RESUMEN
Rotavirus gastroenteritis is a vaccine-preventable disease that confers a high medical and economic burden in more developed countries and can be fatal in less developed countries. Two vaccines with high efficacy and good safety profiles were approved and made available in Europe in 2006. We present an overview of the status of rotavirus vaccination in Europe. We discuss the drivers (including high effectiveness and effect of universal rotavirus vaccination) and barriers (including low awareness of disease burden, perception of unfavourable cost-effectiveness, and potential safety concerns) to the implementation of universal rotavirus vaccination in Europe. By February, 2014, national universal rotavirus vaccination had been implemented in Belgium, Luxembourg, Austria, Finland, Greece, Luxembourg, Norway, and the UK. Four other German states have issued recommendations and reimbursement is provided by sickness funds. Other countries were at various stages of recommending or implementing universal rotavirus vaccination.
Asunto(s)
Gastroenteritis/prevención & control , Infecciones por Rotavirus/prevención & control , Vacunas contra Rotavirus/administración & dosificación , Rotavirus/inmunología , Vacunación/estadística & datos numéricos , Análisis Costo-Beneficio , Europa (Continente) , Gastroenteritis/economía , Gastroenteritis/virología , Humanos , Infecciones por Rotavirus/economía , Infecciones por Rotavirus/virología , Vacunas contra Rotavirus/economíaRESUMEN
We describe 3 symptomatic cases of neurologic syphilis that occurred after the administration of the usual therapy for primary or secondary syphilis in human immunodeficiency virus (HIV)-infected patients. We discuss the difficulty of diagnosing neurosyphilis, the need for lumbar puncture, and risk factors of relapse. Because HIV infection may alter the natural history and response of neurologic syphilis to treatment, scrupulous follow-up and repeated cycles of therapy are warranted.
Asunto(s)
Antibacterianos/uso terapéutico , Infecciones por VIH/complicaciones , Neurosífilis/diagnóstico , Penicilina G Benzatina/uso terapéutico , Sífilis/tratamiento farmacológico , Adulto , Antibacterianos/administración & dosificación , Ceftriaxona/administración & dosificación , Ceftriaxona/uso terapéutico , Estudios de Cohortes , Humanos , Masculino , Persona de Mediana Edad , Neurosífilis/complicaciones , Neurosífilis/tratamiento farmacológico , Recurrencia , Sífilis/complicaciones , Sífilis/diagnósticoRESUMEN
Several chromogenic media have been developed to enhance the specificity of Salmonella detection. We compared the performance of four commercial chromogenic media-namely, ABC medium (Lab M. Ltd., Bury, United Kingdom), COMPASS Salmonella agar (Biokar Diagnostics, Beauvais, France), CHROMagar Salmonella agar (CHROMagar Company, Paris, France), and SM ID agar (bioMerieux, Marcy l'Etoile, France)-with conventional Hektoen medium. Nine hundred sixteen stool samples from inpatients at three hospitals were cultured, in parallel, on the five media, both by direct inoculation and after selective enrichment in selenite broth. Sixty-four Salmonella strains with 12 serotypes were isolated on at least one medium. After 48 h of incubation, sensitivity before and after enrichment was 62.5 and 89.1% with ABC medium, 77.1 and 93.8% with COMPASS agar, 66.7 and 89.1% with CHROMagar, 68.8 and 85.9% with SM ID agar, and 85.4 and 98.4% with Hektoen agar, respectively. Broth enrichment and prolonged incubation (48 versus 24 h) increased the sensitivity of all five media. Only one strain was not isolated on Hektoen agar. The number of false-positive isolates was higher with all five media after enrichment in selenite broth and after incubation for 48 h compared to 24 h. The specificity of the four chromogenic media was better than 91% after incubation for 24 h (77.7% with Hektoen agar) and better than 84% after incubation for 48 h (74.8% with Hektoen agar). This higher specificity reduces the need for confirmatory tests, thereby cutting technical time and reagent requirements. Both COMPASS agar and CHROMagar Salmonella, which after simple additional tests showed close efficiencies (96 and 97%, respectively), can be recommended as single-plate media of choice for the detection and presumptive identification of salmonellae in stools.
Asunto(s)
Técnicas de Tipificación Bacteriana/métodos , Heces/microbiología , Salmonella/aislamiento & purificación , Medios de Cultivo , Técnicas y Procedimientos Diagnósticos , Humanos , Salmonella/clasificación , Sensibilidad y EspecificidadRESUMEN
Com a expansäo da epidemia HIV-AIDS no Brasil, observaram-se avanços terapêuticos com aumento da sobrevida e melhoria da qualidade de vida dos portadores do vírus. Como também modificaçäo no perfil epidemiológico dos indivíduos infectados e, visíveis deslocamentos dos casos de infecçäo para o interior do País e setores marginalizados da sociedade. Objetiva conhecer se o CTA do Distrito Federal atendeu a populaçäo mais vulnerável e de risco para a infecçäo HIV
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Enfermedades de Transmisión Sexual/psicología , Infecciones por VIH/diagnóstico , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Síndrome de Inmunodeficiencia Adquirida/psicología , Consejo SexualRESUMEN
In 1999, in Rhône-Alpes region, in a survey of resistance to antibiotics of Streptococcus pneumoniae, 35 cases of meningitis were observed. A retrospectic questionnary was sent to each participant. MICs to Penicillin, Amoxicillin and Cefotaxime were determined with ATB-PNEUMO gallery or E-test and by disk diffusion for the other antibiotics. The results were interpreted according to the recommendations of the CA-SFM. Mean age was 38.1 years (range : 1 month -78 years) and sex-ratio 2/5. Eight patients had previously received antibiotics, 22 patients had risk factors and 23 were transferred in intensive care unit. The patients received C3G + glycopeptide in 15 of 16 children and in 13/19 adults according to the consensus recommendations. Diagnostic was made on the direct examination of CSF in 83%, and blood cultures was positive in 74.3% of cases. The percentage of PRP was 48.6% with 17.1% of intermediate-amoxicilline and 14.3% intermediate-cefotaxime strains. Resistance to trimethoprim-sulfamethoxazole was 45.7%, to chloramphenicol 30% and to fosfomycin 6.9%. All the strains were susceptible to rifampicin and vancomycin. Among the 17 PRP strains, 7 were belonging to serotype 6 (6 in children). The clinical outcome was fatal in 7 male cases (20%), without risk factors in 3 children and 6 of 7 strains were susceptible to penicillin. Six patients (17%) had auditive and/or neurologic sequellaes. This study shows that nearly 50% of strains isolated in meningitis, in Rhône-Alpes region, were not susceptible to penicillin, and confirms the frequency of sequellaes while the mortality is not related with the resistance of strains to the antibiotics.
Asunto(s)
Meningitis Neumocócica/epidemiología , Adolescente , Adulto , Anciano , Amoxicilina/administración & dosificación , Cefotaxima/administración & dosificación , Niño , Preescolar , Cloranfenicol , Farmacorresistencia Microbiana , Femenino , Fosfomicina , Francia/epidemiología , Humanos , Lactante , Masculino , Meningitis Neumocócica/diagnóstico , Meningitis Neumocócica/tratamiento farmacológico , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Penicilinas/administración & dosificación , Estudios Retrospectivos , Rifampin/administración & dosificación , Encuestas y Cuestionarios , Combinación Trimetoprim y Sulfametoxazol , Vancomicina/administración & dosificaciónRESUMEN
OBJECTIVE: To comparatively assess the performance of three chromogenic agar plates, CPS ID2, Chromogenic UTI, and USA, for the detection and enumeration of all urinary tract pathogens and the direct identification of Escherichia coli, Proteus mirabilis and Enterococcus spp. METHODS: Two hundred and forty-three urine specimens prospectively collected from hospitalized patients were randomly inoculated in parallel on the three media. RESULTS: Of the 243 urine specimens, 235 yielded positive cultures, of which 151 were pure cultures and 84 were mixed cultures. CPS ID2, Chromogenic UTI and USA agar gave detection rates of 99.1%, 97.1% and 96.6%, respectively. The main difference in non-detection between CPS ID2 agar and the two new media concerned Staphylococcus spp. strains. Based on the total number of strains detected (n = 348), the total identification rates of E. coli, P. mirabilis and Enterococcus spp. on CPS ID2 agar, Chromogenic UTI agar and USA agar were 60.3%, 61.2% and 59.2%, respectively. CONCLUSION: The detection rates and identification rates of the three media were very close and only minor differences were noted. The lower detection rates for Chromogenic UTI and USA were mainly due to their lesser ability to support growth of Staphylococcus spp.
Asunto(s)
Agar , Compuestos Cromogénicos/análisis , Compuestos Cromogénicos/aislamiento & purificación , Infecciones Urinarias/diagnóstico , Sistema Urinario/microbiología , Orina/microbiología , Agar/metabolismo , Bacterias/clasificación , Bacterias/aislamiento & purificación , Recuento de Colonia Microbiana/métodos , Medios de Cultivo , Enterococcus/aislamiento & purificación , Escherichia coli/aislamiento & purificación , Estudios de Evaluación como Asunto , Humanos , Proteus mirabilis/aislamiento & purificación , Infecciones Urinarias/enzimología , Infecciones Urinarias/microbiologíaRESUMEN
Screening by ofloxacin disk was carried out on 1158 strains of Streptococcus pneumoniae in order to investigate the in vitro bacteriostatic activity of penicillin G, levofloxacin, moxifloxacin, telithromycin, linezolid, pristinamycin and quinupristin-dalfopristin against ofloxacin-intermediate and -resistant S. pneumoniae strains. It was concluded that these new antimicrobial agents could be useful for the treatment of pneumococcal infections caused by penicillin-sensitive and -resistant S. pneumoniae, and would represent a valid therapeutic option for patients allergic to beta-lactams, should they prove to be potent in vivo.
Asunto(s)
Antibacterianos/farmacología , Compuestos Aza , Fluoroquinolonas , Cetólidos , Levofloxacino , Macrólidos , Ofloxacino/farmacología , Quinolinas , Streptococcus pneumoniae/efectos de los fármacos , Virginiamicina/análogos & derivados , Acetamidas/farmacología , Antiinfecciosos/farmacología , Farmacorresistencia Bacteriana , Lactamas/inmunología , Linezolid , Pruebas de Sensibilidad Microbiana , Moxifloxacino , Ofloxacino/inmunología , Oxazolidinonas/farmacología , Penicilina G/farmacología , Pristinamicina/farmacología , Streptococcus pneumoniae/patogenicidad , Virginiamicina/farmacologíaAsunto(s)
Infecciones por Campylobacter/tratamiento farmacológico , Ceftriaxona/uso terapéutico , Prótesis de la Rodilla/microbiología , Metronidazol/uso terapéutico , Adulto , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Campylobacter/efectos de los fármacos , Campylobacter/aislamiento & purificación , Infecciones por Campylobacter/microbiología , Ceftriaxona/farmacología , Cefalosporinas/farmacología , Cefalosporinas/uso terapéutico , Humanos , Masculino , Metronidazol/farmacología , Resultado del TratamientoRESUMEN
In 1999, during the survey of resistance of Streptococcus pneumoniae to antibiotics by 31 clinical laboratories of Rhône-Alpes area, MIC to penicillin (P), amoxicillin (AMX) and cefotaxime (CTX) of 877 PRP strains or with a diameter of inhibition to oxacillin inferior to 26 mm, were determined by each institution by E-test (n = 220 strains) or ATB-PNEUMO (n = 657 strains). MICs of these three antibiotics were determined by dilution in agar medium by the coordinating center. The essential agreement was respectively for ATB-PNEUMO and E-test 89% versus 84% for P (p > 0.05), of 86% vs 79% for AMX (p < 0.01), and of 91% vs 86% for CTX (p = 0.03). When the strains were classified in clinical category, the differences were significant (p < 0.001) for AMX (85% vs 71%) and for CTX (82% vs 75%) but not for P (73% vs 78%). ATB-PNEUMO method was more sensitive than E-test for the detection of strains susceptible to P (90 vs 73%), to AMX (83 vs 78%) and to CTX (80 vs 72%) and for the strains intermediate to AMX (90 vs 78%). On the contrary, E-test is more specific than ATB-PNEUMO for the detection of P-resistant strains (94 vs 86%). Finally, the specificity of both methods is the same for detection of P-S, AMX-R and CTX-I strains.
Asunto(s)
Antibacterianos/farmacología , Resistencia a Medicamentos , Pruebas de Sensibilidad Microbiana/métodos , Juego de Reactivos para Diagnóstico , Streptococcus pneumoniae/efectos de los fármacos , Amoxicilina/farmacología , Cefotaxima/farmacología , Distribución de Chi-Cuadrado , Humanos , Oxacilina/farmacología , Resistencia a las Penicilinas , Infecciones Neumocócicas/microbiología , Estándares de Referencia , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadAsunto(s)
Programas de Inmunización/organización & administración , Vacuna Antisarampión/provisión & distribución , Sarampión/prevención & control , Servicios de Salud Escolar/organización & administración , Adolescente , Niño , Femenino , Asistencia Técnica a la Planificación en Salud , Prioridades en Salud , Humanos , Esquemas de Inmunización , Masculino , Sarampión/epidemiología , Sarampión/transmisión , Vacuna Antisarampión/efectos adversos , Vigilancia de la Población , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Factores de Riesgo , Rumanía/epidemiología , Organización Mundial de la SaludAsunto(s)
Angiomatosis Bacilar , Endocarditis Bacteriana/epidemiología , Endocarditis Bacteriana/microbiología , Fiebre de las Trincheras , Adolescente , Adulto , Anciano , Aminoglicósidos , Antibacterianos/uso terapéutico , Estudios de Casos y Controles , Quimioterapia Combinada/uso terapéutico , Endocarditis Bacteriana/tratamiento farmacológico , Femenino , Francia , Humanos , Incidencia , Lactamas/uso terapéutico , Masculino , Persona de Mediana EdadRESUMEN
Epidemic diphtheria reemerged in the Russian Federation in 1990 and spread to all Newly Independent States (NIS) and Baltic States by the end of 1994. Factors contributing to the epidemic included increased susceptibility of both children and adults, socioeconomic instability, population movement, deteriorating health infrastructure, initial shortages of vaccine, and delays in implementing control measures. In 1995, aggressive control strategies were implemented, and since then, all affected countries have reported decreases of diphtheria; however, continued efforts by national health authorities and international assistance are still needed. The legacy of this epidemic includes a reexamination of the global diphtheria control strategy, new laboratory techniques for diphtheria diagnosis and analysis, and a model for future public health emergencies in the successful collaboration of multiple international partners. The reemergence of diphtheria warns of an immediate threat of other epidemics in the NIS and Baltic States and a longer-term potential for the reemergence of vaccine-preventable diseases elsewhere. Continued investment in improved vaccines, control strategies, training, and laboratory techniques is needed.
Asunto(s)
Toxoide Diftérico , Difteria/prevención & control , Brotes de Enfermedades/prevención & control , Programas de Inmunización , Adulto , Niño , Comunidad de Estados Independientes/epidemiología , Difteria/epidemiología , Vacuna contra Difteria y Tétanos , Humanos , Toxoide Tetánico , U.R.S.S./epidemiología , Vacunas CombinadasRESUMEN
Increasing international travel, migration to and from epidemic areas, and the emergence of epidemic Corynebacterium diphtheriae strains globally have highlighted the need for better microbiologic surveillance and greater clinical and laboratory awareness. As part of the strategy developed by the World Health Organization, one major goal is particularly applicable to the microbiology and epidemiology of diphtheria: to improve surveillance for early detection of emerging and reemerging diseases by establishing a network of national and international laboratories. The European Laboratory Working Group on Diphtheria (ELWGD) was therefore formed in 1993 as a result of the epidemic situation in Eastern Europe. Currently, there is participation from 20 different countries from Western and Eastern Europe, the United States, Australia, and Southeast Asia. ELWGD is a prime example of a collaborative and coordinated approach to the microbiology of diphtheria and should serve as a potential model for other infectious diseases networks.
Asunto(s)
Corynebacterium diphtheriae/aislamiento & purificación , Difteria/diagnóstico , Difteria/microbiología , Cooperación Internacional , Laboratorios , Difteria/epidemiología , Europa (Continente)/epidemiología , HumanosRESUMEN
Throughout 1996, 22 hospital-based laboratories in the Rhône-Alpes region of France collected pneumococcal strains and used a standardized protocol to record the following data; patient age and sex; type of specimen; and determination of susceptibility to at least the following antibiotics: oxacillin 1 microgram and 5 micrograms, erythromycin (Ery), tetracycline (Tet), chloramphenicol (Chl), rifampin (Rmp), and loracarbef. For penicillin-nonsusceptible strains (PNSSs), which were identified based on results with oxacillin, MICs for penicillin G, amoxicillin (Amx), and cefotaxime (Ctx) were determined using the E Test, at the study site and agar dilution at the coordinating center. Of the 1153 strains, 65.5% were from adults and 31.8% from children; patient age was unknown in 2.7% of cases. PNSPs (MIC > 0.06 mg/l) contributed 32.9% of strains (I: 23.3%; R: 9.6%) and were more common in children (41.1%) than in adults (28.1%). The frequency of PNSSs varied across specimen types: 27.9% in blood cultures (305 strains), 15.6% in cerebrospinal fluid (32), 38.7% in protected bronchopulmonary specimens (31), 31.5% in unprotected bronchopulmonary specimens (434), 50.8% in acute otitis media (118), and 34.4% in other specimens (221). Among PNSSs, nonsusceptibility (I + R) to other antibiotics was variable: Ery, 62.1%; Tet, 41.5%; Chl, 40.4%; Rmp, 1.1%. Corresponding figures for the overall strain population were Ery, 33.3%; Tet, 22.7%; Chl, 22.8%; Rmp, 0.9%. In addition, 56.5% of PNSSs exhibited multiple drug resistance. Resistance to amoxicillin (MIC > 2 mg/l) was demonstrated for only 5 strains. No strains were resistant to loracarbef or cefotaxime. Serotypes of the 379 PNSSs were as follows: 23F, 26.6%; 14 (25.6%); 9V (18.2%), 6 (8.7%), 15 (5%), 19 (4.5%).
Asunto(s)
Antibacterianos/farmacología , Pruebas de Sensibilidad Microbiana/normas , Infecciones Neumocócicas/tratamiento farmacológico , Infecciones Neumocócicas/microbiología , Streptococcus pneumoniae/clasificación , Adulto , Niño , Farmacorresistencia Microbiana , Resistencia a Múltiples Medicamentos , Femenino , Francia , Humanos , Laboratorios/normas , Masculino , Garantía de la Calidad de Atención de Salud , Manejo de Especímenes/métodos , Streptococcus pneumoniae/efectos de los fármacos , Streptococcus pneumoniae/aislamiento & purificaciónRESUMEN
We report the first three documented cases of murine typhus imported into Europe from Indonesia, discuss clues for the diagnosis of the disease, and urge that murine fever be considered in the diagnosis of febrile disease in travelers.
Asunto(s)
Viaje , Tifus Endémico Transmitido por Pulgas/inmunología , Adulto , Animales , Humanos , Indonesia , Masculino , Ratones , Rickettsia typhi/inmunología , Tifus Endémico Transmitido por Pulgas/diagnóstico , Tifus Endémico Transmitido por Pulgas/fisiopatologíaRESUMEN
BACKGROUND: Propionibacterium acnes, a Gram positive microaerophilic bacteria is considered to have a low level of virulence. Nevertheless, it can be associated with infective endocarditis. We report 2 cases and a review of the literature. CASE REPORTS: The first man developed an acute prosthetic valve infective endocarditis and died. The second case was also a prosthetic valve infective endocarditis in a patient who developed infectious spondylitis. DISCUSSION: P. acnes is an uncommon causal agent in infective endocarditis and appears to have a predilectio for prosthetic valves. A prior history of skin infection is rare. P. acnes grow quite slowly, often requiring 7 to 14 days for identification. All isolates of P. acnes from blood or valve do not necessarily mean contamination.
Asunto(s)
Endocarditis Bacteriana/diagnóstico , Infecciones por Bacterias Grampositivas/diagnóstico , Prótesis Valvulares Cardíacas , Propionibacterium acnes/patogenicidad , Infecciones Relacionadas con Prótesis/diagnóstico , Discitis/diagnóstico , Discitis/microbiología , Endocarditis Bacteriana/microbiología , Resultado Fatal , Infecciones por Bacterias Grampositivas/microbiología , Prótesis Valvulares Cardíacas/microbiología , Humanos , Masculino , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/microbiología , VirulenciaRESUMEN
In 1996-1997 a multicentre study was carried out on 450 Streptococcus pneumoniae strains to compare the MICs and susceptibility categories obtained with the Etest (AB Biodisk) used under routine conditions in 22 hospital laboratories in the Rhône-Alpes region, France, with those obtained by the reference technique of agar dilution performed in a single coordinating centre. Each laboratory detected penicillin resistant pneumococci (PRP) by the oxacillin disk method (1 microgram and 5 micrograms) and determined the MICs of penicillin G (PG), amoxycillin (AMX) and cefotaxime (CTX) by the Etest. All the PRP strains were collected in the coordinating centre where MICs were carried out. The strains were classified as susceptible (S), intermediate (I) and resistant (R) according to the CASFM criteria (Comité de l'Antibiogramme de la Société Française de Microbiologie). The concordance results based on susceptibility categories are as follows: PG = 67.6%, AMX = 63.6%, CTX = 71.5%. Minor errors are as follows: PG = 31.2%, AMX = 36%, CTX = 28.5%. Major and very major errors are rare (0% to 0.6%). Agreement within 1 log2 dilution was obtained for about 80% of the strains. The minor errors results from strains clustering near the breakpoints 1 mg/l (PG) and 0.5 mg/l (AMX, CTX), and from practical difficulties in routine use of the Etest. These discrepancies may result in severe therapeutic problems. This study confirms the limits of the Etest. The authors insist on standardization and rigorous use of the Etest under routine conditions.