aeruginosa. Class D carbapenemases still appear to be confined to Acinetobacter baumannii and, interestingly, it has been proposed that OXA-23 was transferred from the nonpathogenic Acinetobacter radioresistens. Crystal structures of KPC-2, GES-1 and OXA-24 have been reported to enhance our understanding of why these clinically important enzymes can bind and hydrolyse carbapenems, whereas others cannot. Therapeutic options continue to be limited and although tigecycline shows activity against carbapenemase-positive Enterobacteriaceae, antibiotic combinations are required for carbapenemase-positive Acinetobacter and P. aeruginosa.
Summary: Carbapenem resistance continues to increase both in number and into new species/strain types, but our therapeutic options remain woefully inadequate - a dilemma that will not improve in the foreseeable future.
180 citations
TL;DR: Cowpox as a human emerging zoonotic hazard raises public health concerns as well as a question about the production of effective vaccine and antiviral agents.
Abstract: Purpose of reviewHuman cowpox, a rare zoonotic infection, evokes a self-limited disease, except for immunocompromised and eczematous patients, particularly children, where it can become severe. The causative agent, cowpox virus, is distributed in Europe, west former USSR, and adjacent areas of North
176 citations
TL;DR: The complexity of Mycobacterium tuberculosis–pattern-recognition receptor interactions and their effects on host cell responses suggest key roles for innate immunity in controlling My cobacteria tuberculosis, and the possibility of developing novel therapeutics for tuberculosis that target Myc Cobacterium TB-regulated innate immunity pathways.
Abstract: Purpose of reviewThe recent discovery of novel classes of receptors, including toll-like receptors and nucleotide-binding oligomerization domain (NOD)-like receptors is challenging the crucial role of the innate immune system in the recognition of Mycobacterium tuberculosis. The present review is to
175 citations
TL;DR: There is a better understanding of risk factors, clinical manifestations and complications, novel diagnosis tests and effective treatment, which together should help reduce the morbidity and mortality of these infections.
Abstract: Purpose of reviewHepatobiliary flukes – Fasciola, Opisthorchis, Clonorchis– are a major public health problem in east Asia, east Europe, Africa and Latin America. The present review focuses on current knowledge of clinical, diagnostic and treatment aspects caused by hepatobiliary flukes that can be
170 citations
TL;DR: A multifaceted approach is needed to prevent a more widespread epidemic of MDR- TB and XDR-TB, and rapid diagnostic assays to detect highly drug-resistant TB are essential in preventing delays in treatment of M DR-TB and XDA and curbing their spread.
Abstract: Purpose of reviewThe spread of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant TB (XDR-TB) is a major medical and public health concern for the world. These two forms of highly drug-resistant TB threaten to make TB into an untreatable and highly fatal disease, particularly i
TL;DR: The data described show that the success of noroviruses is determined by an intricate interplay between virus evolution and susceptibility of the host, both genetically and immunologically.
Abstract: Purpose of reviewNoroviruses are now recognized as important causes of illness, and their incidence, impact, or both appear to have changed in recent years. This review focuses on studies that provide new knowledge needed to understand their transmission, pathogenesis, evolutionary changes and optio
TL;DR: Rapid techniques, mostly antigen detection in serum and urine and histopathological identification of Histoplasma capsulatum in tissues, are the most important rapid diagnostic tests for histoplasmosis in immunosuppressed patients.
Abstract: Purpose of review To define the most appropriate studies for making a diagnosis of histoplasmosis in immunosuppressed patients. Recent findings As is true of all fungal infections in immunosuppressed patients, heightened awareness of the epidemiology and clinical manifestations of histoplasmosis is essential in making an early diagnosis. Increasingly, Histoplasma antigen detection is used to help establish a diagnosis of histoplasmosis. Most of the reported data are on patients with AIDS, but limited data suggest the usefulness of this assay in other immunosuppressed patients as well. False positive reactions occur with other fungal infections, especially blastomycosis, and patients who have histoplasmosis may have a false positive serum Aspergillus galactomannan assay. The identification of the yeast phase of Histoplasma capsulatum in tissue biopsy samples and, uncommonly, in circulating blood phagocytes is also helpful in establishing a diagnosis quickly. PCR techniques have yet to prove useful for the rapid diagnosis of histoplasmosis, and serology is often negative in immunosuppressed patients. Culture remains definitive and should always be performed to confirm the results of the rapid diagnostic studies. Summary Rapid techniques, mostly antigen detection in serum and urine and histopathological identification of Histoplasma capsulatum in tissues, are the most important rapid diagnostic tests for histoplasmosis in immunosuppressed patients.
TL;DR: Based on recent data, antitrypanosomal treatment is recommended for all acute and congenital T. cruzi infections, reactivated infection, and chronically infected children and in adults aged 19–50 years without advanced heart disease, treatment should generally be offered.
Abstract: Purpose of review To describe new developments in blood-bank screening and management of patients with chronic Trypanosoma cruzi infection in the United States. Recent findings The first US Food and Drug Administration licensed serological test for T. cruzi blood screening went into widespread usage in January 2007. More than 500 confirmed T. cruzi-infected donations were detected by mid-June 2008. Until recently, drug therapy was recommended for acute and congenital infections, but seldom for chronic infections, which were believed to respond poorly. However, in the 1990s, efficacy was demonstrated in two placebo-controlled trials of benznidazole in children with chronic T. cruzi infection. In 2006, a nonrandomized, nonblinded trial demonstrated that benznidazole treatment may slow progression of cardiomyopathy and decrease mortality risk in infected adults. Summary Blood-bank screening will continue to detect T. cruzi-infected donors. Based on recent data, antitrypanosomal treatment is recommended for all acute and congenital T. cruzi infections, reactivated infection, and chronically infected children. In adults aged 19–50 years without advanced heart disease, treatment should generally be offered; management should be individualized for older adults. Less toxic, more effective drugs, a sensitive, specific assay for response to treatment, and improved healthcare access would promote more effective management.
TL;DR: The application of therapeutic drug monitoring to fluconazole, itraconazoles, voriconazole and posaconazole is discussed, which suggests that this class displays important concentration–effect and concentration–toxicity relationships.
Abstract: PURPOSE OF REVIEW: Invasive fungal infections are a leading cause of morbidity and mortality in immunocompromised patients, and mechanisms to optimize therapeutic outcomes are urgently required. Therapeutic drug monitoring represents an important component for the routine use of the triazoles. RECENT FINDINGS: Triazoles have revolutionized the prevention and treatment of invasive fungal infections. Increasing data suggest that this class displays important concentration-effect and concentration-toxicity relationships. There has been an increased understanding of the pharmacokinetics and pharmacodynamics of triazoles, and this has facilitated the identification of concentrations (or drug exposures) that are both effective and nontoxic. This review discusses the application of therapeutic drug monitoring to fluconazole, itraconazole, voriconazole and posaconazole. SUMMARY: Therapeutic drug monitoring represents an important mechanism to optimize the outcome of immunocompromised patients receiving triazoles.
TL;DR: Several theories exist to explain differential clinical evolution of Chagas disease and a coherent understanding of these theories will certainly aid in determining what combination of them approximates the true development of chagasic pathology.
Abstract: Purpose of reviewChagas disease is a complex ailment caused by infection with Trypanosoma cruzi. It afflicts millions in Latin America. Years of studies have focused on the development of pathology in Chagas disease and recent studies have helped us understand the cellular mechanisms behind differen
TL;DR: The most promising options for reducing catheter-related blood stream infection are heparin-coated or antibiotic-impregnated central venous catheters.
Abstract: Purpose of reviewClinicians need information on the relative effectiveness of different types of impregnated central venous catheter for serious infection and their relative costs and adverse effects in order to decide which type, if any, to useRecent findingsWe systematically reviewed 37 randomize
TL;DR: Neuraminidase inhibitors, oseltamivir in particular, are the drugs of choice against seasonal influenza, zoonotic H5N1 and are stockpiled as the primary mitigating strategy for pandemic influenza containment and control.
Abstract: Purpose of reviewNeuraminidase inhibitor resistant influenza virus has recently emerged, and circulated, in untreated persons. Influenza virus evolution is causing antiviral susceptibility to change. We review the latest research in this rapidly moving field.Recent findingsOseltamivir-resistant infl
TL;DR: The addition of chelators such as ethylenediamine-tetraacetic acid and citrate to antimicrobial lock solutions provides an innovative and superior alternative to heparin lock solution in the prevention and treatment of catheter-related bloodstream infections.
Abstract: Purpose of reviewAs metallic cations are essential to microbial adherence, biofilm formation, and bacterial growth, efforts have been directed toward utilizing metal-binding chelators that have the capability of inhibiting bacterial growth by disrupting surface adherence and preventing biofilm produ
TL;DR: The promise of parasite proteases as targets for development of new antiparasitic chemotherapy is highlighted to highlight the strong foundation of biochemical, structural, and computational databases already published or available online.
Abstract: Purpose of review
To highlight the promise of parasite proteases as note targets for development of new antiparasitic chemotherapy. Proteolytic enzymes play key roles in the life cycle of protozoan parasites or the pathogenesis of diseases they produce. These include processing of host or parasite’s surface proteins for invasion of host cells, digestion of host proteins for nutrition, and inactivation of host immune defense mediators.
TL;DR: Strong evidence suggests that M. genitalium is associated with pelvic inflammatory disease and is likely resistant to many frequently used pelvicinflammatory disease treatments.
Abstract: Purpose of reviewMycoplasma genitalium is a common sexually transmitted pathogen frequently identified among women with pelvic inflammatory disease, the infection and inflammation of a woman's upper genital tract. Although Chlamydia trachomatis and Neisseria gonorrhoeae frequently cause pelvic infla
TL;DR: If the benefits of HAART are to be fully realized, then not only is availability crucial but also those individuals who require treatment must be appropriately identified.
Abstract: The availability of highly active antiretroviral therapy (HAART) has transformed the outcome for individuals with diagnosed HIV infection where access to therapy is widely available. There continues to be significant (although markedly reduced) ongoing morbidity and mortality despite HAART, however. Although this may result from resistance to available antiretroviral therapies or treatment refusal, a recent audit of deaths in HIV-positive individuals in the UK demonstrated that the commonest reason for HIV-related death was that HIV had been diagnosed too late for effective intervention [1]. Anonymous seroprevalence studies suggest that approximately one in three individuals with HIV infection in developed countries are unaware of their infection [2,3], with much higher rates in developing countries where rollout programmes are currently underway [4]. If the benefits of HAART are to be fully realized, then not only is availability crucial but also those individuals who require treatment must be appropriately identified.
TL;DR: A better understanding of the neonatal inflammatory response to sepsis and identification of sensitive and specific markers of inflammation or rapid microbe-specific diagnostic tests would assist in the early detection of neonatal sepsIS and in safely withholding antibiotics for patients in whom sepsi is unlikely.
Abstract: Purpose of reviewThe present review examines the major developments in early detection of neonatal sepsis, with an emphasis on the utility of diagnostic laboratory markers in clinical practice.Recent findingsMeasures of acute phase proteins, cytokines, cell surface antigens, and bacterial genomes ha
TL;DR: In this article, the authors reviewed recent literature on this area and found that despite longstanding recommendations and the fact that influenza constitutes a serious risk among patients with underlying diseases and those of extreme age, and is associated with excess health-care costs.
Abstract: Purpose of reviewNosocomial influenza constitutes a serious risk among patients with underlying diseases and those of extreme age, and is associated with excess health-care costs. This article will review recent literature on this area.Recent findingsDespite longstanding recommendations and the fact
TL;DR: Despite better epidemiological or bacteriological knowledge of common bacterial skin infections, the exact role of methicillin-resistant staphylococci needs regular surveys in involved geographic areas.
Abstract: Purpose of reviewBacterial skin infections commonly encountered in the community include impetigo, folliculitis/furunculosis, simple abscesses, erysipelas and other nonnecrotizing cellulitis. The review focuses on recent epidemiological, bacteriological and therapeutic advances.Recent findingsImpeti
TL;DR: As the understanding of the aetiology and significance of cervicitis, particularly nonspecific cerviciti, improves, management will be refined, and advances in molecular diagnostic testing will facilitate this process.
Abstract: Purpose of reviewSexually transmitted infections impact significantly on global health. Whereas Chlamydia, Neisseria gonorrhoea and syphilis have been extensively examined, there remains a paucity of knowledge of nonchlamydial and nongonococcal cervicitis, an arguably more prevalent but poorly chara
TL;DR: Replenishment of arginine and restoration of nitric oxide production in clinical malaria should diminish parasitized red blood cells adherence to endothelium and reduce the sequelae of these interactions (e.g. cerebral malaria).
Abstract: Purpose of review
Parasiticidal therapy of severe falciparum malaria improves outcome, but up to 30% of these patients die despite best therapy. Nitric oxide is protective against severe disease, and both nitric oxide and arginine (the substrate for nitric oxide synthase) are low in clinical malaria. Parasitized red blood cell interactions with endothelium are important in the pathophysiology of malaria. This review describes new information regarding nitric oxide, arginine, carbon monoxide, and endothelial function in malaria.
TL;DR: Combined with an effective infection control programme, antibiotic stewardship can help contain antimicrobial resistance and improve patients' outcome while containing bacterial resistance.
Abstract: Purpose of reviewAntibiotic stewardship is designed to optimize antimicrobial therapy administered to hospitalized patients, to ensure cost-effective therapy and improve patients' outcome while containing bacterial resistance. Current data on the development of effective programmes, including guidel
TL;DR: Evidence regarding the history of Kawasaki disease, the epidemiology, etiology, pathology, genetic influences, and long-term sequela is covered, which includes an evaluation of contemporary diagnostic techniques and optimal therapeutic approaches.
Abstract: Purpose of reviewKawasaki disease is an acute, self-limited vasculitis of childhood. The increasing frequency of the disease as well as the deficiency of specific diagnostic means renders its diagnosis and treatment an area of intense investigation. The purpose of this review is to summarize all the
TL;DR: Discoveries of novel mutations and further study of epidermodysplasia verruciformis-human papillomavirus in lesional and nonlesional skin of epidemiological patients and the general population may generate a cohesive theory regarding a viral role in cutaneous oncogenesis.
Abstract: Purpose of review Despite its rarity, epidermodysplasia verruciformis was addressed in depth in recent literature. Patients are afflicted by persistent human papillomavirus infections and develop cutaneous malignancies more frequently and younger than in the general population. The disease is therefore considered a model for a viral role in cutaneous oncogenesis, although implication is controversial. We focus on recent findings in genetics, highlight multiple viewpoints regarding the role of epidermodysplasia verruciformis-human papillomavirus in nonmelanoma skin cancer and other diseases, and discuss treatment strategies. Recent findings Susceptibility loci for epidermodysplasia verruciformis were mapped and encoded protein functions are becoming better understood, but a unified genetic theory for epidermodysplasia verruciformis is lacking. Epidermodysplasia verruciformis-human papillomavirus, originally thought present only in epidermodysplasia verruciformis, is now considered ubiquitous, its role still being elucidated. Numerous therapies for epidermodysplasia verruciformis lesions were proposed, although there is no consensual first-line treatment strategy. Summary Discoveries of novel mutations and further study of epidermodysplasia verruciformis-human papillomavirus in lesional and nonlesional skin of epidermodysplasia verruciformis patients and the general population may generate a cohesive theory regarding a viral role in cutaneous oncogenesis. Future understanding of the disease may yield an optimal approach to treating epidermodysplasia verruciformis patients.