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What's new in infectious diseases


What's new in infectious diseases

ANTIBIOTICS AND ANTIMICROBIAL RESISTANCE

Antibiotics and warfarin — Among patients age 66 and above taking warfarin who require antimicrobial therapy for treatment of urinary tract infection, trimethoprim-sulfamethoxazole and ciprofloxacin appear to be associated with increased risk of upper gastrointestinal tract bleeding (OR 3.84; 95% CI 2.33-6.33 and OR 1.94; 95% CI 1.28-2.95, respectively) [1]. In such patients an alternative antibiotic agent of a different class should be prescribed if feasible. (See "Therapeutic use of warfarin", section on 'Antibiotics'.)

BACTERIAL INFECTIONS

Endocarditis — Routine cerebral magnetic resonance imaging (MRI) may be useful in patients with definite or suspected endocarditis. In one study including 53 patients, early use of cerebral MRI led to the reclassification from possible to definite infective endocarditis in one-third of cases [2]. (See "Diagnostic approach to infective endocarditis", section on 'Cerebral imaging'.)

C. difficile — Symptomatic patients may play a role in airborne dispersal of C. difficile. In a study including 50 patients with confirmed C. difficile infection, air sampling for one hour demonstrated C. difficile organisms in 12 percent of cases [3]. (See "Prevention and control of Clostridium difficile in hospital and institutional settings", section on 'Infection control'.)

New clinical practice guidelines for Clostridium difficile infection in adults have been released by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Disease Society of America (ISDA) [4]. (See "Clinical manifestations and diagnosis of Clostridium difficile infection in adults" and "Treatment of antibiotic-associated diarrhea caused by Clostridium difficile in adults".)

PNEUMONIA

Community-acquired pneumonia and antipsychotics — In a case-control study, current use of atypical or typical antipsychotics was associated with a dose-dependent increased risk for community-acquired pneumonia (CAP) compared with past use [8]. Atypical antipsychotic use was also associated with an increase in the risk of fatal CAP. (See "Epidemiology, pathogenesis, and microbiology of community-acquired pneumonia in adults", section on 'Drugs'.)

SEXUALLY TRANSMITTED DISEASES

Human papillomavirus and HIV acquisition — In a study of 2168 HIV-seronegative men in Kenya (n = 2168) who were participating in a placebo-controlled randomized trial of circumcision, HPV infection at baseline was correlated with an increased risk of HIV acquisition over a four-year period, independent of subsequent circumcision status and behavioral risk factors [9]. (See "Epidemiology of human papillomavirus infections".)

IMMUNIZATIONS AND TRAVEL

Influenza immunization

Universal immunization — In 2010, the US Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices expanded the recommendation for influenza vaccination to include all individuals six months of age and older [10]. This represents a change for adults from previous guidelines, which recommended influenza vaccination for individuals over age 50 and for those at increased risk of influenza complications and close contacts of such individuals. (See "Seasonal influenza vaccination in adults", section on Indications for immunization.)

Measles mumps rubella (MMR) — Monovalent vaccines are no longer available in the United States for measles, mumps or rubella [15]. Their use unnecessarily delays administration of the three vaccine components, leaving individuals susceptible for a longer period of time to serious, life-threatening diseases. (See "Standard childhood immunizations", and other related topics).

MYCOBACTERIA

HIV and tuberculosis — In a prospective, open-label, randomized trial (CAPRISA) in South Africa, 642 HIV-infected patients with CD4 counts of <500 cells/microL, and sputum smears positive for acid fast bacilli, were randomly assigned to either integrated TB/HIV treatment (ART initiation during TB therapy) or sequential treatment (ART initiation after completion of TB therapy) [18]. The trial was stopped early since all-cause mortality was 56 percent lower in the integrated treatment arm compared with the sequential treatment arm. Furthermore, mortality was lower in the integrated therapy group within all CD4 count strata while rates of adverse events were similar in both arms. The optimal timing of overlapping therapy, however, is still unknown. (See "Treatment of pulmonary tuberculosis in the HIV-infected patient".)

(والمؤمنون والمؤمنات بعضهم أولياء بعض يأمرون بالمعروف وينهون عن المنكر ويقيمون الصلاة ويؤتون الزكاة ويطيعون الله و رسوله أولئك سيرحمهم الله إن الله عزيز حكيم)

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New updates on infectious diseases were published recently on UpToDate. Very important for those preparing for USMLE exams

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