IDSA News - September 2011
The Emerging Infections Network (EIN) is a forum for infectious diseases consultants and public health officials to report information on clinical phenomena and epidemiological issues with public health significance. Any diagnostic or therapeutic recommendations and all opinions presented are those of the individual contributor. They do not necessarily represent the views of EIN, IDSA (EIN’s sponsor), or the Centers for Disease Control and Prevention (CDC), which funds EIN. The reader assumes all risks in using this information.
EIN members recently discussed the appropriate use of non-microbiologic diagnostic tests, including complete blood counts (CBCs), for infectious diseases.
A member in Florida began the discussion, asking about “the necessity of frequent CBCs on hospitalized patients admitted with infectious diagnoses, for the most part general ID issues (not neutropenic or in the intensive care unit [ICU]). Under what circumstances would you want frequent CBC monitoring (i.e., aside from disseminated intravascular coagulation [DIC] from sepsis and hemolysis from infections such as malaria)?”
A respondent in Minnesota noted that “the same could be asked about inflammatory markers (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], procalcitonin). The trend curves look nice and make us feel good,” the member wrote. “But do they add meaningfully to the bedside clinical assessment?”
An EIN member in Canada reported CBC monitoring “not often and based mostly on clinical assessment first,” sometimes in cases of a fever not yet diagnosed, if the patient’s initial white blood count (WBC) was extremely high, if there is concern about development of hemolytic-uremic syndrome (HUS) in a patient with colitis, or with malaria.
“I've always thought that in general, we order too many CBCs and too many chemistry panels on stable patients,” a member in New Hampshire responded. “I’ll check a CBC more frequently when there are significant abnormalities to begin with (low platelets, for example), or when the patient has a high risk of other complications (septic patient in the ICU, not responding to treatment).”
Short of that, a CBC every two to three days while the patient is in-house is usually reasonable, the member continued, and “maybe not at all when following a patient with something like cellulitis or pneumonia, who is obviously improving and ready for oral antibiotics.”
Daily CBC or electrolyte monitoring do not make sense in regular day-to-day admissions, another member in Canada wrote, “and I don’t mean only for infectious disease related issues. Eventually, the iatrogenic drop in hemoglobin might change our clinical management, but this is avoidable.”
“The only time we ask for regular CBCs is when we treat our patients with long-term high-dose beta-lactam antibiotics (e.g., for osteomyelitis) to monitor drug-induced neutropenia,” the member noted, “and when we start an HIV-exposed newborn on azidothymidine (AZT) to monitor anemia, and this is at most a weekly CBC. I suppose that CBC monitoring with linezolid treatment is also warranted, but we haven’t needed to use this in children.”
For most uncomplicated infectious illnesses, two WBCs are needed, one to assist with initial diagnosis and/or to demonstrate that the patient is having the expected response, and another to document that the WBC is consistent with clinical recovery, an EIN member in Pennsylvania wrote.
“It’s not necessary to get daily WBCs (or chemistry panels or chest x-rays, etc.) in a patient with a solid clinical diagnosis who is clinically improving,” the member continued. “Many of our residents get daily labs regardless of the patient’s clinical progress. This is wasteful, expensive, hard on the patient’s antecubital fossae, and a barrier to learning the essentials of critical thinking.”
A respondent in Tennessee agreed: “‘Following the white count daily’ is almost never helpful in monitoring the clinical course of patients with infectious diseases. In situations where laboratory test results can provide additional evidence of adequate response to therapy, monitoring acute phase reactants, such as C-reactive protein, is much more likely to be of value.”
“Some doctors order daily CBC and differential when CBC without differential is often adequate in many non-ICU patients,” an EIN member in California responded. “We are often asked to do consults for leukocytosis and frequently find the reason.
A consensus on when CBC monitoring is appropriate could lead to savings, the member suggested, although “one would have to balance cost savings with fewer CBCs against missed changes in patient conditions with daily CBC that might interfere with patient care or eventually lead to higher costs.”
The Emerging Infections Network (EIN) is a provider-based sentinel network designed to help the public health community detect trends in emerging infectious diseases.
A joint project of IDSA and the Pediatric Infectious Diseases Society (PIDS) with funding from the Centers for Disease Control and Prevention (CDC), EIN tracks emerging infectious diseases and keeps the public health community up to date with new disease trends, difficult cases, and other issues affecting members’ clinical practices. The Network provides a great opportunity for members to share knowledge quickly across large geographical distances. Both IDSA and PIDS members are eligible to join. Click here for more information or to join EIN.
IDSA offers two email services to help members stay informed of updates from the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA). Content includes a range of topics, including new drug approvals and warnings. Recent alerts have included:
IDSA members can sign up for these services online. (You must be logged in to have access to this link. Once logged in, click on the “My Alerts” tab to subscribe to the alerts. To subscribe, check the appropriate boxes to receive CDC’s Health Alert Network (HAN) messages and/or alerts from FDA, and provide your email address and name where indicated.)
The Center for Global Health Policy and HIVMA released a policy statement (PDF) this month, calling for greater investment domestically and globally in HIV treatment in light of the results of the HIV Prevention Trial Networks (HPTN) 052 study. The study found that early initiation of antiretroviral therapy (ART) for HIV-infected patients reduced their chances of sexually transmitting HIV to their uninfected partners by more than 96 percent.
The Center and HIVMA recommend that a larger share of the President's Emergency Plan for AIDS Relief (PEPFAR) budget be devoted to treatment; that ART be included in studies of combination prevention strategies, and that HIV counseling and testing, including couples counseling, be expanded in all venues. The policy statement also calls for an evaluation of PEPFAR prevention expenditures based on evidence of efficacy and a redeployment of resources from less efficacious interventions to those known to be effective, including ART.
In addition, the groups call for prioritizing domestic HIV funding for early HIV diagnosis with reliable and ongoing linkage and access to HIV care and treatment; and for fully funding the Ryan White program and addressing state waiting lists for ART medication.
Check out the Science Speaks blog for more information.
The Center for Global Health Policy hosted House and Senate staffers on a week-long trip to Kenya in August designed to give Hill staff a first-hand view of key HIV and tuberculosis (TB) programs that receive U.S. funding, the progress they are making, and why U.S. support is needed. The trip included stops in Nairobi to visit hospitals and clinics that serve Kibera’s impoverished neighborhoods, meetings with key Ministry of Health officials and civil society organizations, as well as clinical site visits in the more rural parts of the country, Kisumu, Kericho and Eldoret. Check out these posts from the trip on the Center’s blog, Science Speaks:
The Center for Global Health Policy’s blog, Science Speaks, featured interviews this month with key staff members in the Office of the U.S. Global AIDS Coordinator (OGAC), which is responsible for the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program.
Leaders from the medical and public health community, government, and the pharmaceutical industry earlier this month convened in Washington, D.C., to discuss the critical need for antibiotic development, current challenges limiting innovation, and what can be done to address this public health crisis.
The Sept. 22 conference, “Reviving the Pipeline of Lifesaving Antibiotics: Exploring Solutions to Spur Innovation,” was organized by IDSA, the Pew Health Group, and the Pharmaceutical Research and Manufacturers of America (PhRMA). (An archived webcast of the day-long conference is available online. An edited version will also be available on the IDSA website in the near future.)
Several IDSA members participated. David Gilbert, MD, FIDSA, chair of IDSA’s Antimicrobial Availability Task Force, described the urgent medical need, including preliminary results from a survey of ID physicians conducted by the Emerging Infections Network. Sixty-two percent of respondents reported seeing at least one infection caused by an organism resistant to all available agents. More than half of these respondents, 55 percent, said that the number of such cases had increased during the past two years.
Helen Boucher, MD, FIDSA, a member of the Antimicrobial Availability Task Force, spoke about the scientific and regulatory challenges hindering antibiotic development and outlined IDSA’s recommendations. (See the Society’s April 2010 policy paper, "Combating Antimicrobial Resistance: Policy Recommendations to Save Lives.”)
A session at the conference also addressed the failure of the marketplace to stimulate new antibiotic development. Panelists discussed how various incentives could stimulate development at different stages (e.g., discovery vs. clinical) by different players, including large and small companies.
The event was an outgrowth of IDSA’s 10 x ’20 initiative, launched in 2010 to spur the development of 10 new systemic antibiotics by 2020 and a sustainable antibiotic research and development enterprise for the long-term.
A new streamlined system announced by the Food and Drug Administration (FDA) in September is designed to respond more efficiently and rapidly to human and animal foodborne illness outbreaks.
The Coordinated Outbreak Response and Evaluation (CORE) Network will allow for more consistency in monitoring and investigating outbreaks, as well as streamline decision making and improve food safety practices, while building on lessons learned from previous outbreaks, FDA said in a press release.
The CORE Network includes epidemiologists, veterinarians, microbiologists, environmental health specialists, emergency coordinators, and risk communications specialists. Investigators in FDA field offices will complement CORE’s efforts, which will be coordinated with the Centers for Disease Control and Prevention, the U.S. Department of Agriculture, and state public health and agriculture agencies.
CORE will be led by Kathleen F. Gensheimer, MD, MPH, FIDSA, who serves in the new position of chief medical officer/outbreak director. Dr. Gensheimer, a recognized leader in public health, was recently the state epidemiologist for Maine. She has served on numerous IDSA committees, including the Bioemergencies Task Force, Bioterrorism Work Group, National & Global Public Health Committee, Emerging Infections Committee, Public Policy Committee, and the Pandemic Influenza Task Force.
“A real benefit of the network approach is enhancing communication and coordination with federal, state, and local food safety agencies, as well as industry and consumers,” Dr. Gensheimer said in FDA’s press release. “Given my background at the state public health level, this is a major priority for me.”
For more information, visit the CORE website.
The deadline has been extended for comments on sweeping changes proposed by the Department of Health and Human Services (HHS) in late July to regulations that govern research on human subjects. Comments are now due to HHS by Oct. 26. IDSA plans to submit comments on the proposed changes and encourages IDSA members to do so as well. (See the July/Aug. 2011 IDSA News and an email sent to IDSA members in August for additional resources and how to submit comments to HHS.)
Often referred to as the Common Rule, the regulations have not been substantially revised since they were established in 1991 to guide federally funded research involving human subjects. HHS’ goal is to strengthen protections for subjects while also modernizing and simplifying the current system. Many of the proposed changes address issues IDSA has previously raised concerning the increasing regulatory burden on research (see IDSA’s related policy statement).
For more information, or to share your comments on the proposed changes with IDSA, contact Audrey Jackson, PhD, at IDSA.
Of all the changes in Medicare’s 2012 Physician Fee Schedule Proposed Rule, the one posing the most immediate challenge to ID physicians is the steep payment cuts called for by the flawed Medicare physician payment formula. In an Aug. 30 comment letter (PDF), IDSA once again urged the Centers for Medicare and Medicaid Services to work with Congress to fix the Sustainable Growth Rate payment formula, which—if not addressed—will result in a 29.5 percent payment cut for all physicians starting in 2012.
Earlier this month, IDSA, the American Medical Association, every state medical society, and 64 other medical specialty societies called on the special congressional committee tasked with identifying $1.2 trillion in deficit reduction to reform the flawed physician payment formula. The groups’ letter is available online (PDF).
In comments on the CMS proposed rule, IDSA also addressed proposed changes to the Physician Quality Reporting Rule System, the Physician Compare website, and plans to implement a Value-Based Payment Modifier, which will pay physicians differently based on the risk-adjusted cost and quality of their care compared to their peers. In addition, IDSA highlighted problems caused by Medicare’s lack of coverage for home infusion therapy services and the decision not to cover all preventive vaccines under Part B.
In other advocacy news:
The IDSA Education and Research Foundation (ERF) and the National Foundation for Infectious Diseases (NFID) announce the winners of the 2011 IDSA ERF/NFID Joint Research Awards.
Katherine A. Plewes, MD, MSc, an infectious disease fellow at the University of British Columbia in Vancouver, Canada, proposes a randomized trial to assess the effect of acetaminophen as an adjunct to artesunate in adults with severe falciparum malaria complicated by blackwater fever. Dr. Plewes hypothesizes that acetaminophen may decrease kidney injury in such patients by inhibiting the hemoglobin-induced lipid peroxidation of free hemoglobin released during massive hemolysis.
Margaret L. Pollack, MD, a fellow in the Division of Allergy and Infectious Diseases at the University of Washington in Seattle, will investigate abortive cytomegalovirus (CMV) transmission from hematopoietic stem cell products to naïve CMV hosts. To further characterize patients with abortive infection and the role of neutralizing antibodies, Dr. Pollack will retrospectively correlate abortive CMV DNAemia and neutralizing antibody titers in a cohort of patients who were transplanted prior to the adoption of pp65 antigenemia/DNA-based pre-emptive treatment strategy and who did not develop replicative CMV infection.
Jeffrey D. Dvorin, MD, PhD, assistant professor in the Division of Pediatric Infectious Diseases at Children’s Hospital Boston and Harvard Medical School, focuses his project on novel therapies that target fundamental life cycle steps of Plasmodium falciparum, the agent that causes most severe cases of human malaria. Dr. Dvorin has identified a plant-like calcium-dependent protein kinase, PfCDPK5, which is crucial for P. falciparum egress. His proposal is to provide a molecular characterization of PfCDPK5 function with advanced genetic and cell biologic techniques. Because the egress life cycle step is not currently targeted by anti-malarials, the identification of the signaling pathway downstream of PfCDPK5 may identify new targets for malaria therapies.
Alexander Ploss, PhD, is an assistant research professor at The Rockefeller University in New York City. His proposal builds on a recent breakthrough from his research group—an engineered mouse that is permissive for hepatitis C virus (HCV) entry. The model, where human HCV entry factors are delivered either transiently or through germ line transgenesis, provides an in vivo model for studying inhibitors of the entry process, including virus-neutralizing antibodies. Dr. Ploss proposes to use state-of-the-art in vivo mutagenesis approaches, coupled with capture of HCV-permissive infected cells, to identify mutations that facilitate HCV replication in the murine cell environment. His goal is to create a fully HCV-permissive mouse model.
Robin L.P. Jump, MD, PhD, an ID physician at Louis Stokes Cleveland VA Medical Center, aims to reduce the incidence of C. difficile infection among residents of long-term care facilities (LTCF). Her hypothesis is that colonization resistance established by the gut microbiota of older LTCF residents has delayed restoration following antibiotic exposure, rendering this population more vulnerable to C. difficile infection. Her study proposes to incorporate basic science (measuring changes in gut flora) and clinical research (a prospective observational cohort study to determine when patients are no longer vulnerable to C. difficile). This investigation is the first step in determining the specific bacteria taxa and their functions that maintain colonization resistance and developing evidence-based antibiotic stewardship programs to minimize the unintended, adverse effects of antibiotic exposure.
David K. Hong, MD, an instructor of pediatrics at Stanford University, proposes to better understand the mechanisms by which a novel adjuvant, cationic lipid/DNA complexes (CLDC), induces antigen-specific CD8T cells when injected with protein antigen. Dr. Hong will examine the role of CD8a+ dendritic cells, a specialized dendritic cell involved in cross-presenting antigen to prime naïve CD8 T cells. He will also examine the role of Type 1 interferons (interferon-a/b) in mediating cross-presentation in dendritic cells. Dr. Hong’s long-term goal is to study the role of adjuvants to improve vaccines for respiratory viruses in children. The ultimate goal is to develop improved vaccines that eliminate the need for precisely matched influenza strains every year.
More information about the 2011 Joint Research Award Winners is available online.
The IDSA Education and Research Foundation (ERF) announces the 2011 recipients of the Medical Scholars Program awards, which are intended to encourage medical students to choose ID as a career path. The program offers scholarships to students in U.S. medical schools with mentorship by an IDSA member or fellow. IDSA members and fellows identify and solicit interested students. To learn more, please visit IDSA’s website.
2011 Medical Scholars Recipients and Mentors
Jonathan Abraham, Harvard University
Therapeutic Antibody for New World Hemorrhagic Fevers
Mentor: Stephen B. Calderwood, MD, FIDSA
Ali Ainsworth, University of Kansas
Mupirocin and Chlorhexidine Resistance in Staphylococcus aureus Before and After Patient Decolonization
Mentor: Stephanie A. Fritz, MD
Jonathan Andereck, Vanderbilt University
Prevalence and Intensity of Soil-Transmitted Heminth Infections Among Adults in Rural Kenya
Mentor: Sten H. Vermund, MD, PhD, FIDSA
Molly Anderson, New York University School of Medicine
Enhancing Innate Vaginal Defenses to Reduce the Risk of HIV+ Reproductive Tract Infection
Mentor: Sumathi Sivapalasingam, MD
Jennifer Blasé, St. Louis University
Trypanosoma cruzi Vaccine Development
Mentor: Daniel Hoft, MD, PhD, FIDSA
Karin Blecher, Albert Einstein College of Medicine
The Therapeutic Promise of Nitric Oxide Releasing Nanoparticles in Superficial Skin Infections
Mentor: Joshua Nosanchuk, MD, FIDSA
Andrew Bouley, Duke University School of Medicine
Typhoid Fever Surveillance Program in Moshi, Tanzania
Mentor: John A. Crump, MD, FIDSA
Megan Burger, Baylor College of Medicine
Bacteriophage as an Adjunct to Bacterial Interference: A Study in the Prevention of Catheter-Associated UTI
Mentor: Barbara Trautner, MD, FIDSA
Elissa Butler, University of Minnesota
Neurologic Outcomes of Central Nervous System Infections in Kampala, Uganda
Mentor: David R. Boulware, MD, MPH
Charles Caffrey, St. Louis University
Laboratory Diagnosis and Clinical Treatment in Haiti
Mentor: Sharon E. Frey, MD, FIDSA
Kathy Jo Carstarphen, University of Alabama at Birmingham
HIV Education Effects on Knowledge and Sexual Practices
Mentor: David O. Freedman, MD, FIDSA
Nicholas Carter, Warren Alpert Medical School of Brown University
Evidence-Based Medicine at the Epicenter: A Retrospective Review of Inpatient Management of Severe Acute Malnutrition and Complicating Infections in Port-au-Prince, Haiti
Mentor: Timothy P. Flanigan, MD, FIDSA
Hannah Dundey, University of Tennessee College of Medicine
Randomized, Double-Blind Trial of Clindamycin, Trimethoprim-Sulfamethoxazole, or Placebo for Uncomplicated Skin and Soft Tissue Infections caused by Community-Associated Methicillin-Resistant Staphylococcus aureus
Mentor: Clarence B. Creech, II, MD, MPH
Sara Anne Fabiano, Wake Forest University
Factors Associated with Adverse Outcome in Children Admitted with Gastroenteritis
Mentor: Andrew Steenhoff, MD
Eric Foote, Emory University
Health Impact of Improved Cookstoves on Rural Kenyan Children
Mentor: James M. Hughes, MD, FIDSA
Traci Fraser, Baylor College of Medicine
Acute Kidney Injury Associated with Trimethoprim-Sulfamethoxazole
Mentor: Daniel M. Musher, MD, FIDSA
Timothy Gaulton, University of Pennsylvania
The Association Between Obesity and Hospital Mortality in Presumed Sepsis
Mentor: Ebbing Lautenbach, MD, MPH, MS, FIDSA
Michael Gillette, Tulane School of Medicine
Malaria in Artibonite Valley, Haiti
Mentor: Margarita Silio, MD
Elena Gonzalez, Cleveland Clinic Lerner College of Medicine
Pre-Transplant Vaccination Status of Pediatric Solid Organ Transplant Candidates
Mentor: Lara Danziger-Isakov, MD
Katherine Gray, Duke University School of Medicine
PMTCT Performance and Resistance Patterns of HIV-Infected Infants in Tanzania
Mentor: John A. Crump, MD, FIDSA
Tara Hardiman, University of Maryland
Classifying the Structure of the Type IV Pilus in Clostridium difficile for Future Vaccine Development
Mentor: Michael S. Donnenberg, MD, FIDSA
Whitney Harrington, University of Washington
International and Pediatric Infectious Disease in Laos
Mentor: Wesley Van Voorhis, MD, PhD, FIDSA
Abhinav Kapur, University of Chicago
Cell Phone Social Network Structure of Indian Men Who Have Sex With Men (MSM)
Mentor: John Schneider, MD
Northwestern University, HVEM and Nectin-1 in Ocular HSV
Mentor: William J. Muller, MD, PhD
Natalia Khalaf, Baylor College of Medicine
Potential Foodborne Transmission of Clostridium difficile Infection in Local Hospitals
Mentor: Hoonma Koo, MD
Janine Knudsen, Harvard Medical School
Risk Factors for the Development of Drug-Resistant Cytomegalovirus Infection in Solid Organ Transplant Recipients: A Retrospective Case-Control Study
Mentor: Ajit P. Limaye, MD, FIDSA
Brittney Jean Lemke, University of Minnesota
Control of Host Gene Expression by HIV
Mentor: Paul R. Bohjanen, MD
Eugene Lin, Baylor College of Medicine
Enterococcal Bacteriuria is Often Managed Inappropriately
Mentor: Barbara Trautner, MD, FIDSA
Hermioni Lokko, Harvard University
Study of Algorithms for Diagnosing Febrile Illness in a Malaria Endemic Region to Inform Diagnostic Tool Development
Mentor: Stephen B. Calderwood, MD, FIDSA
Dustin Long, University of California, San Francisco
Human Genetics of Herpes Simplex Meningoencephalitis
Mentor: Adam S. Lauring, MD
Kaysia Ludford, Yale University
Alcohol and Sexual Risk Behaviors in Peruvian MSM
Mentor: Frederick Altice, MD
Micah Manary, University of California, San Diego
Exploring Animal Models for Environmental Enteropathy
Mentor: Robert T. Schooley, MD, FIDSA
Benjamin Margolis, Yale University
Comparison of Latent TB Infection and Active TB Disease Prevalence Among Congregated HIV-Infected Inmates in an Open-Air and Closed Prison in Malaysia
Mentor: Frederick Altice, MD
Oren Mechanic, University of North Carolina
Comorbid Infections and Cancer
Mentor: Charles M. van der Horst, MD, FIDSA
Jason Melehani, University of North Carolina
NLRP3 Inflammasome Contributes to S. aureus Pathology
Mentor: Joseph A. Duncan, MD, PhD, FIDSA
Amir Mohareb, Johns Hopkins University School of Medicine
Developing a Registry of Emergency Department Visits Made by Patients with HIV
Mentor: Charlotte A. Gaydos, PhD, FIDSA
Emma Mohr, University of Iowa
Tropical Medicine Training in Brazil
Mentor: Mary E. Wilson, MD, FIDSA
David Noyd, Oregon Health & Science University
Dengue Epidemiology in Valencia, Venezuela 2010
Mentor: Kevin Winthrop, MD
Lynda Nwabuobi, New York University School of Medicine
Postpartum Adherence and Outcomes among HIV-Infected Women Started on HAART during Pregnancy in a Resource-Limited Setting
Mentor: Richard A. Murphy, MD
Rachel Ochotny, University of Buffalo
Selection for Antimicrobial Assay and Toxicity of Medical Plants
Mentor: John K. Crane, MD, PhD, FIDSA
Evan Orenstein, Emory University
Cost-Effectiveness of Pneumococcal Vaccine Introduction in Mali
Mentor: Myron M. Levine, MD, FIDSA
Lauren Orenstein, Emory University
Cost-Effectiveness and Potential Impact of Maternal Influenza Immunization in Mali
Mentor: Myron M. Levine, MD, FIDSA
Christian Parobek, University of North Carolina
Discovering Balancing Selection in Plasmodium vivax
Mentor: Jonathan J. Juliano, MD
Anar Patel, University of Cincinnati
Knowledge and Attitudes of Women of Childbearing Age Regarding Maternal-Fetal Transmission of HIV in Mwanza, Tanzania
Mentor: Judith Feinberg, MD, FIDSA
Vishal Patel, University of South Florida
Development of Field Evaluation of a Universal-Sample Transportation-Optimized Platform (U-STOP) for Economic and Cold Chain-Free Transportation of Clinical Samples for Molecular and Immunological Diagnoses
Mentor: Sandra G. Gompf, MD, FIDSA
Bhavana Pendurthi, University of Miami
The Association Between 14 Novel Virulence Genes and Endocarditis
Mentor: Vance G. Fowler, Jr., MD
Hannibal Person, Duke University School of Medicine
Regulation of Virulence in Uropathogenic E. coli
Mentor: Patrick C. Seed, MD, PhD
Tracy Pham, University of Minnesota
Effectiveness of Screening and Decolonization of S. aureus in Surgery Outpatients
Mentor: Susan Kline, MD
Alexander Rabin, Emory University School of Medicine
Delays in Diagnosis of Pulmonary TB and the Effect of Severity of Disease and Clinical Outcomes in the Republic of Georgia
Mentor: Henry M. Blumberg, MD, FIDSA
Mansi Shah, Warren Alpert Medical School of Brown University
STI Prevention in Incarcerated Females
Mentor: Tanya O. Rogo, MD, MPH
David Tehrani, University of California, Irvine
Adjudicating CDC and Claims-Based Criteria for Hospital-Associated Infections
Mentor: Susan S. Huang, MD, FIDSA
Carla Valenzuela, Vanderbilt University
The Role of HIV Stigma in Preventing Peruvians Living with HIV from Remaining in HIV Care at the Clinica Medica Cayetano Heredia
Mentor: Eduardo Gotuzzo, MD, FIDSA
Sarah Ventre, SUNY Upstate Medical University
Dengue Fever Clinics and Research Experience
Mentor: Timothy P. Endy, MD, PhD
Trang Vu, Johns Hopkins University School of Medicine
HCV Disease Management in HCV-HIV Coinfected IDU
Mentor: Mark Sulkowski, MD
Audrey Wallace, Duke University
Malignancy in HIV Positive Individuals
Mentor: William Saltzer, MD
Megan Ward, University of Tennessee
Markers of Endothelial Function and Oxidative Stress and Adipokines in HIV Infection
Mentor: Todd Hulgan, MD
Emily West, Columbia University College of Physicians and Surgeons
Initiation of Antiretroviral Therapy in Youth with HIV
Mentor: Lisa Saiman, MD
Breanna Zarmbinski, University of Minnesota
Overuse of Antimicrobials for Asymptomatic Bacteriuria
Mentor: Dimitri M. Drekonja, MD
Sarah Joy Zielsdorf, Loyola University Chicago Stritch School of Medicine
Efficacy of Hand Hygiene Interventions Against Clostridium difficile Spores
Mentor: Dale N. Gerding, MD, FIDSA
Jonathan Zipursky, Dartmouth Medical School
Physician and Patient Attitudes Towards Fecal Biotherapy for Recurrent Clostridium difficile Infection
Mentor: Kathryn B. Kirkland, MD
A prominent ID physician scientist, clinician, and teacher, Richard B. Hornick, MD, FIDSA, a former president of IDSA and a founding member of the Society, died Aug. 9, 2011, at the age of 82 in Winter Park, Fla.
During a medical career spanning more than five decades, Dr. Hornick contributed to the treatment and prevention of diseases including tularemia, typhoid fever, dysentery disorders, and others. He was behind some of the groundbreaking studies establishing the typical number of bacteria required to cause typhoid fever and infectious diarrhea, according to a remembrance from the University of Rochester Medical Center in New York, where he was chair of the Department of Medicine from 1979 to 1985.
“One of Dr. Hornick’s greatest strengths was that he recognized the talents of developing physicians and provided them both the emotional and scientific help they needed to jumpstart their careers,” said Robert F. Betts, MD, FIDSA, professor emeritus in the University of Rochester Medical Center’s Department of Medicine, Infectious Diseases, in the university’s remembrance. “He was an extremely nice guy and always welcomed young professionals into the field with open arms.”
Born in Johnstown, Pa., in 1929, Dr. Hornick graduated from Johns Hopkins University in Baltimore in 1951, later earning a medical degree from the university and completing his residency in internal medicine there. Following his service in the U.S. Army at the Walter Reed Medical Unit at Fort Detrick in Maryland, Dr. Hornick joined the faculty of the University of Maryland.
There he rose from assistant instructor to professor of medicine and director of the Division of Infectious Diseases before his appointment in 1979 as professor and chair of medicine at the University of Rochester. In 1987, Dr. Hornick was named vice president for medical education at Orlando Regional Medical Center in Florida. Despite stepping down in 1999, he continued to teach students and treat patients until three weeks before his death from cancer, according to an Orlando Sentinel article.
An active member of many professional organizations and societies, Dr. Hornick was a founding member of IDSA in 1963, a Joseph E. Smadel Lecture winner in 1982, and served as Society president in 1986.
He was also elected to the Institute of Medicine and served as an infectious diseases consultant to the World Health Organization and the Food and Drug Administration. Widely published, he contributed to more than 300 scholarly articles, book chapters, and reports on ID-related topics throughout his career.
Dr. Hornick is survived by his wife, Susan; two sons, Douglas and Thomas; two daughters, Martha Hornick and Blaine Hawley; and seven grandchildren.
Paul A. Volberding, MD, FIDSA, has been named the new chief medical editor of Infectious Disease News. Dr. Volberding is currently professor and vice chair of the University of California San Francisco (UCSF) Department of Medicine, co-director of the UCSF-GIVI Center for AIDS Research, and the chief of medicine at the San Francisco Veterans Affairs Medical Center. He served on the Infectious Disease News Editorial Board for about six years. Dr. Volberding presented the Edward H. Kass Lecture, “Responding to a Pandemic: Lessons from the Early HIV Experience” at the 47th Annual Meeting of IDSA in Philadelphia in 2009, and has served on the HIVMA Board of Directors, where he served as chair in 2005, the Annual Meeting Program Committee, and the AIDS Training Program Committee.
Are you a member on the move? Do you know someone who is? Contact Stephanie Cox at firstname.lastname@example.org so that we can announce it to our membership.
Abaskharoun, Mena, PharmD
Ahmad, Sharjeel, MD
Akbar, Muhammad, MD
Akhter, Kauser, MD
Barron, Kathryn, NP, MSN
Bhagwati, Ashit, MD
Bullard, Jared, MD
Chung, Philip, PharmD
Edberg, Stephen, PhD
Hollender, Elena, MD
Idigbe, Emmanuel, PhD
Jafary, Ahmar, DO
Johnson, Marsha, NP
Karthik, Rajiv, MD, MBBS
Laughlin, Catherine, PhD
Liebowitz, David, MD, PhD
Low, Chian Yong, MBBS, MRCP
Mokhbat, Jacques, MD
Nasidi, Abdulsalami, MD, PhD
Noonan, Lisa, ChB, MB, MSc
Pumpradit, Wadchara, MD
Quan, Stella, PhD
Rawot, Bonnie, MD
Schweizer, Marin, PhD
Sharapov, Umid, MD, MSc
Simmons, Matthew, MD
Valdivieso, Maria Francisca, MD
Yu, Diana, PharmD
Abariga, Samuel, MD, MS, DTM&H
Abbas, Muneel, MBBS
Anderson, Leah, PhD
Arora, Mohit, MS
Badaro, Roberto, MD, PhD
Bardin, Matthew, PharmD
Baures, Tim, MD
Bernarducci, Marc, PharmD
Boyington, Curtiss, MD
Cadena Zuluaga, Jose
Cecka, Walter, ME
Chen, Mary, RPh
Christoff, Patricia, PharmD
Clark, Rachel, MBA
Cluck, David, PharmD
Connolly, Elizabeth, MD
de Abreu Pereira, Barbara, MD
De Los Reyes, Ma Theresa, MD
Elias, Richard, MBBS
Espenshade, Bruce, MD
Finkelstein, Julia, MPH, MS, ScD
Fortes, Claudio, BCh
Gonzalez Saldana, Napoleon, MD
Guarascio, Anthony, PharmD
Hasan, Muhammad, MD
Higashino, Hermes, MD
Huang, Cynthia, PharmD
Ishiguro, Nobuhisa, MD
Jain, Dinesh, MD
Jhanjee, Sandeep, MS
Jorgensen, Daniel, MD
Jurado, Rafael, MD
Kang, Susan, PharmD
Khan, Umar, MD
Kim, Liz, PharmD
Klish, Lindsey, PharmD
Kotwal, Vaishali, MD
Koul, Parvaiz, MD
Kubiak, David, PharmD
Kumar, Vipin, MD
Kurai, Hanako, MD
Kwak, Yee Gyung, MD
Kwong, Jason, MBBS
Lee-Yoo, Jean, RPh
Marino, Deborah, BSN
McGann, Patrick, PhD
McGeer, Allison, MD
Moore, Stacey, BSN
Nei, Takahito, MD
Nelson, Margret, BSN
Notenboom, Robert, PhD
Okpokoro, Evaezi, MD, MBBS, MPH
Paradis, Alain, MD
Patel, Kejal, PharmD
Paul, Kavita, MD
Quan, Jayne, RPh
Rathbun, Robert, PharmD
Reyes, Romina, MD, MSc
Robledo, Iraida, PhD
Scanlon, Patricia, MPH
Schneider, Tulip, PharmD
Singh, G., MD
Singh, Gurjinder, MD
Sprong, Tom, MD, PhD
Tempel, Ann, PhD
Tong, Michelle, RPh
Tremolet de Villers, Kathryn, PharmD
van Rijn, Saskia, MPH
Vaupel, Christine, PhD
Weinstein, Robert, BSN
Wu, Gary, PharmD
Yoshida, Makiko, PhD
Abu-Khdeir, Maha, MBBS
Adams, Nehkonti, MD
Al Mohajer, Mayar, MD
Altman, Deena, MD
Altomare, Antonia, DO
Anthony, Paul, MD
Arun, Aparna, MD, MD
Asare, Kingsley, DO
Ashley, Cassandra, MD
Aswad, Firas, MD
Ayensu, Thelma, MD
Badger, Victor, MD
Bagasra, Alexander, MD
Bailey, Jason, DO
Bailey, Theodore, MD
Baloch, Saeed, MBBS
Barsoumian, Alice, MD
Bartelt, Luther, MD
Bernas, Carl, MD
Beyene, Tesfaye, MD
Bhargava, Ashish, MD
Bonura, Erin, MD
Boyd, Adetinuke, MD
Branch-Elliman, Westyn, MD
Briggs, Heather, MD, PhD
Budge, Philip, MD, PhD
Burgess, Mary, MD
Cardile, Anthony, DO
Cariello, Paloma, MD
Cartwright, Emily, MD
Castilho, Jessica, MD
Cataline, Philip, MD
Chaiwongkarjohn, Suttirak, MD
Chan, Candice Yuen Yue, ChB, MB
Chandrakasan, Shanmuganathan, MD
Chang Cojulun, Alicia, MD
Chaparro, Juan, MD
Chaparro-Rojas, Fredy, MD
Chi, Suyin, MD
Chirca, Ioana, MD
Chrisler, Courtney, MD
Cluzet, Valerie, MD
Coakley, Peter, MB
Cohen, Yehuda, MD
Crowell, Trevor, MD
Cutro, Scott, MD
Daniel, Aju, MD, MBBS, MRCP
de Nobrega, Rachael, MD
Desai, Devak, MD
Douglas, James, MD
Duque-Silva, Alexandra, MD
Echaiz, Jose, MD
Edeoga, Ndubuisi, MD
Escota, Gerome, MD
Fadul, Nada, MD
Farmakiotis, Dimitrios, MD
Foote, Mary, MD
Forster, Derek, MD
Gaviria Agudelo, Claudia, MD
Goto, Michihiko, MD
Guillaume, Jourdan, MD
Hataye, Jason, MD, PhD
Herati, Ramin, MD
Hernandez, Rafael, MD, PhD
Holguin T., Geraldo, MD
Holubar, Marisa, MD
Hu, Carol, MD
Huaman Joo, Moises, MD
Iliaki, Eirini, MD
Isner, Caroline, MD
Iyer, Karthik, MD
Jacinto, Pauline, MD
Javeri, Heta, MD
Johnson, Daniel, MD
Johnson, Katherine, DO Kabbani, Sarah, MD
Kabchi Jitani, Badih, MD
Kafle, Prakash, MD
Kasper, Douglas, MD
Katouzian, Taher, DO
Kenney, Patrick, DO
Ketterer, Daniel, MD
Khan, Muhammad, MD, MBBS
Khanna, Sahil, MBBS
Khokhar, Saba, MD
Kim, Janet, MD
Kim, JiYeon, MD, MPH
Kim, Joseph, MD
Komal, Rashida, MD, MBBS
Krsak, Martin, MD
Kuriakose, Safia, PharmD
Landman, Keren, MD
Larue, Richard, MD
Latte, Shelly, MD
Lee, Doreen, MD
Leininger, Robert, MD
Lepak, Alexander, MD
Lior, Nesher, MD
Lobo, Stephen, MD, MS
Loo, Angela, PharmD
Lopez, Jose, MD
Luckett, Keith, MD
Luft, LeeAnne, MD, MSc
Lusardi, Katherine, PharmD
Madaline, Theresa, MD
Maier, Marissa, MD
Malik, Bhavna, MD
Marion, Dennis, MD
Marquez, Carina, MD
Martin, Kimberly, DO
Matsumoto, Eiyu, MD
McDonald, Robert, MD
Mehta, Seema, MD
Melendez, Andre, MD
Mezu, Ngozi, MD
Min, Zaw, MD
Moh'd, Hamzah, MBBS
Morikawa, Yoshihiko, MD
Mortensen, Eva, MD, MS
Muthiah, Chethra, MD
Nagra, Shehzadi, MD
Narayanan, Shivakumar, MD
Nichols, Kensley, MD
Nori, Priya, MD
Ojeda-Martinez, Hector, MD
Olabige, Olutayo, MD
Onyeaso, Elizabeth, MD
Openshaw, John, MD, MSc
Paranandi, Anu, DO
Parsaci, Shadi, DO
Patel, Apurva, MD
Patwari, Priti, MD
Peck, Melicent, MD,PhD
Pepito, Brian, MD
Pilkinton, Mark, MD, PhD
Pouch, Stephanie, MD
Ranganath, Sangeetha, MD
Rebick, Gabriel, MD
Reece, Rebecca, MD
Reyes-Sacin, Carlos, MD
Rhein, Joshua, MD
Richards, Eric, MD
Richardson, Eugene, MD
Robilotti, Elizabeth, MD, MPH
Rock, Clare, MD
Roidad, Nasira, MD
Rojas Moreno, Christian, MD
Sachdev, Darpun, MD
Salazar, Wayra, MD
Salinas, Catalina, MD
Schuster, Jennifer, MD
Schwartz, Kevin, MD
Scully, Eileen, MD, PhD
Sears, David, MD
Shah, Neel, MD
Sharma, Dipi, MD
Shiotsuka, Mika, MD
Shrikanth, Vandana, MD
Siddique, Bushra, MD
Simon, Ryan, MD
Singaravelu, Kumara, MD
Slosar, Magdalena, MD
Smyczek, Petra, MD
Suramaethakul, Nuttanun, MD
Syed, Razi, MD
Szvalb, Ariel, MD
Tande, Aaron, MD
Tangham, Gwen, MD
Tedja, Rudy, DO
Thakarar, Kinna, DO
Tingpej, Bhatraphol, MD
Todd, William, DO
Torres-Torres, Karla, MD
Upadhyayula, Shankar, MD, MBBS, MRCP
Valencia Rey, Paula, MD
Van Winkle, Jason, MD
Vasquez, Amber, MD
Vaz, John, MD
Vilsaint, My-Charllins, MD
Williams, Aria, DO
Winston, Susanna, MD
Woods, Krystina, MD
Wurcel, Alysse, MD
Yacisin, Kari, MD, MSc
Zaniello, Benjamin, MD
Hornick, Richard B., MD, FIDSA
Kitchen, Lynn, MD
Litwack, Kenneth, MD
The National Foundation for Infectious Diseases (NFID) has developed a new toolkit to improve pneumococcal immunization rates among adults to reduce the impact of related illness and death in this population.
The burden of invasive pneumococcal disease in the U.S. lies primarily among adults; 85 percent of all cases occur in people age 18 or older. Vaccination rates are low despite the fact that the Centers for Disease Control and Prevention recommends vaccination for all adults age 65 and older and younger adults who have certain chronic conditions.
To help health care professionals maximize opportunities to vaccinate their patients, NFID has created a new Professional Practice Toolkit. This toolkit includes materials to help educate adult patients about the importance of pneumococcal prevention and assess their risk for pneumococcal disease, and various tools to support providers’ vaccination efforts. The materials are available in English and Spanish, and include information that can be tailored for practices that serve populations affected by disease and immunization disparities (e.g., African Americans, Hispanics, American Indians, Alaska natives).
The HIV Medicine Association created the Minority Clinical Fellowship Program to increase the number of African American and Latino physicians with the expertise to provide clinical care to patients with HIV in the communities most affected by HIV disease. Two one-year fellowships are awarded annually with one going to an African American physician and one to a Latino physician interested in pursuing careers in HIV medicine in the U.S. During the year, fellows manage the ongoing care of patients with HIV disease under the supervision of an HIVMA mentor. The award includes a $60,000 stipend plus funding to support benefits for one year.
Applications are being accepted for the 2012 to 2013 fellowship year, which will start on July 1, 2012. Eligible candidates will be African American or Latino physicians who are within the first five years of their medical practice and have a demonstrated interest in HIV medicine. Individuals who have completed or have been recently accepted to an infectious diseases training program are not eligible for the program.
The application along with information on current and past fellows is available online at www.hivma.org/Minority_Clinical_Fellowship.aspx. The deadline to apply for the two fellowships that begin in July 2012 is December 9, 2011.
Contact Julio Fonseca at email@example.com with questions or for more information.
Although we certainly live in challenging times, the Society’s commitment to work for the good of patients, public health, and our diverse membership remains incredibly strong. Some highlights from the past year illustrate the progress IDSA is making in high priority areas.
As my term as IDSA president nears its end, I want to let you know what a privilege it has been to serve you. Although we certainly live in challenging times, the Society’s commitment to work for the good of patients, public health, and our diverse membership remains incredibly strong. Some highlights from the past year illustrate the progress IDSA is making in high priority areas.
IDSA’s Standards and Practices Guidelines Committee released several important new guidelines for clinicians, including the Society’s first-ever guideline for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections and the first national guideline for the management of pneumonia in children, a joint effort with the Pediatric Infectious Diseases Society (PIDS). A growing number of IDSA guidelines are now available in formats for PDAs, iPhones, and iPads, and as pocketcards (see the new IDSA website).
Documenting the value that ID specialists provide to the health care system through improved patient outcomes and reduced health care costs remains an important focus for the Society. IDSA’s Value of ID Specialists Task Force is continuing its work with a health services research firm to assess the value ID clinicians provide to patients and the health system at large.
There is also a special focus on ensuring that the non-patient care activities of ID specialists will be recognized and compensated under the new reimbursement mechanisms envisioned under health care reform. The Clinical Affairs Committee is monitoring the rapidly changing practice environment and promoting the need for equitable reimbursement for the services provided by ID specialists.
Much progress has been made on efforts to address antimicrobial resistance and the antibiotic pipeline crisis:
In a time of difficult economic constraints, IDSA has advocated for appropriate federal funding for public health and research at the Centers for Disease Control and Prevention (CDC), the National Institutes of Health, the Food and Drug Administration, and other agencies. The Society has emphasized the long-term value of these investments in preventing needless deaths and reducing health care costs. We will continue to emphasize this message to Congress.
Earlier this month, IDSA and HIVMA launched redesigned websites, part of our commitment to improve communication with members. If you haven’t visited the redesigned sites yet, please do. We welcome your feedback as we continue to work to improve the Society’s online tools (see related article for information to help you navigate the new sites).
Another highlight of this year is the 49th Annual Meeting of IDSA and HIVMA in Boston on October 20-23.This year’s terrific program, developed under the leadership of Barbara D. Alexander, MD, FIDSA, chair of the Annual Meeting Program Committee, features several notable additions: a new global ID programming track; a Friday afternoon symposium focused on “One Health,” an approach that recognizes the connections among people, domestic animals and wildlife, and the environment, and their relevance to infectious disease emergence; and a special Presidential Plenary Session on Sunday morning featuring three lectures on cholera by Stephen J. Calderwood, MD, FIDSA, of Massachusetts General Hospital; J. William Pape, MD, of GHESKIO; and Scott F. Dowell, MD, MPH, of CDC. In addition, I will provide an update on IDSA activities.
Looking ahead, plans are progressing for IDWeek 2012, the first-ever joint meeting of IDSA, the Society for Healthcare Epidemiology of America (SHEA), HIVMA, and PIDS, next fall in San Diego.
Thomas Slama, MD, FIDSA, will assume the role of IDSA president on Oct. 23 in Boston. I am certain his leadership will help the Society build on its accomplishments and serve our diverse and growing membership. He will have much on his plate, as our recent strategic priority setting session indicates (see July/Aug. 2011 IDSA News). He will benefit, as I have, from the excellent work and dedication of IDSA leaders, committee members, and staff.
It has been an honor to serve you this past year. I look forward to seeing you in Boston.
The first national guidelines for the management of community-acquired pneumonia (CAP) in infants and children are now available.
The first national guidelines for the management of community-acquired pneumonia (CAP) in infants and children are now available. Developed by IDSA and the Pediatric Infectious Diseases Society, the guidelines are online and appear in the Oct. 1 issue of Clinical Infectious Diseases.
The guidelines are designed to provide physicians who care for children with a roadmap to the most scientifically valid diagnosis and treatment recommendations. They also place an emphasis on preventing bacterial pneumonia through immunization, including annual influenza vaccination for children 6 months and older, and for parents and caregivers of infants 6 months and younger.
Topics in the guidelines include:
“Diagnostic methods and treatments that work well in adults may be too risky and not have the desired result in children,” said John S. Bradley, MD, FIDSA, lead author of the guidelines and professor and chief of the division of infectious diseases at the University of California at San Diego Department of Pediatrics. “With these guidelines, we are hopeful that the standard and quality of care children receive for community-acquired pneumonia will be consistent from doctor to doctor—providing much better treatment outcomes.”
For each of the guidelines’ specific recommendations, the strength of each as well as the quality of evidence for each is noted. The document also notes the lack of solid evidence in some areas, often due to the ethical challenges of studying children, and calls for research in specific areas.
The guidelines have been endorsed by the American Academy of Pediatrics, the American College of Emergency Physicians, the American Society of Microbiology, the American Thoracic Society, the Society for Hospital Medicine, and the Society of Critical Care Medicine.
The CAP guidelines are available online and are also being developed in both mobile device and pocketcard format for use at the point of care. Other IDSA guidelines are also available on the IDSA website, including guidelines available in these formats.
While the newly redesigned IDSA website has a new look, the real change is in the overall user experience. You can browse and engage our website in whole new ways.
IDSA is proud to announce the release of our newly redesigned website. While the website does have a new look, the real change is in the overall user experience. We hope you find the new site easier to navigate, so you spend less time searching for the information you need and more time using that information. You can browse and engage our website in whole new ways:
This month, studies investigating: outcomes of C. difficile-associated diarrhea in patients using concomitant antibiotics; a possible new broad-spectrum antiviral; daily azithromycin for the prevention of chronic obstructive pulmonary disease exacerbations; and exposure to varicella zoster virus and risk of herpes zoster.
In this feature, a panel of IDSA members identifies and critiques important new studies in the current literature that have a significant impact on the practice of infectious diseases medicine.
Click here for the previous edition of Journal Club. For a review of other recent research in the infectious diseases literature, see “In the Literature,” by Stanley Deresinski, MD, in each issue of Clinical Infectious Diseases.
A secondary analysis from two trials demonstrated that concomitant antibiotic use during or shortly after Clostridium difficile-associated diarrhea (CDAD) treatment resulted in lower cure rates and longer duration of symptoms, and suggested that participants treated with fidaxomicin had fewer recurrences than those treated with vancomycin. The findings are published in the Sept. 1 issue of Clinical Infectious Diseases.
Thirty percent (N=275) of participants enrolled in the two randomized controlled trials (N=999), which compared efficacy of 10 days of oral fidaxomicin (200 mg orally twice daily) with oral vancomycin (125 mg orally four times daily) in the treatment of CDAD, received concomitant antibiotics (CA). Patients were assessed and compared to participants who did not receive CA. The investigators’ goal was to describe the impact of CA use during or shortly after CDAD therapy and compare cure rates in participants receiving oral vancomycin vs. fidaxomicin. Participants were followed up for 40 days after CDAD treatment completion.
Overall, clinical cure was achieved in 93 percent of participants who did not receive CA vs. 84 percent of those who did. Median time to resolution of diarrhea was longer in participants who received CA (97 hours vs. 54 hours). There was a statistical trend for increased probability of recurrence among patients who received CA (23 percent vs. 17.6 percent). Among participants who received CA, the cure rate for fidaxomicin was 90 percent vs. 79.4 percent for vancomicin.
This study provides clinicians with useful estimates of recurrence risk, cure rates, and duration of symptoms in CDAD, particularly among persons who use CA during CDAD therapy, a not uncommon occurrence among hospitalized patients. Clinicians must weigh costs and benefits when deciding to use fidaxomicin over vancomycin. The question of extending the duration of CDAD therapy in participants who were receiving CA was not addressed in the study.
A novel class of compounds that induces cell death only in virus-infected cells may one day serve as a broad-spectrum antiviral strategy, according to an article published online on July 27 in PLoS One.
To specifically target cells that are infected by a virus, the investigators took advantage of a naturally occurring intracellular immune process that recognizes double-stranded RNA, a product produced in virus-infected cells during the course of virus replication. The investigators synthesized compounds that coupled domains that recognize double-stranded RNA to domains capable of triggering apoptotic cell death. The compounds were nontoxic and effective in a variety of cell types.
In a series of in vitro experiments, the compounds induced the death of virus-infected cells, thereby limiting ongoing viral replication and preserving the viability of uninfected cells. This strategy was successful when cells were infected with rhinovirus, influenza, and several other RNA and DNA viruses. No obvious toxicities were documented when mice were treated with the compounds, and treatment of mice infected with H1N1 influenza decreased viral replication and increased survival.
Established and emerging viruses continue to cause substantial disease. There have been important successes with vaccines to prevent virus infection and associated disease, but the repertoire of effective antiviral drugs is still very small. The successes with the novel antiviral strategy described in this report were confined to the laboratory, but the strategy is very appealing. The compounds used by the investigators are very specific, because double-stranded RNA is produced only in virus-infected cells. They are also broad-spectrum, because double-stranded RNA is produced during the replication of both RNA and DNA viruses. It will be exciting to see if compounds such as these move beyond the proof-of-concept stage and into clinical trials to provide a much-needed new class of antiviral therapeutics.
Exacerbations of chronic obstructive pulmonary disease (COPD) result in recurrent courses of antibiotics, steroids, and hospitalizations, and are associated with an increased risk of death. In the Aug. 25 issue of the New England Journal of Medicine, investigators tested whether daily azithromycin, when added to the usual care of patients, would decrease the frequency of these exacerbations compared to a placebo.
In a large, multi-center clinical trial, 1,142 patients were randomized to receive azithromycin at 250 mg by mouth daily or an identical placebo for one year. The primary outcome of the study was the time to the first acute exacerbation of COPD, defined as the increase or new onset of cough, sputum, or respiratory difficulty with the initiation of antibiotics or steroids. The authors also investigated changes in quality of life, nasopharyngeal bacterial colonization, and hearing.
An intention-to-treat analysis showed that the risk of acute exacerbations of COPD was reduced among subjects receiving azithromycin (P<0.001), and that the median time to the first exacerbation was 266 days in the azithromycin arm compared to 174 days in the placebo arm (P<0.001). These differences were significant even when controlled for demographics, behaviors, and pulmonary function. The authors calculated that the number needed to treat to prevent one acute exacerbation of COPD was 2.86.
Though there were no significant differences in the frequency of serious adverse events, the authors did report that subjects treated with azithromycin had more pronounced hearing decrements than those who received placebo. In addition, subjects who became colonized with respiratory pathogens during the study were more likely to have macrolide-resistant organisms if they had received azithromycin as opposed to placebo.
In sum, this large, randomized clinical trial demonstrates that azithromycin can be a valuable tool when treating patients suffering from recurrent COPD exacerbations.
Control of varicella zoster virus (VZV) reactivation and the avoidance of herpes zoster is largely dependent upon effective cell-mediated immunity. However, the relationship between the epidemiology of varicella and zoster remains unclear. Two primary hypotheses have been proposed: (1) exogenous boosting from exposure to children with varicella, and (2) endogenous boosting from subclinical reactivation of latent VZV within the sensory ganglia. A study published in the Sept. 1 issue of Clinical Infectious Diseases offers some interesting findings on this issue.
Researchers conducted a national, multicenter, observational, comparative study of exposed versus nonexposed subjects. The nonexposed group consisted of members of Roman Catholic monastic orders (monks and nuns), an isolated population in France with little exposure to children. Those who were members for <2 years or had previous zoster were excluded. The exposed group was comprised of members of the general population and matched to members of the monastic order group.
The frequency of zoster in the monastic order group (16.2 percent) did not significantly differ from the frequency in the general population group (15.1 percent) (P=0.27). Additionally, the age of onset was 54.8 years in the monastic order group and 48.6 years in the general population (P=0.06).
The authors’ results are intriguing and challenge prior assumptions that the absence of contact with varicella causes an increased risk of zoster. Additionally, their findings support the assertion that childhood vaccine programs against VZV will not lead to an increasing number of cases of zoster in young adults.
For a review of other recent research in the infectious diseases literature, see “In the Literature,” by Stanley Deresinski, MD, in each issue of Clinical Infectious Diseases: