ABSTRACT
INTRODUCTION: Five anti-tumor necrosis factor (anti-TNF) agents have received regulatory approval for use in rheumatology: adalimumab, golimumab, infliximab, certolizumab, and etanercept. Apart from their well-documented therapeutic value, it is still uncertain to what extent they are associated with an increased risk of infectious adverse events. Areas covered: We conducted a systematic review and meta-analysis of published randomized studies to determine the effect of anti-TNF drugs on the occurrence of infectious adverse events (serious infections; tuberculosis; opportunistic infections; any infection). We searched Medline, Embase, and the Cochrane Library up to May 2014 to identify eligible studies in adult patients with rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis that evaluated anti-TNF drugs compared with placebo or no treatment. Expert opinion: Our study encompassed data from 71 randomized controlled trials involving 22,760 participants (range of follow-up: 1-36 months) and seven open label extension studies with 2,236 participants (range of follow-up: 6-48 months). Quantitative synthesis of the available data found statistically significant increases in the occurrence of any infections (20%), serious infections (40%), and tuberculosis (250%) associated with anti-TNF drug use, while the data for opportunistic infections were scarce. The quality of synthesized evidence was judged as moderate. Further evidence from registries and long-term epidemiological studies are needed to better define the relationship between anti-TNF agents and infection complications.
Subject(s)
Antirheumatic Agents/adverse effects , Infections/chemically induced , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Adult , Antirheumatic Agents/pharmacology , Antirheumatic Agents/therapeutic use , Arthritis, Psoriatic/drug therapy , Arthritis, Rheumatoid/drug therapy , Humans , Infections/epidemiology , Randomized Controlled Trials as Topic , Spondylitis, Ankylosing/drug therapyABSTRACT
More than 21 million participants attended EXPO Milan from May to October 2015, making it one of the largest protracted mass gathering events in Europe. Given the expected national and international population movement and health security issues associated with this event, Italy fully implemented, for the first time, an event-based surveillance (EBS) system focusing on naturally occurring infectious diseases and the monitoring of biological agents with potential for intentional release. The system started its pilot phase in March 2015 and was fully operational between April and November 2015. In order to set the specific objectives of the EBS system, and its complementary role to indicator-based surveillance, we defined a list of priority diseases and conditions. This list was designed on the basis of the probability and possible public health impact of infectious disease transmission, existing statutory surveillance systems in place, and any surveillance enhancements during the mass gathering event. This article reports the methodology used to design the EBS system for EXPO Milan and the results of 8 months of surveillance.
Subject(s)
Biosurveillance/methods , Public Health Surveillance/methods , Anniversaries and Special Events , Humans , Italy , Linear Models , Program Development , Program EvaluationSubject(s)
Counseling/methods , HIV Infections , Patient Education as Topic/methods , Social Media , Adult , Female , Humans , Male , Middle Aged , Prospective StudiesSubject(s)
Abscess/microbiology , Muscular Diseases/microbiology , Mycobacterium tuberculosis/isolation & purification , Surgery, Plastic/adverse effects , Transvestism/complications , Tuberculosis/diagnosis , Tuberculosis/epidemiology , Bacterial Typing Techniques , Behavior , Brazil/epidemiology , Buttocks , Cluster Analysis , Humans , Molecular Typing , Mycobacterium tuberculosis/classification , Mycobacterium tuberculosis/genetics , Silicon/administration & dosageABSTRACT
Enfuvirtide is a large protein that should be injected subcutaneously to ensure an appropriate absorption. Here we report the case of a transgender HIV-positive patient receiving enfuvirtide with an individualized background regimen of antiretroviral drugs, who had previously undergone liquid silicone oil injections. We performed US scan to detect silicone-free areas for following enfuvirtide injections. US can be useful in the correct management of those patients with liquid silicone oil soft tissue augmentation who require subcutaneously injected drugs.
Subject(s)
Anti-HIV Agents/administration & dosage , HIV Envelope Protein gp41/administration & dosage , HIV Infections/diagnostic imaging , HIV Infections/drug therapy , Peptide Fragments/administration & dosage , Subcutaneous Tissue/diagnostic imaging , Transsexualism/diagnostic imaging , Adult , Breast Implants/adverse effects , Enfuvirtide , Humans , Male , Silicone Oils/adverse effects , UltrasonographyABSTRACT
Recent studies pointed out the increasing rate of infective endocarditis (IE) in diabetic patients. As diabetes mellitus (DM) prevalence is expected to increase in the coming years, infective endocarditis could be more frequently reported in these patients. We here describe a rare case of Enterococcus gallinarum endocarditis developing on normal native heart valve in an elderly diabetic woman. Therapeutic options were restricted due to resistance factors of the microorganism, limited guidance in the medical literature, and the patient's history and underlying condition. Despite these challenges, adequate antibiotic therapy led to the patient's recovery.
